Management of Non-Plaque-Induced Gingival Conditions: A Systematic Review-Part 2: Inflammatory and Immune Conditions; Neoplasms; and Gingival Pigmentation.

Abstract

Aims: This systematic review assesses current evidence on the management of non-plaque (dental biofilm)-induced gingival diseases and conditions (NPIGDs), including (i) inflammatory and immune conditions, (ii) neoplasms and (iii) gingival pigmentations.

Material and methods: To address the question 'How should NPIGDs affecting the gingiva be managed?' specific searches were conducted in four electronic databases to identify clinical studies evaluating the effectiveness of any intervention for NPIGDs in patients of all ages. All descriptive and analytical study designs were eligible, provided they described conditions presenting at the gingival level.

Results: Over a total of 6111 articles initially identified, 461 met inclusion criteria. Reports ranged from case reports to randomised controlled trials. Overall evidence quality was moderate to very low, reflecting highly heterogeneous literature published over the past 50 years. Treatment approaches varied substantially depending on whether the condition was primarily gingival (e.g., leukoplakia, pigmentations) or a gingival manifestation of a systemic disease (e.g., leukaemic infiltration). Potentially malignant and malignant gingival lesions required careful evaluation and biopsy for diagnosis, followed by surgical management, typically involving radical excision. Gingival pigmentations were most often managed by dentists and, generally, only when patients expressed aesthetic concerns.

Conclusions: NPIGD management is challenging due to the heterogeneity of these conditions and often requires multidisciplinary care. Dental professionals must conduct thorough clinical assessments, identify prognostic factors, perform appropriate screening and diagnosis and select the most suitable treatment strategy-which frequently includes referral to medical or oral medicine specialists, especially for potentially malignant or malignant gingival lesions.