Systemic disease or periodontal disease? Distinguishing causes of gingival inflammation: a guide for dental practitioners. Part 1: immune-mediated, autoinflammatory, and hereditary lesions


Periodontitis and gingivitis remain two of the most common diseases that affect the oral cavity. As they are caused by plaque, effective oral hygiene, elimination of plaque-retentive factors and successful periodontal treatment will result in resolution of gingival and periodontal inflammation. Certain systemic diseases can have a clinical appearance similar to periodontal diseases or exacerbate existing periodontitis/gingivitis and vice versa. This paper aims to provide the dental practitioner with an understanding of the manifestations of systemic diseases to the periodontium and highlights elements in the clinical assessment, which will aid in establishing a correct diagnosis. Additional anamnestic and clinical clues are important for distinguishing between plaque-induced and non-plaque-induced lesions. The first part of this compendium covers immune-mediated and hereditary conditions as causes of gingival lesions, which can resemble those caused by dental plaque. The different conditions are presented concisely and exemplified by clinical photographs. Dental practitioners should be aware of the various manifestations of systemic diseases to the periodontium in order to offer appropriate diagnosis and treatment, which can reduce both patient morbidity and mortality.

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The authors would like to thank Mr Mutahir Rahman at the Department of Periodontology of the Birmingham Dental School and Hospital for his permission to use clinical photographs. We further thank our patients for their consent to utilise their clinical photographs for this publication.

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JH (Josefine Hirschfeld) took the lead in writing and finalising the manuscript. JH (Jon Higham), DC and JH drafted the manuscript and gathered demographic data for the table; FB, AR and ILC provided guidance and clinical photographs. All authors provided critical feedback.

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Correspondence to Josefine Hirschfeld.

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Hirschfeld, J., Higham, J., Chatzistavrianou, D. et al. Systemic disease or periodontal disease? Distinguishing causes of gingival inflammation: a guide for dental practitioners. Part 1: immune-mediated, autoinflammatory, and hereditary lesions. Br Dent J 227, 961–966 (2019).

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