Volume 4 • Number 1 • December 1999

Consensus Report: Dental Plaque-Induced Gingival Diseases

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1) leukemia-associated gingivitis2) other

3. Gingival diseases modified by medicationsa. drug-influenced gingival diseases

1) drug-influenced gingival enlargements2) drug-influenced gingivitis

a) oral contraceptive-associated gin-givitis

b) other4. Gingival diseases modified by malnutrition

a. ascorbic acid-deficiency gingivitisb. other

The following working definitions for subcategoriesof, or items related to, dental plaque-induced gingivaldiseases were developed by the group:

● Ascorbic acid-deficiency gingivitis. Inflammatoryresponse of the gingiva to plaque aggravated bychronically low ascorbic acid levels.

● Blood dyscrasia-associated gingivitis. Gingivitis asso-ciated with abnormal function or number of bloodcells.

● Diabetes-associated gingivitis. Inflammatory responseof the gingiva to plaque which is aggravated bypoorly controlled plasma glucose levels.

● Drug-influenced gingival enlargement. Gingivalenlargements resulting in whole or in part from sys-temic drug use.

● Drug-influenced gingivitis. Pronounced inflamma-tory response of the gingiva to plaque and drug(s).

● Gingival diseases. The pattern of observable signsand symptoms of different disease entities that arelocalized to the gingiva.

● Leukemia-associated gingivitis. Pronounced inflam-matory response of the gingiva to plaque resultingin increased bleeding and enlargement subsequentto leukemia.

● Local contributing factor. A local feature that mayinfluence the presentation of the disease, such asan overhanging restoration.

● Menstrual cycle-associated gingivitis. Pronounced

The group accepted the review paper that was writtenprior to the workshop. A classification for those gingi-val diseases primarily associated with dental plaquewas developed and agreed upon. It was acknowledgedthat there are 4 main types of plaque-associated gin-gival diseases. The most common form is plaque-induced gingivitis or inflammation of the gingiva result-ing from dental plaque only. The other 3 types ofplaque-associated gingival diseases are those modifiedby: 1) systemic factors, 2) medications, or 3) malnu-trition.

Traditionally, assignment of the diagnosis of “gin-givitis” has been limited to the clinical situation inwhich there is gingival inflammation of a periodontiumthat has not experienced loss of attachment. One ofthe problems with this approach is that it does notcover the common circumstance in which clinicallydetectable gingival inflammation develops in a peri-odontium that has had attachment loss from previousbouts with periodontitis, but is currently stable and notundergoing additional attachment loss (i.e., nonpro-gressing). This probably occurs most often in patientswho have been successfully treated for periodontitisbut who subsequently develop a transient or reversiblegingivitis. The group concluded that if a clinician isgoing to make the diagnosis of “gingivitis on a reducedbut stable periodontium,” it is necessary to longitudi-nally demonstrate that attachment loss is not occur-ring.

The group agreed upon the following classificationfor dental plaque-induced gingival diseases:

I. Gingival DiseasesA. Dental Plaque-Induced Gingival Diseases*

1. Gingivitis associated with dental plaque onlya. without other local contributing factorsb. with local contributing factors

2. Gingival diseases modified by systemic fac-torsa. associated with the endocrine system

1) puberty-associated gingivitis2) menstrual cycle-associated gingivitis3) pregnancy-associated

a) gingivitisb) pyogenic granuloma

4) diabetes mellitus-associated gingivitisb. associated with blood dyscrasias

* Can occur on a periodontium with no attachment loss or on aperiodontium with attachment loss that is not progressing.

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Ann Periodontol Consensus Report

inflammatory response of the gingiva to plaque andhormones immediately prior to ovulation.

● Oral contraceptive-associated gingivitis. Pronouncedinflammatory response of the gingiva to plaque andoral contraceptives.

● Plaque-induced gingivitis. An inflammation of thegingiva resulting from dental plaque.

● Pregnancy-associated gingivitis. Pronounced inflam-matory response of the gingiva to dental plaque andhormones usually occurring during the second andthird trimesters of pregnancy.

● Pregnancy-associated pyogenic granuloma. A local-ized, painless, protuberant, exophytic gingival massthat is attached by a sessile or pedunculated basefrom the gingival margin or more commonly froman interproximal space resulting from dental plaqueand hormones during pregnancy.

● Puberty-associated gingivitis. Pronounced inflam-matory response of gingiva to dental plaque and

hormones during the circumpubertal period as des-ignated by Tanner Stage 2.

GROUP MEMBERSJack G. Caton, Jr., Henry GreenwellGroup Leader Rangsini Mahanonda

Ray Williams, Chair Angelo MariottiUrs Zappa, Secretary Jerome ZackinNoel Claffey

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