Suggestions for Patients With Sensitive Gingiva

One of my patients has such sensitive gingiva that her oral hygiene has really suffered. Any suggestions on what implements may help her be more successful at self-care?

By Purnima S. Kumar, DDS, PhD On Aug 17, 2022 0

One of my patients has such sensitive gingiva that her oral hygiene has really suffered. Any suggestions on what implements may help her be more successful at self-care?

I am sure you will agree that sensitive gingiva is not a physiological presentation. I am also certain that you and your dentist are investigating the underlying causes and ruling out infections (viral, bacterial, or fungal); nutritional deficits (vitamin B6/B12, C, and other essential minerals, vitamins and co-factors); injury/trauma blood dyscrasias; autoimmune diseases, hypersensitivity to food additives or chlorhexidine;¹ or nonspecific mucositis.²

Low Abrasive Toothpaste

In the meantime, toothpastes with a moderate or low relative dentine abrasion value between 30 and 70 are recommended.³ Nonfoaming toothpastes are also very helpful because, even though detergents such as sodium lauryl sulphate improve cleansing action, they are dehydrating agents and can irritate the mucosa.

Addressing Dryness

Dehydration and xerostomia can also contribute to sensitive gingiva. Mouthrinses, oral gels, and pastes containing mucin, carboxymethylcellulose, hydroxymethylcellulose, xanthan, linseed oil, and polyethylene oxide can improve viscosity and wettability.⁴ Some evidence suggests patients with xerostomia may be helped by edible oils, such as olive or vegetable oils, as well as milk products. Probiotics may address hyposalivation.⁵While they are not long-term solutions, saliva substitutes can assist in managing the symptoms associated with dry mouth.⁶

There have been reports of treating sensitive oral mucosa, especially in those with radiation-induced mucositis, with an anti-inflammatory chemical—benzydamine—which also works as an analgesic and antimicrobial.⁷

References

Kotsailidi EA, Kalogirou EM, Michelogiannakis D, Vlachodimitropoulos D, Tosios KI. Hypersensitivity reaction of the gingiva to chlorhexidine: case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020;130:156–160.
Holmstrup P. Non-plaque-induced gingival lesions. Ann Periodontol. 1999;4:20–31.
Panagakos FS, Migliorati CA. Concepts of Oral Hygiene Maintenance that Would Apply for the Different Groups of Patients. In: Migliorati CA, ed. Diagnosis and Management of Oral Lesions and Conditions: A Resource Handbook for the Clinician. London: IntechOpen; 2014.
Scully C, Felix DH. Oral medicine—update for the dental practitioner: dry mouth and disorders of salivation. Br Dent J. 2005;199:423–427.
Meurman JH, Grönroos L. Oral and dental health care of oral cancer patients: hyposalivation, caries and infections. Oral Oncol. 2010;46:464–467.
Kandaswamy E, Kumar PS. Oral effects of cancer treatment. Dimensions of Dental Hygiene. 2018;16(10):45–48.
Hitz Lindenmüller I, Lambrecht, JT. Oral care. Curr Probl Dermatol. 2011;40:107–115.

The Ask the Expert column features answers to your most pressing clinical questions provided by Dimensions of Dental Hygiene’s online panel of key opinion leaders, including: Jacqueline J. Freudenthal, RDH, MHE, on anesthesia; Nancy K. Mann, RDH, MSEd, on cultural competency; Claudia Turcotte, CDA, RDH, MSDH, MSOSH, on ergonomics; Van B. Haywood, DMD, and Erin S. Boyleston, RDH, MS, on esthetic dentistry; Michele P. Carr, RDH, MA, EdD, on ethics and risk management; Denise Muesch Helm, RDH, EdD, on fluoride; Kandis V. Garland, RDH, MS, on infection control; Mary Kaye Scaramucci, RDH, MS, on instrument sharpen ing; Kathleen O. Hodges, RDH, MS, on instrumentation; Karen Davis, RDH, BSDH, on insurance coding; Cynthia Stegeman, EdD, RDH, RD, LD, CDE, on nutrition; Olga A.C. Ibsen, RDH, MS, on oral pathology; Martha McComas, RDH, MS, on patient education; Michael W. Roberts, DDS, MScD, on pediatric dentistry; Purnima Kumar DDS, PhD, on periodontal therapy; Ann Eshenaur Spolarich, RDH, PhD, on pharmacology; and Caren M. Barnes, RDH, MS, on polishing. Log on to dimensionsofdentalhygiene.com/asktheexpert to submit your question.

From Dimensions of Dental Hygiene. August 2022; 20(8)46.