Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions
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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 periodontium 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 restored 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–induced gingival diseases and dental plaque‐induced gingivitis. Non‐dental plaque biofilm‐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 periodontium or on a reduced periodontium in either a non‐periodontitis patient or in a currently 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 comprehensive 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 therefore, 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 definitions 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.
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The clinical parameters listed in Table 1 support the diagnoses that were retrospectively deduced.
“This might be attributed to tooth loss due to nonperiodontitis causes; 48 however, the clinical parameters listed in Table 1 otherwise support the diagnoses which were retrospectively deduced.”
From Prognostic utility of oral neutrophil counts in high-risk periodontitis: A retrospective study (2025) · cites this paper as [48]
The source’s Table 1 is a diagnostic look-up table using clinical parameters to distinguish gingival health from gingivitis, so it supports the general use of such parameters for diagnosis. It does not contain the citing document’s Table 1 or assess its retrospectively deduced diagnoses. In the printed sentence, citation 48 also appears before “however,” attaching it to the preceding tooth-loss explanation rather than directly to the quoted claim. (LLM, conf=0.78)
Experimental — accuracy not yet measuredGingivitis is an inflammatory response to oral biofilm accumulation and is almost always a necessary precursor to periodontitis.
“Gingivitis is a nonspecific inflammatory lesion in response to the accumulation of oral biofilm and is a necessary precursor to periodontitis.”
Preventing destructive periodontal disease depends on disrupting dysbiotic biofilm and lowering gingival inflammation.
“The primary prevention of destructive periodontal diseases requires the removal and disruption of dysbiotic biofilm and the subsequent reduction in gingival inflammation seen in patients with gingivitis.47”
Gingivitis is a necessary precursor to destructive periodontitis, but not all individuals who develop gingivitis progress to periodontitis.
“Gingivitis is a necessary precursor to destructive periodontitis, but not all individuals who develop gingivitis progress to periodontitis, indicating the role of the host immune-inflammatory response in the development and disease progression of periodontitis. 44-46”
A periodontitis patient remains a periodontitis patient for life, even following successful therapy.
“It was accepted that a patient with gingivitis can revert to a state of health, but a periodontitis patient remains a periodontitis patient for life, even following successful therapy, and requires life-long supportive care to prevent recurrence of disease.6”
From A new classification scheme for periodontal and peri‐implant diseases and conditions – Introduction and key changes from the 1999 classification (2018) · cites this paper as [6]
A patient with gingivitis can revert to a state of health.
“It was accepted that a patient with gingivitis can revert to a state of health, but a periodontitis patient remains a periodontitis patient for life, even following successful therapy, and requires life-long supportive care to prevent recurrence of disease.6”
From A new classification scheme for periodontal and peri‐implant diseases and conditions – Introduction and key changes from the 1999 classification (2018) · cites this paper as [6]
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- Authors
- Chapple, I. L. C., Mealey, B. L., Van Dyke, T. E., Bartold, P. M., Dommisch, H., Eickholz, P., Geisinger, M. L., Genco, R. J., Glogauer, M., Goldstein, M., Griffin, T. J., Holmstrup, P., Johnson, G. K., Kapila, Y., Lang, N. P., Meyle, J., Murakami, S., Plemons, J., Romito, G. A., Shapira, L., Tatakis, D. N., Teughels, W., Trombelli, L., Walter, C., Wimmer, G., Xenoudi, P., & Yoshie, H.
- Affiliations
- University of Birmingham (GB)
- The University of Texas at San Antonio Health Science Center (US)
- The Forsyth Institute Cambridge MA USA
- The University of Adelaide (AU)
- Charité – Universitätsmedizin Berlin (DE)
- Goethe University Frankfurt (DE)
- University of Alabama at Birmingham (US)
- University at Buffalo, State University of New York (US)
- University of Toronto (CA)
- Hebrew University of Jerusalem (IL)
- Tufts University (US)
- University of Copenhagen (DK)
- University of Iowa (US)
- University of California, San Francisco (US)
- University of Bern (CH)
- Justus-Liebig-Universität Gießen (DE)
- The University of Osaka (JP)
- Texas A&M University (US)
- Universidade de São Paulo (BR)
- The Ohio State University (US)
- Universitair Ziekenhuis Leuven (BE)
- University of Ferrara (IT)
- University of Basel (CH)
- University of Graz (AT)
- Niigata University (JP)
- Corresponding author
- Chapple, Iain L.C.
- ORCID
- Chapple, Iain L.C.
- Mealey, Brian L.
- Bartold, P. Mark
- Dommisch, Henrik
- Eickholz, Peter
- Geisinger, Maria L.
- Genco, Robert J.
- Glogauer, Michael
- Goldstein, Moshe
- Holmstrup, Palle
- Kapila, Yvonne
- Lang, Niklaus P.
- Meyle, Joerg
- Murakami, Shinya
- Plemons, Jacqueline
- Romito, Giuseppe A.
- Shapira, Lior
- Tatakis, Dimitris N.
- Teughels, Wim
- Trombelli, Leonardo
- Walter, Clemens
- Venue
- Journal of Periodontology
- Publisher
- Wiley
- Published
- 2018-06
- Volume
- 89
- Issue
- S1
- Pages
- S74-S84
- ISSN
- 0022-3492 (ISSN-L)
- 1943-3670
- OpenAlex
- W2808996141
- Cited by
- 1,216
- References
- 26
- Citations by year
- 2026: 101 · 2025: 158 · 2024: 206 · 2023: 216 · 2022: 171 · 2021: 164 · 2020: 134 · 2019: 55 · 2018: 7 · 2013: 2
- FWCI
- 103.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Periodontology (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- Funders
- Philips
- Procter and Gamble
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Medicine › Urology › Periodontal Regeneration and Treatments
- Health Sciences › Health Professions › Pharmacy › Oral and gingival health research
- Keywords
- periodontal disease, periodontitis, gingivitis, gingival health, reduced periodontium, periodontal classification, case definition, bleeding on probing, dental plaque, gingival recession, crown lengthening, periodontitis recurrence, periodontal risk assessment, periodontal homeostasis
- MeSH terms
- Gingivitis, Humans, Periodontitis, Periodontium, Consensus, Peri-Implantitis
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