Bleeding/plaque ratio and the development of gingival inflammation

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Abstract
In a recent publication, it was hypothesized that the ratio between bleeding and plaque scores may act as a prognostic indicator for periodontal breakdown. Furthermore, it was found that the rate of development of gingival inflammation in terms of bleeding on probing during experimental gingivitis is more rapid in patients susceptible to periodontal breakdown than in subjects insusceptible to periodontal breakdown. The purpose of the present investigation was to compare the gingival reaction to dental plaque in an experimental gingivitis study in individuals without periodontal breakdown, having either a low or a high bleeding/plaque ratio. A group of 8 volunteers (18-23 years) with a low bleeding/plaque ratio and 7 volunteers (19-22 years) with a high bleeding/plaque ratio were selected. In both groups, an experimental gingivitis study of 23 days duration was carried out. Results showed that individuals with a high bleeding/plaque ratio developed significantly more clinical inflammation in terms of bleeding and swelling of the gingiva than individuals with a low bleeding/plaque ratio. After 23 days of plaque accumulation, gingival biopsies as well as supragingival plaque samples were taken from both groups. Phase-contrast microscopy of the plaque samples showed no significant differences between the 2 groups. Low %s of spirochetes and motile rods were found. Stereologic point-counting procedures showed equal amounts of infiltrated connective tissue in both groups. However, significant differences in composition of the infiltrate appeared to be present. The high ratio group showed more IgA producing plasma cells and complement activation than the low ratio group. The results of the present study suggest that the bleeding/plaque ratio of an individual may be regarded as a prognostic indicator for the degree of experimentally induced gingival inflammation in terms of bleeding and swelling of the gingiva as well as complement activation and IgA-plasma cell activity.