The times they are a changing

Gingivitis is one of those words that can make you seem like an instant expert (which actually you are) when someone asks what it means. “Gum disease,” you reply “‘itis’ meaning inflammation and ‘gingiv’ referring to the gums or gingival tissues. Inflammation of the gums; bleeding gums!” The enquirer thinks you’re wonderful.

Dinner parties and pub quizzes aside, the knowledge that we have built up in the last half century on gingivitis and periodontitis is immense, and we are still learning. It still seems surprising that the initial work on plaque and the establishment of the link between it and soft tissue inflammation was completed in the 1960s and 1970s with the pioneering work notably in Sweden of Löe and co-workers.

With the benefit of hindsight, what then followed was logical but we now think not entirely correct. In the excitement of watching plaque grow on the teeth and gum margins of Nordic volunteers, the subsequent measurement of bleeding and then the resolution back to healthy pink tissue with the control of plaque, the logic of the process guided us to believe that the inevitable continuation of gingivitis was periodontitis; a linear progression. It is easy now to scoff but this was the teaching and accepted wisdom for many years (and probably still lingers in some backwaters).