Diagnosis
Diagnosis
Clinical diagnosis is made using the plaque index (or control record), gingival index, and BOP percentage. The Löe-Silness Gingival Index scores 0–3 for erythema, edema, and bleeding tendency. A BOP score >25% indicates generalized gingivitis requiring intervention.
Probing depth measurement distinguishes gingivitis (probing depth ≤3mm, no attachment loss) from periodontitis (probing depth >4mm, clinical attachment loss, bone loss on radiograph). This distinction is fundamental as management differs entirely.
Radiographic evaluation: for standard plaque-induced gingivitis, radiographs show no alveolar bone loss — the level of alveolar crest is within 2mm of the cemento-enamel junction (CEJ). Radiographs are still taken to rule out early periodontitis and detect calculus.
Systemic evaluation: when gingivitis appears disproportionate to plaque levels (severe inflammation with minimal plaque), investigate systemic modifying factors — pregnancy test, blood glucose, medication review, FBC if blood dyscrasia suspected, HIV test if necrotizing presentation.