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CHAPPLE et al .
TABLE 1 Diagnostic look‐up table for gingival health or dental plaque‐induced gingivitis in clinical practice Intact periodontium Health
Gingivitis
No
No
Probing attachment loss
Probing pocket depths (assuming no pseudo pockets) a
≤3 mm
≤3 mm
Bleeding on probing a Radiological bone loss
<10%
Yes (≥ 10%)
No
No
Reduced periodontium
Non‐periodontitis patient
Health
Gingivitis
Yes
Yes
Probing attachment loss
Probing pocket depths (all sites & assuming no pseudo pockets) a
≤3 mm
≤3 mm
Bleeding on probing a Radiological bone loss
<10%
Yes (≥ 10%)
Possible Possible NB: In conditions where there is treatment but not cure, e.g. rheumatoid arthritis, periodontitis, the post‐treatment parameters that define stability/health or gingivitis may differ from the parameters for health/gingivitis in a non‐periodontitis patient. The threshold for “clinical health” in a treated and stable periodontitis patient is therefore set at ≤ 4 mm.
Gingivitis in a patient with a history of periodontitis
Successfully treated stable periodontitis patient
Health
Yes
Yes
Probing attachment loss
Probing pocket depths (all sites & assuming no pseudo pockets) a
≤4 mm (no
≤3 mm
site ≥ 4 mm with BOP) b
Bleeding on probing a Radiological bone loss
<10%
Yes (≥ 10%)
Yes Yes NB: A successfully treated periodontitis patient in whom sites of gingival bleeding appear remains at high risk of disease recurrence at those sites and of progressive attachment loss. Therefore, gingivitis is defined as bleeding at a shallow site of ≤ 3 mm rather than ≤ 4 mm, as is the case in gingival heath. Where the probing depth is 4 mm or higher with bleeding, this is no longer a “closed pocket.” 21,27 a Assumes a light probing pressure of 0.2 to 0.25 N . b There was a rational minority view expressed that the threshold for defining a clinical case of health in a successfully treated periodontitis patient should be set at ≤ 3 mm with no BOP to acknowledge the elevated risk of recurrent disease. However, the counter and majority view was that the ≤ 3 mm threshold is rarely achieved at 100% of treated sites and could lead to over‐treatment, since any non‐bleeding site > 3 mm would not be classified as “health” and thus open to further invasive treatment, rather than monitoring and supportive care. The threshold was therefore set at ≤ 4 mm ac- knowledging that post‐treatment clinical phenotypes need to be considered differently to pre‐treatment phenotypes.
(bleeding on probing). Gingival inflammation may arise at specific sites, and where probing depths are ≤ 3 mm is termed gingival inflammation in a stable periodontitis patient. However, such patients remain at high risk of recurrent periodontitis and require close monitoring as such sites are at high risk of reverting to periodontitis (Table 1). How do we classify non–dental plaque‐induced gingival conditions? Although oral health and systemic health are frequently consid- ered as separate entities, both are strongly interrelated. There are numerous examples of how oral diseases may impact systemic health and how the oral cavity may be a window to general health. Consequently, it is crucial for all health‐care providers to understand these interrelationships, inform patients of such conditions, and make appropriate referrals. Non‐dental plaque‐induced gingival conditions encompass 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. 25 Although these lesions are not caused by the dental plaque biofilm, the severity of the clinical manifestations often depends on plaque accumulation and subsequent gingival inflammation. 26 The proposed classification considers those conditions listed in Table 2. Which non–dental plaque‐induced gingival conditions may have associated systemic involvement and how does that impact upon patient‐centered care pathways? In recent years, the traditional treatment model in which the pa- tient was a passive receiver of care is changing toward patient‐ centered care in precision dental medicine (PDM). In PDM, an individual's specific health needs and desired health outcomes
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