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

Research output: Contribution to journalArticlepeer-review


  • Brian L. Mealey
  • Thomas E. Van Dyke
  • P. Mark Bartold
  • Henrik Dommisch
  • Peter Eickholz
  • Maria L. Geisinger
  • Robert J. Genco
  • Michael Glogauer
  • Moshe Goldstein
  • Terrence J. Griffin
  • Palle Holmstrup
  • Georgia K. Johnson
  • Yvonne Kapila
  • Niklaus P. Lang
  • Joerg Meyle
  • Shinya Murakami
  • Jacqueline Plemons
  • Giuseppe A. Romito
  • Lior Shapira
  • Dimitris N. Tatakis
  • Wim Teughels
  • Leonardo Trombelli
  • Clemens Walter
  • Gernot Wimmer
  • Pinelopi Xenoudi
  • Hiromasa Yoshie

Colleges, School and Institutes

External organisations

  • University of Birmingham
  • University of Texas Health Science Center
  • The Forsyth Institute; Cambridge MA USA
  • University of Adelaide
  • Charité-Universitätsmedizin Berlin
  • Department of Periodontology, Center for Oral Medicine, Goethe-University Frankfurt
  • University of Alabama
  • Department of Oral Biology; SUNY at Buffalo; NY USA
  • University of Toronto
  • Department of Periodontology; Faculty of Dental Medicine; Hebrew University-Hadassah Medical Center; Jerusalem Israel
  • Periodontal Department; Tufts University School of Dental Medicine; Boston MA USA
  • University of Copenhagen
  • University of Iowa
  • University of California, San Francisco
  • University of Bern
  • Department of Periodontology; University of Giessen; Germany
  • Osaka University
  • Department of Periodontics; Texas A&M College of Dentistry; Dallas TX USA
  • University of Sao Paulo
  • Ohio State University
  • University Hospitals Leuven
  • University of Ferrara
  • University of Basel
  • Medical University of Graz
  • Niigata University


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.


Original languageEnglish
Pages (from-to)S68-S77
Number of pages10
JournalJournal of Clinical Periodontology
Issue numberS20
Early online date20 Jun 2018
Publication statusE-pub ahead of print - 20 Jun 2018