Gingivitis
Managing patients with a diagnosis of gingivitis
Gingivitis is defined in the 2018 Classification of Periodontal Diseases as ≥10% of sites with bleeding on probing and all sites with probing pocket depths of ≤3 mm and no clinical attachment loss due to periodontitis (see figure: Gingivitis). There should be no evidence of bone loss.8
Key recommendation
For patients with a diagnosis of gingivitis, provide personalised oral hygiene instruction. In addition, assess levels of plaque and calculus and deliver professional mechanical plaque removal (PMPR) at required sites, especially where inflammation is present, to enable and encourage oral hygiene self-care.
(Strong recommendation; high certainty evidence)
In patients with a diagnosis of gingivitis, the priority is to support the patient to resolve the inflammation and avoid progression to more serious disease.
The 2015 European Workshop Principles in Prevention of Periodontal Diseases,90 recommends repeated and individually tailored oral hygiene instruction (OHI) to treat gingival conditions, with the addition of professional mechanical plaque removal (PMPR) both supra- and subgingivally, where required, to allow good self-performed oral hygiene. DBOH states that ‘daily, effective plaque removal is critical to periodontal health’, with professional interventions such as ‘routine scale and polish’ considered less important.7
A systematic review assessed studies investigating the provision of periodontal “standard care” (i.e. 6-monthly review appointments, where the focus was on calculus removal) conducted in general dental practice in regularly attending adults without severe periodontitis compared to less frequent care. The review found that providing calculus removal on a less frequent basis was as effective as “standard care” when assessing plaque biofilm (low certainty evidence due to risk of bias and indirectness) and gingival bleeding (high certainty evidence) levels over two to three years follow-up.57
Resolving inflammation and avoiding progression to more serious disease is dependent on the patient controlling, and eliminating where possible, risk factors for disease and improving and consistently performing adequate home care. In combination with this, patients are supported by the dental team who can provide information about risk factors, support for skills development in oral hygiene and removal of plaque retentive factors. Calculus removal is likely to be required to enable adequate home care.
Further details on the development of the recommendations in this guidance can be found in Methodology.
Explain to the patient that gingivitis is a risk factor for periodontitis, which can lead to tooth loss.
Provide personalised oral hygiene advice and instruction to assist and encourage the patient to improve their oral hygiene skills, with the aim of reducing and controlling their inflammation as well as improving their understanding of the value of good self-care routines (see Oral hygiene).
Where applicable, give information regarding personal risk factors and modifying them, for example, advice on smoking cessation and diabetes control (see Smoking cessation and Control of diabetes).
Perform professional mechanical plaque removal (PMPR) at sites where inflammation is present.
- Remove both supra- and subgingival plaque and calculus using an appropriate method.
Ensure that local plaque retentive factors are corrected - for example, remove overhanging restorations or alter denture design.
Re-assess at future visits to determine whether the gingivitis has resolved.