Treatment
Non-Surgical Periodontal Therapy (Step 1)
Eliminate plaque biofilm and calculus; modify risk factors
- • Oral hygiene instruction: toothbrushing technique (modified Bass technique for sulcular cleansing), interdental cleaning
- • Professional supragingival scaling and polishing with ultrasonic and hand scalers
- • Subgingival debridement at inflamed sites using curettes (Gracey curettes per sextant)
- • Calculus removal (both supra and subgingival)
- • Chlorhexidine 0.12–0.2% mouthwash twice daily for adjunctive chemical plaque control (4–6 weeks)
- • Address local retention factors: replace overhanging restorations, improve ill-fitting appliances
Systemic Factor Modification (Step 2)
Treat underlying systemic contributors
- • Medication review with physician: switch phenytoin to levetiracetam; switch nifedipine to amlodipine (less overgrowth); discuss cyclosporin alternatives with transplant team
- • Pregnancy gingivitis: professional cleaning in second trimester; enhanced home care; resolves post-partum
- • Diabetic gingivitis: optimize blood glucose control in coordination with physician
- • NUG: metronidazole 400mg TID x 5 days + intensive debridement + H2O2 rinses
Surgical Therapy (Step 3 — for Overgrowth Cases)
Gingivectomy to correct persistent gingival overgrowth unresponsive to non-surgical treatment
- • Gingivectomy: excision of excess gingival tissue with scalpel or electrosurgery
- • Surgical recontouring to restore normal gingival architecture
- • Enhance plaque control access
- • Recurrence common if medication not changed; requires long-term monitoring