Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, University of Birmingham, UK.
University of Texas Health Science Center at San Antonio, USA.
J Clin Periodontol. 2018 Jun;45 Suppl 20:S68-S77. doi: 10.1111/jcpe.12940.
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.
牙周健康定义为无临床可检测的炎症。存在一种与临床牙龈健康和内稳定一致的生物学水平的免疫监视。临床牙龈健康可能存在于完整的牙周组织中，即无临床附着丧失或骨丧失，也可能存在于非牙周炎患者的减少的牙周组织中（例如，存在某种形式的牙龈退缩或牙冠延长手术后），或存在牙周炎病史但目前牙周稳定的患者中。牙龈健康可在治疗牙龈炎和牙周炎后恢复。然而，经治疗且稳定的牙周炎患者目前有牙龈健康，但仍有复发性牙周炎的风险增加，因此必须密切监测。两种主要的牙龈疾病类别包括非牙菌斑生物膜引起的牙龈疾病和牙菌斑引起的牙龈炎。非牙菌斑生物膜引起的牙龈疾病包括各种不是由菌斑引起的疾病，并且通常在菌斑去除后不会消退。此类病变可能是全身性疾病的表现，也可能局限于口腔。牙菌斑引起的牙龈炎有多种临床症状和体征，局部诱发因素和全身调节因素都可以影响其程度、严重程度和进展。牙菌斑引起的牙龈炎可能发生在完整的牙周组织上，也可能发生在非牙周炎患者的减少的牙周组织上，或在目前稳定的“牙周炎患者”上，即经过成功治疗，临床炎症已消除（或大大减少）。有牙龈炎症的牙周炎患者仍然是牙周炎患者（图 1），全面的风险评估和管理至关重要，以确保早期预防和/或治疗复发性/进行性牙周炎。精准牙科医学定义了一种以患者为中心的护理方法，因此，在临床实践中定义牙龈健康或牙龈炎“病例”的方式与人群流行率调查中的流行病学定义有所不同。因此，为临床和流行病学目的都提出了牙龈健康和牙龈炎的病例定义。虽然牙龈健康和牙龈炎有许多临床特征，但病例定义主要基于探诊出血的存在与否。在这里，我们对牙龈健康和牙龈疾病/状况进行分类，并提供了一个总结表，用于在各种临床情况下定义健康和牙龈炎的诊断特征。
