# Toothache and Gum Problems - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Gingivitis - StatPearls (NCBI Bookshelf NBK557422) - https://www.ncbi.nlm.nih.gov/books/NBK557422/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DS19 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Chlorhexidine Gluconate oral rinse DailyMed label, SetID 0f8bc307-3069-45f2-aa03-8a4178d562a9, Dosage and Administration - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Toothache and Gum Problems - disease-level clinical article (dental-gum-complaint-clinical.txt) ## Treatment metadata - Referral & safety-netting (no drug therapy) - Chlorhexidine gluconate — mouth ## Complete treatment card ```text TOOTHACHE AND GUM PROBLEMS Sources: Gingivitis - StatPearls (NCBI Bookshelf NBK557422) - https://www.ncbi.nlm.nih.gov/books/NBK557422/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DS19 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Chlorhexidine Gluconate oral rinse DailyMed label, SetID 0f8bc307-3069-45f2-aa03-8a4178d562a9, Dosage and Administration Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Toothache and Gum Problems - disease-level clinical article (dental- gum-complaint-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Gum pain, bleeding when brushing, and bad breath are the classic complaints of gum disease [bleeding] - Severe pain and bad breath with a rapid onset over just days suggests a necrotizing gum infection rather than ordinary gum disease - Gums that bleed on their own or with the lightest touch is a feature of the necrotizing form - An intraoral swelling with or without pain, pain on biting, or a loose-feeling tooth points to a periodontal abscess [abscess] - Pain over the back gum around an emerging wisdom tooth suggests pericoronitis - Severe socket pain starting one to five days after an extraction, radiating along the jaw and unrelieved by usual painkillers, suggests dry socket - A severe toothache that worsens with hot or cold, becoming constant as the nerve dies, points to pulp inflammation or necrosis [necrosis · toothache] SIGNS - what you find (8) - Inflamed gum tissue with pockets of 4 to 12 mm on probing is expected in gum disease, though depth is hard to measure during a flare - Punched-out ulcers, dead-looking gum tissue, and a grey pseudomembrane mark the necrotizing form - Unlike ordinary gum disease, the necrotizing form rarely produces deep pockets because it progresses too fast for them to form - A palpable swelling at the base of a tooth points to an abscess of nerve rather than gum origin [abscess] - Red, inflamed gum tissue around a partly or fully erupted molar is seen with pericoronitis - Exposed bone in the socket with a lost or partly lost blood clot is the classic finding of dry socket - As the pulp dies the tooth itself can discolor to yellow, grey, brown, or black - Redness, swelling, or pus draining from the tissue are the general signs looked for on exam when infection is suspected [pus · redness] TESTS (6) - Looking and feeling the tissue is the first and best way to check for infection - Probing the gum pocket depth helps confirm periodontal disease - Periapical, bitewing, and panoramic x-rays reveal the extent of decay, an abscess at the root tip, and bone loss from gum disease - CT or MRI is used to assess infections that have spread into deeper spaces or into bone - Dry socket is a clinical diagnosis that does not need blood tests or x-rays - A panoramic film is reasonable if a retained tooth fragment is suspected after an extraction IF NOT THIS - what else fits (7) - Squamous cell carcinoma can cause bone loss and be mistaken for gum disease - Leukemia can cause gum bleeding that is mistaken for an infection - Cysts, tumors, or granulomas can look infectious even though they are not - A drug side effect on the mouth can be mistaken for an oral infection - Salivary gland disease and sinusitis are also on the differential for a dental infection - A severe presentation must not be mistaken for a simple gum complaint when it is really a deep neck or facial space infection - When post-extraction pain is severe or lasts beyond a week, consider jaw osteomyelitis, a subperiosteal infection, or a bone sequestrum instead of simple dry socket Source StatPearls "Dental Emergencies" - disease-level clinical article Status traced to the source above Rx: Main treatment | Antimicrobial mouth rinse alongside cleaning and oral hygiene MAIN TREATMENT 1. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Toothache, gum bleeding, denture problems or teething; a GP is not a dentist but commonly gives pain relief and, when infection is suspected, antibiotics while referring the patient on to dental care. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Toothache, gum bleeding, denture problems or teething; a GP is not a dentist but commonly gives pain relief and, when infection is suspected, antibiotics while referring the patient on to dental care. Caution Referral is the pathway; the medicines listed alongside are what primary care can give before or while it happens. RED FLAG - There is a risk of contiguous bacterial spread to deep neck spaces, mediastinum, facial sinuses, and brain, causing life-threatening infections and airway compromise (e.g. Ludwig's angina). RED FLAG - Facial swelling or spreading cellulitis from a dental abscess, fever or trismus (difficulty opening the mouth), or difficulty breathing or swallowing from a deep-space infection: refer urgently. ANTIMICROBIAL MOUTH RINSE ALONGSIDE CLEANING AND ORAL HYGIENE - give alongside 2. CHLORHEXIDINE GLUCONATE [add-on - not a substitute] Adult Rinse with 15 mL of undiluted chlorhexidine gluconate mouthwash for 30 seconds, twice a day, morning and evening after brushing. Spit it out - it is not swallowed - and do not rinse with water, brush or eat straight afterwards. - Continue as an adjunct to oral hygiene, with dental review and professional cleaning at intervals no longer than six months Peds Not for children under the age of 18: the label states effectiveness and safety have not been established below that age. Source Chlorhexidine Gluconate oral rinse DailyMed label, SetID 0f8bc307-3069-45f2-aa03-8a4178d562a9, Dosage and Administration - verbatim: "Recommended use is twice daily rinsing for 30 seconds, morning and evening after tooth brushing. Usual dosage is 15 mL (marked in cap) of undiluted chlorhexidine gluconate oral rinse." Why The disease article names antimicrobial mouth rinses of this kind as part of routine management of gum disease, and it is the one thing a GP in Cairo can actually supply while the patient waits for a dental appointment. It supports, and never replaces, professional scaling and home brushing. Caution It stains teeth, restorations and the tongue brown; warn the patient before starting, and the stain usually needs a professional clean to remove. It commonly alters taste while in use, and rare permanent taste change has been reported after use. Do not use it in anyone known to be hypersensitive to chlorhexidine; anaphylaxis has been reported with dental chlorhexidine products. It is a rinse, not a drink - swallowing it is not intended, so it must be kept away from small children. It does not treat an abscess or a decayed tooth; anyone with facial swelling, fever or a dental abscess needs dental or emergency care, not a mouthwash. Egypt EZ-CARE TOOTH PASTE 80 GM VITA PHARM > ... 18.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)