What are the key clinical features that differentiate gingivitis from periodontitis in adult patients?

The key clinical features that differentiate gingivitis from periodontitis in adult patients primarily relate to the extent of tissue involvement and the presence of irreversible damage. Gingivitis is characterised by inflammation confined to the gingival tissues without loss of the underlying alveolar bone or periodontal ligament, presenting clinically with redness, swelling, bleeding on probing, and tenderness but no attachment loss or pocket formation NICE NG30. In contrast, periodontitis involves not only gingival inflammation but also progressive destruction of the supporting structures of the teeth, including alveolar bone resorption, periodontal ligament breakdown, and clinical attachment loss, which manifest as periodontal pocket formation, gingival recession, tooth mobility, and potentially tooth loss NICE NG18,NICE NG30.

Specifically, gingivitis presents with bleeding on gentle probing and erythematous, oedematous gingiva, but probing depths remain within normal limits (usually ≤3 mm) without clinical attachment loss NICE NG30. Periodontitis, however, shows increased probing depths (>3 mm), clinical attachment loss, and radiographic evidence of bone loss, which are absent in gingivitis NICE NG18,NICE NG30. Additionally, periodontitis may present with suppuration and increased tooth mobility, features not seen in gingivitis Ranney 1992Herrera et al. 2014.

Therefore, the presence of clinical attachment loss and alveolar bone destruction are the critical distinguishing features that separate periodontitis from gingivitis in adults. Gingivitis is reversible with appropriate oral hygiene and professional care, whereas periodontitis requires more complex management due to its irreversible tissue damage NICE NG18,NICE NG30.