Condition
Gingivitis
Gingivitis is gum inflammation caused by plaque, and the strongest trial evidence is for products used in the mouth, not pills. Across 29 industry-funded trials of at least 6 months, adding an essential-oil mouthwash to brushing and cleaning between the teeth cut gum inflammation by 16%. Herbal rinses lowered plaque and gum scores more than placebo rinses in a review of 13 trials. Among supplements, 200 mg of vitamin C a day limited gum inflammation, compared with water, in young adults who stopped cleaning their teeth for 14 days. Probiotics gave no significant gain across 10 gingivitis trials, and we found no trial of CoQ10 capsules for gingivitis. Gums that keep bleeding need a dentist.
Sources: PMID 26227646; PMID 32419797; PMID 29757462; PMID 40186219
- Supplements studied
- 3
- Graded outcomes
- 3
- Trials
- 1
- People studied
- 1,191
What the evidence says
- Mouthwash added to brushing: moderate evidence. In a pooled analysis of 29 industry-sponsored, placebo-controlled trials lasting 6 months or longer, people who added an essential-oil mouthwash to brushing and cleaning between the teeth had 16% less gum inflammation and 27.7% less plaque than people who only brushed and cleaned. A network review of 6-month home-use trials (53 papers) found that essential-oil, cetylpyridinium chloride (CPC), chlorhexidine and triclosan-copolymer rinses had the largest effects on gum scores, while the active toothpastes tested did not differ from one another.
- CPC and chlorhexidine rinses: in 8 trials of at least 6 weeks, a CPC rinse used with brushing lowered plaque and gum scores between the teeth more than a placebo rinse, though results varied widely between studies. A Cochrane review of 51 studies found that chlorhexidine rinse cut plaque sharply over 4 to 6 weeks, but in people with mild gingivitis its effect on gum inflammation was too small to be clinically relevant.
- Herbal rinses: limited evidence. A review of 13 trials in people with gingivitis found herbal mouthwashes lowered plaque, gum inflammation and bleeding scores more than placebo, with no clear difference from chlorhexidine. A review of neem rinses found only 3 trials; they reported neem about as good as chlorhexidine, but their methods were generally flawed. In a 6-month trial of 240 adults with bleeding gums, a diluted calendula tincture rinse used twice a day lowered plaque and gum scores over the first 3 months while a water rinse did not, and it kept a larger advantage after both groups had a dental scaling.
- Vitamin C: limited to moderate evidence. In a trial in young nonsmoking adults who stopped all tooth cleaning for 14 days, those taking 200 mg of vitamin C or 200 g of guava a day developed less gum inflammation than a group given water. A meta-analysis of 15 trials (1,140 people, mostly healthy) found vitamin C reduced gum bleeding when blood vitamin C started low; at higher or unknown starting levels the benefit was not clear.
- Probiotics: limited, mixed evidence. A 2025 meta-analysis found slightly lower plaque and bleeding scores with probiotics in its 10 gingivitis trials, but the differences were not significant. In a 2-week trial of 59 people with moderate to severe gingivitis, one of two Lactobacillus reuteri formulas improved gum scores more than placebo; the other did not.
- We found no trials of CoQ10 capsules for gingivitis. The closest was a 28-day trial in 30 people that applied CoQ10 directly to the gums; gum scores fell there, but they also fell where the teeth were only scaled.
Safety and when to see a clinician
- Chlorhexidine rinse used for 4 weeks or more clearly stains the teeth, and trials reported taste changes, sore or irritated gums and cheeks, and a burning feeling in the mouth.
- Vitamin C pills: in 4 studies pooled in a 2019 review, vitamin C supplements were linked with more kidney stones in men, but not in women. If you have had kidney stones, ask your doctor before taking vitamin C every day.
- See a dentist if your gums still bleed after a few weeks of careful brushing and cleaning between the teeth, if your gums pull back from the teeth, if teeth feel loose, or if bad breath does not go away. These can be signs that gingivitis has moved on to periodontitis, which damages the bone around the teeth.
- Get prompt care from a doctor or dentist if bleeding gums come with easy bruising, nosebleeds, fever or unusual tiredness, if your gums are very painful with ulcers between the teeth, or if you bleed more than usual while taking a blood thinner.
Evidence by supplement
- Strong
- Moderate
- Limited
- Very limited
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Plaque Reduction Neem mouthwash reduces plaque scores comparable to chlorhexidine in some studies | Improves (the measure goes down) | Small effect | 200 people | |||
| Gingival Index Modest improvement in gingival inflammation markers | Improves (the measure goes down) | Small effect | 180 people |
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Dental Health Metrics No effect | NoneNo effect | 1 study | 240 people | |||
Studies that measured dental health metrics | ||||||
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Dental Health Metrics | Improves (the measure goes up) | 1 study | 951 people | |||
Studies that measured dental health metrics | ||||||
Key findings
- Plaque ReductionImproves (the measure goes down)
- Gingival IndexImproves (the measure goes down)
- Dental Health Metrics
The Gingivitis Support protocol
2 primary supplements · 3 supporting supplements
- Coenzyme Q10100–200 mg daily
- Vitamin C500–1,000 mg daily
Studies cited
13 studies from PubMed
- Meta-analysis of the effect of an essential oil-containing mouthrinse on gingivitis and plaque.
- Efficacy of adjunctive anti-plaque chemical agents in managing gingivitis: A systematic review and network meta-analyses.
- The effect of cetylpyridinium chloride mouthrinse as adjunct to toothbrushing compared to placebo on interproximal plaque and gingival inflammation-a systematic review with meta-analyses.
- Chlorhexidine mouthrinse as an adjunctive treatment for gingival health.
- Effects of Herbal Mouthwashes on Plaque and Inflammation Control for Patients with Gingivitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.
- Effectiveness of Azadirachta indica (neem) mouthrinse in plaque and gingivitis control: a systematic review.
- Evaluation of Calendula officinalis as an anti-plaque and anti-gingivitis agent.
- Effect of guava and vitamin C supplementation on experimental gingivitis: A randomized clinical trial.
- Bleeding tendency and ascorbic acid requirements: systematic review and meta-analysis of clinical trials.
- Clinical effects of probiotics on the treatment of gingivitis and periodontitis: a systematic review and meta-analysis.
- Decreased gum bleeding and reduced gingivitis by the probiotic Lactobacillus reuteri.
- Evaluation of Co-Q10 anti-gingivitis effect on plaque induced gingivitis: A randomized controlled clinical trial.
- Ascorbic Acid Supplements and Kidney Stones Incidence Among Men and Women: A systematic review and meta-analysis.