{ "model": { "rank": 6440, "code": "thing-q673083", "model_id": "vr.tr.gingivitis", "name": "gingivitis", "purpose": "Enable an AI agent to record and assess gingival inflammation, distinguish gingivitis from neighbouring conditions, and support appropriate clinician-directed care and reassessment.", "family": "Thing Registry", "category": "Information and virtual systems", "status": "research-draft", "kind": "thing", "plane": "INF", "domain": "INF.KNW", "industry": "", "version": "", "url": "/models/thing/q673083/", "tier": 2, "score": 60, "payload": { "layer": "wikidata", "aliases": [ "plasma cell gingivitis", "Desquamative gingivitis", "Vincent's angina", "gingival pocket" ], "aliasCount": 4, "merged": 4, "knownIn": 60, "facets": null, "markers": [], "lexicalClass": "", "senseRank": null, "alsoRegisteredAs": "vr.tr.gingivitis", "source": { "dataset": "wikidata", "item": "Q673083", "url": "https://www.wikidata.org/wiki/Q673083", "license": "CC0 1.0" } }, "research": { "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-07T14:34:11Z", "providers": [ "Codex", "Grok" ], "missingProviders": [], "pass": 2, "cost": { "grok": { "usd": 0.00938808, "turns": 1, "seconds": 86.9, "error": null }, "codex": { "seconds": 98, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.3\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a07c46-9e36-7ea3-9a2f-97703b0488bf\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: gingivitis\nRegistry id: vr.tr.gingivitis\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this entry: (none)\n\nA V" } } }, "metaModel": { "id": "THING-Q673083", "registryId": "vr.tr.gingivitis", "name": "gingivitis", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q673083/", "model": { "registry_id": "vr.tr.gingivitis", "name": "gingivitis", "purpose": "Enable an AI agent to record and assess gingival inflammation, distinguish gingivitis from neighbouring conditions, and support appropriate clinician-directed care and reassessment.", "definition": "Gingivitis is a reversible inflammatory disease of the gingiva driven primarily by dental-plaque biofilm at the gingival margin, clinically marked by redness, swelling and bleeding on probing without loss of periodontal attachment.", "scope_statement": "This model owns the gingivitis state represented by vr.tr.gingivitis in XCT/XCT.STA: affected gingival sites, clinical evidence, extent, suspected causes, periodontal context, management decisions and response over time; underlying diseases and dental procedures remain linked entities.", "in_scope": [ "Observed and reported inflammation of gingiva around natural teeth", "Site-level findings and whole-mouth gingivitis case assessment", "Plaque association, local contributing factors and relevant host modifiers", "Intact or reduced periodontal support and previous periodontitis as diagnostic context", "Atypical gingival presentations requiring differential assessment", "Care objectives, reassessment and persistence or recurrence of inflammation" ], "out_of_scope": [ "Periodontitis staging, grading and management of destructive attachment loss", "Peri-implant mucositis and peri-implantitis", "Dental caries, pulpal disease and odontogenic abscesses", "Independent diagnosis and treatment of systemic, infectious or immune-mediated diseases", "Technical specifications for dental cleaning, surgery or medication prescribing" ], "distinguishing_features": [ "Check that the affected tissue is gingiva around natural teeth; inflammation around an implant requires a peri-implant assessment.", "Separate current gingival inflammation from periodontal support loss and its history; previously treated periodontitis must not be relabelled as an uncomplicated gingivitis-only case. [Classification consensus](https://www.efp.org/fileadmin/uploads/efp/Documents/Campaigns/New_Classification/Reports/Consensus_report__Workgroup_1__Chapple_et_al-2018-Journal_of_Clinical_Perontology.pdf)", "Separate an inflamed site from a whole-mouth case: the cited plaque-induced gingivitis definition uses bleeding on probing at at least 10% of sites, with periodontal-context qualifications. [Case definition](https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.17-0576)", "Test whether the distribution and treatment response support plaque-associated inflammation; non-plaque-induced gingival conditions generally do not resolve through plaque