Date amended:
External
Statements of Principles
Current RMA Instruments
Reasonable Hypothesis SOP
17 of 2022 as amended
Balance of Probabilities SOP
18 of 2022 as amended
Changes from previous Instruments

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ICD Coding

ICD-10-AM Codes: A69.1, K05.0, K05.1

Brief description

This is inflammation of the gums (also known as the gingiva). This SOP does not extend to inflammation of the deeper supporting structures of the tooth, which is covered by the SOP for periodontitis.

Confirming the diagnosis

The diagnosis is made on clinical grounds. 

The relevant medical specialist is a dentist or oral surgeon.

Additional diagnoses covered by SOP
  • Acute gingivitis
  • Acute necrotising ulcerative gingivitis, also known as trench mouth or Vincent’s gingivitis
  • Chronic gingivitis
  • Desquamative gingivitis
  • Gingival abscess
  • Linear gingival erythema
  • Peri-implant mucositis
  • Plasma cell gingivitis
  • Vincent’s angina
Conditions excluded from SOP
  • Gingival hyperplasia and overgrowth#
  • Gingival recession#
  • Oral aphthae#
  • Pericoronal abscess#
  • Pericoronitis#
  • Periodontitis*
  • Periodontal abscess*
  • Primary herpetic gingivostomatitis* - Herpes simplex SOP

* Another SOP applies

# Non-SOP condition

Clinical onset

Clinical onset may be based on relevant symptoms (swelling of gums, tendency for gums to bleed) but is more likley to be when first diagnosed by a dentist.

Clinical worsening

The condition is responsive to treatment and to good dental hygeine.  Worsening may be evidenced by an increase in symptoms or assessed based on dental reports.  The development of periodontitis or loss of teeth associated with gingivitis represents onset of a new condition and not worsening of gingivitis.