Plaque‐induced gingivitis: Case definition and diagnostic considerations

• Published in: Journal of clinical periodontology Vol. 45; no. S20; pp. S44 - S67
• Main Authors: Trombelli, Leonardo, Farina, Roberto, Silva, Cléverson O., Tatakis, Dimitris N.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.06.2018
• Subjects: Dental plaque; Dentistry; Epidemiology; Genetic markers; Gingiva; gingival diseases; gingival hemorrhage; Gingivitis; Inflammation; Medical personnel; Patients; Periodontium; gingival hemorrhage; gingivitis; gingival diseases
• ISSN: 0303-6979; 1600-051X
• DOI: 10.1111/jcpe.12939

Objective Clinical gingival inflammation is a well‐defined site‐specific condition for which several measurement systems have been proposed and validated, and epidemiological studies consistently indicate its high prevalence globally. However, it is clear that defining and grading a gingival inflammatory condition at a site level (i.e. a “gingivitis site”) is completely different from defining and grading a “gingivitis case” (GC) (i.e. a patient affected by gingivitis), and that a “gingivitis site” does not necessarily mean a “GC”. The purpose of the present review is to summarize the evidence on clinical, biochemical, microbiologic, genetic markers as well as symptoms associated with plaque‐induced gingivitis and to propose a set of criteria to define GC. Importance A universally accepted case definition for gingivitis would provide the necessary information to enable oral health professionals to assess the effectiveness of their prevention strategies and treatment regimens; help set priorities for therapeutic actions/programs by health care providers; and undertake surveillance. Findings Based on available methods to assess gingival inflammation, GC could be simply, objectively and accurately identified and graded using bleeding on probing score (BOP%) Conclusions A patient with intact periodontium would be diagnosed as a GC according to a BOP score ≥ 10%, further classified as localized (BOP score ≥ 10% and ≤30%) or generalized (BOP score > 30%). The proposed classification may also apply to patients with a reduced periodontium, where a GC would characterize a patient with attachment loss and BOP score ≥ 10%, but without BOP in any site probing ≥4 mm in depth.