Dental Biofilm-Induced Gingivitis in Children and Adolescents Without Known Systemic Involvement: A Systematic Review

To synthesize evidence on gingival diseases and conditions in children and adolescents (< 18 years) without known systemic disorder involvement, focusing on their distribution, aetiology, diagnosis, management and oral health-related quality of life (OHRQoL).

A systematic review was carried out following PRISMA guidelines, including PubMed Central, Scopus, EMBASE and LILACS, up to January 2025. Clinical trials and observational studies addressing gingival diseases or conditions in healthy individuals under 18 years were included.

The search identified 33,180 studies. Title and abstract screening narrowed these to 2264, of which 433 were full-text-reviewed. Ultimately, 269 studies, all restricted to biofilm-induced gingivitis, were included. Considerable heterogeneity was observed in diagnostic criteria and study quality. Dental biofilm-induced gingivitis was common (52%) and associated with poorer OHRQoL. Key determinants for gingival inflammation included socioeconomic status, oral hygiene behaviours, pubertal changes and malocclusion. Based on current evidence, effective management of gingivitis in children should combine supervised toothbrushing with a fluoridated toothpaste and school- or caregiver-based oral health education. Adjunctive use of chlorhexidine may provide additional benefit in certain clinical situations.

Dental biofilm-induced gingivitis is frequent among children and adolescents and influenced by numerous determinants. Prevention and treatment should emphasise accessible, behaviour-focused and education-based strategies for biofilm control.