Identification of inflamed gingival surfaces

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Abstract
The present study was undertaken to clarify whether visual inflammation or gingival bleeding on probing is the earlier indicator of gingivitis. A dental prophylaxis was given to 90 male students and 1 month later the gingiva adjacent to the mesio‐buccal, mid‐buccal and mid‐lingual surfaces of all teeth was evaluated. Two subsequent examinations were done at 1‐month intervals. Each gingival margin was examined visually and classified as either non‐inflamed or inflamed and these same surfaces were then probed for bleeding. The number of gingival surfaces at each examination was 6990 and, at the first examination, 16798 of these combined absence of visual inflammation and bleeding (healthy). One month later only 766 of these surfaces were still healthy. Inspection of the data from the surfaces which had changed since the first examination showed that there were a significantly greater number of surfaces which bled after probing compared to either a color change only or combined both a color change plus bleeding. The same trend was seen between the second and third examinations. It was concluded that substantial changes in healthy gingival surfaces occur in as brief a period as 1 month. When healthy gingival surfaces (no visual inflammation and no bleeding) developed clinically detectable signs under investigation, a significantly greater number manifested bleeding alone compared to either visual inflammation alone or a combination of visual inflammation plus bleeding. These findings support an emphasis on gingival bleeding indices for detection of early deviations from health.

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