Other periodontal conditions

Management of other periodontal conditions

Non-plaque biofilm-induced periodontal diseases are a group of conditions characterised by atypically presenting gingival, and sometimes oral mucosal, lesions. They may be manifestations of systemic conditions, a medical disorder or may represent pathologic changes in the gingival tissues. Their atypical appearance will often extend beyond the mucogingival margin and will not respond to oral hygiene measures. Although these lesions are not directly caused by plaque, their clinical course may be impacted by plaque accumulation and subsequent gingival inflammation. 

As many of these conditions are rare, their appearance may not be recognised or may cause concern to the primary care team. In those cases, early referral to a specialist in periodontology, oral medicine or oral surgery should be considered to confirm a diagnosis and exclude underlying disease which requires separate management. 

A brief summary of non–plaque‐induced gingival diseases and conditions is presented below, and specific examples are discussed in more detail later in this guidance (i.e. necrotising periodontal disease, drug-induced gingival enlargement, puberty gingivitis, leukaemia).

• Genetic/developmental disorders (e.g. hereditary gingival fibromatosis);
• Specific infections (bacterial origin [e.g. necrotising periodontal diseases], viral origin [e.g. Coxsackie virus, Herpes simplex virus], fungal origin [e.g. candidosis]);
• Inflammatory and immune conditions and lesions (hypersensitivity reactions, autoimmune diseases of skin and mucous membranes [e.g. lichen planus], granulomatous inflammatory conditions [e.g. orofacial granulomatosis]);
• Reactive processes (epulides [e.g. fibrous epulis]);
• Neoplasms (premalignant leukoplakia/erythroplakia, malignant squamous cell carcinoma, leukaemia, lymphoma);
• Endocrine, nutritional, and metabolic diseases (e.g. vitamin C deficiency);
• Traumatic lesions (physical/mechanical insults [e.g. toothbrushing trauma; lip or tongue piercing], chemical injury [e.g. etching], thermal injury [e.g. burns of mucosa]);
• Gingival pigmentation (e.g. amalgam tattoo). 

More information on these conditions is available in an article from the Proceedings of the World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.⁹⁴