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CHAPPLE et al .
25 Orofacial Sciences, School of Dentistry, University of California San Francisco, USA 26 Division of Periodontology, Niigata University Graduate School of Medical and Dental Sciences, Japan
Correspondence Dr. Iain Chapple Email: I.L.C.Chapple@bham.ac.uk
Abstract Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodon- tium in either a non‐periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be re- stored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non‐dental plaque biofilm–in- duced gingival diseases and dental plaque‐induced gingivitis. Non‐dental plaque bio- film‐induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque‐induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque‐induced gingivitis may arise on an intact periodon- tium or on a reduced periodontium in either a non‐periodontitis patient or in a cur- rently stable “periodontitis patient” i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehen- sive risk assessment and management are imperative to ensure early prevention and/ or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient‐centered approach to care, and there- fore, creates differences in the way in which a “case” of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case defi- nitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations. KEYWORDS allergic reaction, amalgam tattoo, aspergillosis, biofilm, blastomycosis, calcifying fibroblastic granuloma, candidosis, chemical trauma, clinical health, coccidioidomycosis, condylomata acuminatum, contact allergy, coxsackie virus, Crohn's disease, dental plaque‐induced gingivitis, disease control, disease remission, disease stability, drug‐induced gingival enlargement, drug‐induced pigmentation, dysbiosis, erythema multiforme, erythroplakia, factitious injury, fibrous epulis, focal epithelial hyperplasia, frictional keratosis, geotricosis, gingival pigmentation, hand foot and mouth, hereditary gingival fibromatosis, herpangina,
Sources of Funding : The workshop was planned and conducted jointly by the American Academy of Periodontology and the European Federation of Periodontology with financial support from the American Academy of Periodontology Foundation, Colgate, Johnson & Johnson Consumer Inc., Geistlich Biomaterials, SUNSTAR, and Procter & Gamble Professional Oral Health. The proceedings of the workshop were jointly and simultaneously published in the Journal of Periodontology and Journal of Clinical Periodontology .
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