Clinical Symptoms

•  Bleeding

•  Erythema

•  Edematous and hyperplastic swelling

•  Ulceration

The earliest clinical symptom of an established lesion is bleeding subsequent to careful sulcus probing. This hemorrhage is elicited by the penetration of the probe tip through the disintegrating junctional epithelium and into the highly vascular sub-epithelial connective tissue. At this stage of the inflammatory process (PBI = 1), no gingival erythema may be


Visible clinically. Clinical symptoms of advanced (established) gingivitis include profuse bleeding after sulcus probing, obvious erythema and simultaneous edematous swelling. In the most severe cases, spontaneous bleeding and eventually ulceration may occur. The chronic types (and severities) do not elicit pain; pain occurs only in acute gingivitis (e. g., NUG, p.85).

Even severe gingivitis may never progress to periodontitis. With proper treatment, gingivitis is reversible.


149 Healthy Gingiva (left)

The gingiva is pale salmon-pink in color, and stippled. The narrow free gingival margin is distinguishable from the attached gingiva. After gentle probing with a blunt periodontal probe, no bleeding occurs.

150 Mild Gingivitis (right)

The localized erythema is scarcely visible, and one observes slight edematous swelling. Some of the former stippling is lost, and there is minimal bleeding upon probing.

151 Moderate Gingivitis (left)

Obvious erythema and edematous swelling. No stippling is apparent, and there is hemorrhage following probing of the sulcus.

152 Severe Gingivitis (right)

Fiery redness, edematous and hyperplastic swelling; complete absence of any stippling; interdental ulceration, copious bleeding on probing, and spontaneous hemorrhage.

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