Gingivitis Can Be Diagnosed on a Stable Reduced Periodontium
Yes, gingivitis can absolutely be diagnosed in a patient with a stable reduced periodontium—it does not automatically become "unstable periodontitis." The diagnosis depends on the presence of gingival inflammation (bleeding on probing ≥10%) without active periodontal breakdown at sites with probing depths ≥4 mm 1, 2.
Diagnostic Framework for Reduced Periodontium
The 2017 World Workshop established clear distinctions for diagnosing gingival conditions on a reduced periodontium 3:
When It's Gingivitis on Reduced Periodontium
- A patient with attachment loss and BOP score ≥10% is diagnosed as a gingivitis case if there is no BOP at any site probing ≥4 mm in depth 1, 2
- This applies to both non-periodontitis patients (e.g., after crown lengthening or with recession) and successfully treated periodontitis patients who are currently stable 3
- The gingivitis can be classified as localized (BOP 10-30%) or generalized (BOP >30%) 1, 2
When It Becomes Unstable Periodontitis
- If bleeding on probing occurs at sites with probing depths ≥4 mm, the patient remains classified as having periodontitis (unstable), not gingivitis 1, 2
- A periodontitis patient with gingival inflammation at deeper sites remains a periodontitis patient requiring comprehensive risk assessment and management 3
Critical Clinical Distinction
The key differentiator is not just the presence of inflammation, but where that inflammation occurs relative to pocket depth 1, 2:
- Inflammation at shallow sites (<4 mm) on reduced periodontium = Gingivitis on reduced periodontium
- Inflammation at deeper sites (≥4 mm) on reduced periodontium = Unstable/recurrent periodontitis
Clinical Implications
For Successfully Treated Periodontitis Patients
- These patients can achieve clinical gingival health and be considered stable 3
- If inflammation returns but only at shallow sites, they have gingivitis on a reduced periodontium 1, 2
- However, they remain at increased risk for recurrent periodontitis and require close monitoring 3
- The diagnosis matters because it guides treatment intensity and monitoring frequency 3
Treatment Approach
- Gingivitis on reduced periodontium is treated similarly to gingivitis on intact periodontium: professional mechanical plaque removal, improved oral hygiene, and adjunctive chlorhexidine mouthwash 4
- Reassessment after 2-4 weeks is crucial to ensure the inflammation resolves and doesn't progress to active periodontitis 4, 5
Common Pitfall to Avoid
Do not automatically classify any inflammation in a patient with attachment loss as "unstable periodontitis"—this leads to overtreatment and unnecessary anxiety. The presence and location of bleeding on probing at specific pocket depths determines whether the patient has gingivitis on reduced periodontium versus active/recurrent periodontitis 1, 2.