{
  "schema_version": 1,
  "kind": "condition",
  "id": "dental-gum-complaint",
  "name": "Toothache and Gum Problems",
  "category": "chronic",
  "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",
  "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)",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 585,
      "generic": "Referral & safety-netting (no drug therapy)",
      "line": 1,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": "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.",
      "adult_duration": "Refer, with advice",
      "dose_source": "No dose - referral pathway, no medicine given in primary care",
      "rationale": "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.",
      "cautions": [
        "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."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Children follow the same pathway: recognise and refer. No primary-care medicine is implied.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "dental-gum-complaint"
    },
    {
      "id": 586,
      "generic": "Chlorhexidine gluconate",
      "line": 1,
      "is_adjunct": true,
      "form": "mouth",
      "strength_mg": null,
      "adult_dose": "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.",
      "adult_duration": "Continue as an adjunct to oral hygiene, with dental review and professional cleaning at intervals no longer than six months",
      "dose_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.\"",
      "rationale": "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.",
      "cautions": [
        "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."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Not for children under the age of 18: the label states effectiveness and safety have not been established below that age.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "EZ-CARE TOOTH PASTE 80 GM",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "VITA PHARM > NATIONAL COMPANY FOR DENTAL MATERIALS (EZ-PAC)",
          "price_egp": 18.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 80000.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "dental-gum-complaint"
    }
  ]
}