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March 24, 1956


JAMA. 1956;160(12):1056-1057. doi:10.1001/jama.1956.02960470052013

Periodontal disease (pyorrhea) is by far the major cause of tooth loss in individuals over 35 years of age.1 Although some forms of periodontal disease progress with little outward manifestation, the characteristic diagnostic signs most frequently seen by the physician are gingivitis and bleeding of the gums. Gingival inflammation is present to some degree in most persons who eat chiefly soft and cooked foods, and gums may bleed from a variety of causes, local and systemic. However, local irritation almost always is the primary cause, and indeed it is the rare case in which systemic factors cause bleeding of the gums in the absence of some form of local irritation.2 Dental calculus, trauma, malocclusion, food impaction, and ill-fitting prostheses or restorations are a few of the common local factors.3

It would be a mistake, however, to consider every gingival hemorrhage as a manifestation of uncomplicated gingivitis or