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Plaque-induced gingivitis
Figure 30.1 Classification of plaque-induced gingivitis from the 1999 International Workshop.
Figure 30.2 Section through a tooth with established, clinically evident, plaque-induced gingivitis.
Figure 30.3 Plaque-induced gingival inflammation. (a) Left and (b) right views showing plaque visible at the gingival margin, blunted papillae and red, swollen gingiva.
Figure 30.4 BPE codes, criteria and management. Plaque-induced gingivitis would typically be associated with a BPE code 1 or 2. Note that if the BPE code is 3, there is a need to differentiate between false gingival pockets and true periodontal pockets.
Figure 30.5 A false gingival pocket.
Figure 30.6 (a) Pre-treatment: a false pocket is associated with a subgingival cavity (arrow) and plaque retention on the mesial UL2. The papilla is swollen and red. (b) Post-treatment for gingivitis: the inflammation is diminished. The cavity on UL2 is now supragingival and accessible for restoration.
Figure 30.7 Plaque accumulation around a fixed orthodontic appliance in a 17-year-old female. There is gingival inflammation and a hyperplastic response to plaque.
Figure 30.8 A 13-year-old boy with pronounced gingivitis anteriorly which is associated with poor plaque control and lack of saliva there due to incompetent lips, a high lip line and being a mouth breather in relation to nasal blockages.
Figure 30.9 Pregnancy-associated gingivitis. (a) A 21-year-old pregnant patient with inflamed anterior gingivae, which bled on gentle probing. (b) A close up of the lower anterior gingivae which are inflamed and swollen. (c) A different pregnant patient with an even more marked response to plaque and severe gingival overgrowth, especially on the lower incisors.
Figure 30.10 (a) Diabetes-associated gingivitis and uncontrolled caries in a young woman with poorly controlled type 1 diabetes mellitus. (b, c) Right and left bitewing radiographs showing caries but good bone levels. Courtesy of Mr P. J. Nixon.
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