Periodontal Health and Gingival Diseases

A clinically usable summary of periodontal/gingival health and gingival diseases distinguishing an intact periodontium from a reduced periodontium, based on Chapple et al., Consensus report of workgroup 1 of the 2017 World Workshop.

Key Concepts

• Periodontal health = absence of clinically detectable inflammation (no bleeding on probing, erythema, edema, or symptoms), compatible with immune surveillance/homeostasis.
• Intact periodontium = no clinical attachment loss or bone loss (physiological bone 1.0–3.0 mm apical to the CEJ).
• Reduced periodontium = reduced attachment/bone levels, in one of two patient types:
  • Non-periodontitis patient — e.g. gingival recession or post-crown-lengthening; no increased risk of periodontitis.
  • Successfully treated stable periodontitis patient — remains at increased lifelong risk of recurrence; requires close monitoring. A periodontitis patient with gingival inflammation is still a periodontitis patient.

Gingival Health vs Gingivitis (Intact vs Reduced Periodontium)

Category	Intact periodontium	Reduced periodontium
Clinical gingival health	No attachment/bone loss; BoP <10%; PPD ≤3 mm; no erythema, edema, or symptoms	Reduced attachment/bone but no inflammation; BoP <10%. Non-periodontitis: PPD ≤3 mm. Stable periodontitis patient: PPD ≤4 mm (no site ≥4 mm bleeds), bone loss present
Plaque-induced gingivitis	BoP ≥10%; PPD ≤3 mm; no attachment/bone loss	Gingivitis in non-periodontitis patient: BoP ≥10%, PPD ≤3 mm. In stable periodontitis patient: gingival inflammation at sites with PPD ≤3 mm (= “gingival inflammation in a stable periodontitis patient”; recurrence cannot be ruled out)
Non–plaque-induced gingival diseases	Conditions not caused by plaque and not resolving with plaque removal (genetic/developmental, infections, immune/inflammatory, reactive, neoplasms, nutritional/metabolic, traumatic, pigmentation); may be local or a systemic manifestation	Same categories apply; severity often still influenced by superimposed plaque accumulation

Key Definitions and Thresholds

• Health (intact / reduced non-periodontitis): BoP <10% of sites, PPD ≤3 mm, no attachment/bone loss (intact).
• Gingivitis (intact / reduced non-periodontitis): BoP ≥10% of sites, PPD ≤3 mm.
  • Localized gingivitis: 10–30% bleeding sites.
  • Generalized gingivitis: >30% bleeding sites.
• Stable periodontitis patient — health: BoP <10%, PPD ≤4 mm with no site ≥4 mm that bleeds; bone loss present.
• Gingivitis in a treated periodontitis patient: bleeding at a shallow site ≤3 mm (threshold set lower than health’s ≤4 mm because of elevated recurrence risk); PPD ≥4 mm with BoP is no longer a “closed pocket.”
• Probing: six sites per tooth, light force ~0.2–0.25 N.
• Severity (communication only): mild <10%, moderate 10–30%, severe >30% sites — no objective criteria.
• Gingivitis is a clinical diagnosis (signs: erythema, edema, bleeding/discomfort on gentle probing, loss of knife-edge margin/papilla blunting); radiographs cannot diagnose gingivitis.

Modifying and Predisposing Factors

• Local (predisposing) factors: plaque-retention factors (e.g. subgingival/overhanging restoration margins, tooth anatomy), oral dryness/xerostomia.
• Systemic (modifying) factors: smoking (can mask BoP), hyperglycemia/diabetes, nutritional deficiency (vitamin C/scurvy), pharmacological agents (incl. drug-induced gingival enlargement), sex steroid hormones (puberty, menstrual cycle, pregnancy, oral contraceptives), hematological conditions (e.g. leukemia).

See the full source paper here for Table 1 (diagnostic look-up tables) and Table 2 (full classification of non-plaque-induced gingival diseases).