Plaque-induced gingivitis: Case definition and diagnostic considerations

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.