system provides the framework necessary for early diagnosis and Autoimmune diseases of skin and mucous membranes management of gingival manifestations of systemic disease .6 • Pemphigus vulgaris • Pemphigoid Conclusions • Lichen planus As advances in periodontal research and science are realized, • Lupus erythematosus disease classifications must be modified to reflect the progress of • Systemic lupus erythematosus knowledge. The new World Workshop classification of the • Discoid lupus erythematosus spectrum of periodontal disease resulted from a global • Granulomatous inflammatory lesions collaboration and consensus of European and American experts in • Crohn’s disease • Sarcoidosis the field. While the new classification brings implementation Reactive process challenges to dental professionals and associated industries, the • Epulides goal of the change is to promote improved communication among • Fibrous epulis dental and medical colleagues, establish a universal classification • Calcifying fibroblastic granuloma system that encourages standardized research and ultimately, • Vascular epulis enhances the management of periodontal patients. • Peripheral giant cell granuloma Neoplasms • Premalignancy SUMMARY OF GINGIVAL DIAGNOSES • Leukoplakia Periodontal & Gingival Health (Bleeding Score <10%): • Erythroplakia • Clinical and gingival health on an intact periodontium • Malignancy • Clinical gingival health on a reduced periodontium • Squamous cell carcinoma • Stable periodontitis patient or Non-periodontitis patient • Leukemic cell infiltration Plaque-induced Gingival Diseases (Bleeding Score ≥10%): • Lymphoma • Localized (Bleeding Score ≥10 to ≤30%) or Generalized (>30%) • Hodgkin • Gingivitis on an intact periodontium • Non-Hodgkin endocrine, nutritional and metabolic disorders • Gingivitis on a reduced periodontium • Vitamin deficiencies • With or Without a history of periodontitis Traumatic lesions Figure 1. • Physical/mechanical trauma • Chemical burn • Thermal insults SUMMARY OF PERIO-SYSTEMIC RELATIONSHIPS Gingival pigmentation Mediated by Systemic or Local Risk Factors: • Melanoplakia • Systemic factors • Smoker’s melanosis • Smoking • Drug-induced pigmentation • Hyperglycemia • Amalgam tattoo • Nutrition Figure 2. Adapted from Caton (2018) and Holmstrup (2018) • Pharmacological agents • Sex steroid hormones • Hematological conditions References • Local Risk Factors (predisposing factors) 1. Caton J, Armitage G, Berglundh T, et al. A new classification scheme for • Dental plaque retention factors periodontal and peri-implant diseases and conditions – Introduction and key changes from the 1999 classification. J Periodontol. 2018;89(Suppl 1):S1–S8. • Oral dryness Non-Plaque-Induced Gingival Diseases: Free Access Link: https://doi.org/10.1111/jcpe.12935 2. Lang NP, Bartold PM. Periodontal health. J Periodontol. 2018;89(Suppl 1): S9– Genetic/Developmental Disorders S16. Free Access Link: https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.12936 • Hereditary gingival fibromatosis 3. Lang NP, Joss A, Orsanic T, Gusberti FA, Siegrist BE. Bleeding on probing. A Specific Infections predictor for the progression of periodontal disease. J Clin Periodontol. • Bacterial origin 1986;13:590–596. • Neisseria gonorrhoeae 4. Murakami S, Mealey BL, Mariotti A, Chapple ILC. Dental plaque–induced • Treponema pallidum gingival conditions. J Periodontol. 2018;89(Suppl 1): S17–S27. Free Access Link: https://doi.org/10.1111/jcpe.12937 • Mycobacterium tuberculosis 5. Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque-induced gingivitis: Case • Streptococcal gingivitis def- inition and diagnostic considerations. J Periodontol. 2018;89(Suppl 1):S46– • Viral origin S73. Free Access Link: https://doi.org/10.1111/jcpe.12939 • Coxsackie virus 6. Holmstrup P, Plemons J, Meyle J. Non–plaque-induced gingival diseases. J Peri • Herpes simplex I & II odontol. 2018;89(Suppl 1):S28–S45. • Varicella zoster Free access link: https://doi.org/10.1111/jcpe.12938
Molluscum contagiosa • Dr. Polak is a recent graduate of the NPDS Periodontics program. Dr. Merchant is • Human papilloma virus the Program Director of the NPDS Periodontics Residency Program. • Fungal origin • Candidosis The views expressed in this article reflect the results of research conducted by the • Other mycoses author and do not necessarily reflect the official policy or position of the Inflammatory and immune conditions Department of the Navy, Department of Defense, nor the United States Hypersensitivity reactions Government. • • Contact allergy The Naval Postgraduate Dental School is affiliated • Plasma cell gingivitis with the Uniformed Services University of the • Erythema multiforme Health Sciences’ Postgraduate Dental College