BackgroundLinear gingival erythema is inflammation of the margins of the gingiva. It is characterized by a 2-3 mm band of intense erythema around the necks of the teeth that does not resolve with routine oral hygiene. The erythematous changes usually are generalized, but may be confined to a few teeth. This condition is one of the most common oral manifestations of advanced HIV/AIDS. It also may be referred to as HIV gingivitis or red-band gingivitis. S: SubjectiveThe patient may complain of bleeding, tender gums, and a bad taste in the mouth. O: ObjectiveExamine the oral cavity carefully for inflamed gingival tissues, which bleed easily upon manipulation (including brushing). This condition is seen most commonly in the buccal area of lower anterior teeth, as a continuous red band around the necks of teeth. A: Assessment
The differential diagnosis includes necrotizing gingivitis, periodontitis, and Kaposi sarcoma. (See chapters on
Necrotizing Ulcerative Periodontitis and Gingivitis
and
Kaposi Sarcoma
for more information.)
P: PlanThe diagnosis is based on clinical features; perform additional testing to rule out other causes, as indicated. Recommend patient education and counseling, meticulous home care, frequent dental visits during treatment phase, and regular recall visits. Refer for nutrition counseling as needed. TreatmentLinear gingival erythema should be treated aggressively to prevent progression to necrotizing periodontal disease; referral should be made for prompt dental care and the patient should be educated in oral hygiene techniques. A chlorhexidine gluconate (0.12%) rinse twice daily for 2 weeks will relieve some of the symptoms. Refer to a dentist or dental hygienist for a thorough dental prophylaxis (cleaning). If this combination is not successful, it may be appropriate to add an antibiotic such as: - Metronidazole 250 mg orally 4 times daily for 7 days
- Amoxicillin-clavulanate (Augmentin) 875 mg orally twice daily for 7 days
- Clindamycin 150-300 mg orally 4 times daily for 7 days
Patient Education- Good oral hygiene is essential to management, especially with concomitant periodontitis. Advise patients to brush and floss after every meal. Any rinses prescribed by care providers should be used after brushing.
- Advise patients not to eat or drink for 30 minutes after rinsing with chlorhexidine gluconate.
- Urge regular dental checkups and cleaning at least every 3-6 months.
- Patients should not drink alcohol while taking metronidazole, and for at least 48 hours after the last dose.
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