removal alone. [Classification consensus](https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.17-0719)", "Record ulceration, necrosis, desquamation, focal swelling or disproportionate bleeding as reasons to investigate competing explanations rather than automatically classify routine plaque-induced gingivitis." ], "characteristics": [ { "name": "Affected gingival sites", "kind": "relation", "unit_or_values": "Natural tooth identifier, surface and marginal, interdental or attached gingival region", "why_it_matters": "Locates inflammation and permits comparison with plaque distribution and later examinations." }, { "name": "Bleeding on probing", "kind": "measurement", "unit_or_values": "Positive sites / examined sites × 100%; retain site results and examination protocol", "why_it_matters": "Measures inflammatory extent while preserving the denominator needed for interpretation." }, { "name": "Inflammation extent", "kind": "category", "unit_or_values": "Localized, generalized, below selected case threshold or indeterminate; retain classification source", "why_it_matters": "Separates distribution from intensity; the cited framework uses 10-30% bleeding sites for localized and more than 30% for generalized gingivitis. [Case definition](https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.17-0576)" }, { "name": "Gingival appearance", "kind": "state", "unit_or_values": "Observed colour change, swelling, contour change, ulceration, desquamation or necrosis; absent or unassessed", "why_it_matters": "Captures the clinical presentation and evidence that may challenge the working diagnosis." }, { "name": "Probing depth", "kind": "measurement", "unit_or_values": "Millimetres by tooth site", "why_it_matters": "Supports assessment of sulcus or pocket findings alongside attachment measurements." }, { "name": "Clinical attachment level", "kind": "measurement", "unit_or_values": "Millimetres by tooth site relative to a documented reference", "why_it_matters": "Helps distinguish gingival enlargement from loss of periodontal support." }, { "name": "Periodontal background", "kind": "category", "unit_or_values": "Intact; reduced without known periodontitis; reduced after periodontitis; uncertain", "why_it_matters": "Determines which diagnostic interpretation and follow-up pathway apply." }, { "name": "Plaque and calculus distribution", "kind": "measurement", "unit_or_values": "Site presence or score using a named index; calculus recorded separately", "why_it_matters": "Supports assessment of plaque association and local cleaning needs." }, { "name": "Etiologic assessment", "kind": "category", "unit_or_values": "Plaque-associated; suspected non-plaque cause; mixed contribution; undetermined", "why_it_matters": "Makes causal uncertainty explicit before selecting a care pathway." }, { "name": "Relevant modifiers", "kind": "relation", "unit_or_values": "Linked tobacco exposure, medications, hormonal context, metabolic conditions and local dental factors", "why_it_matters": "Preserves context that may affect presentation, interpretation or response." }, { "name": "Symptoms and functional impact", "kind": "state", "unit_or_values": "Reported bleeding, soreness, eating or cleaning difficulty, onset and patient-rated impact", "why_it_matters": "Keeps patient experience distinct from examiner findings." }, { "name": "Assessment and course", "kind": "state", "unit_or_values": "Suspected or clinician-confirmed; new, persistent, improving, resolved, recurrent or indeterminate", "why_it_matters": "Separates diagnostic confidence from change over time." } ], "affordances": [ "Assemble a gingival assessment from site findings, patient reports and periodontal history.", "Calculate bleeding extent when examination coverage and protocol support it.", "Flag missing attachment evidence or atypical findings that prevent confident classification.", "Support a clinician-directed plaque-control plan and record professional care. [NIDCR care guidance](https://www.nidcr.nih.gov/health-info/gum-disease)", "Compare reassessments and identify persistent or recurrent inflammation.", "Prepare a dental or medical referral summary with the unresolved differential and supporting observations." ] }, "sources": [ { "id": "aap-efp-2017", "title": "A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification", "url": "https://pubmed.ncbi.nlm.nih.gov/29926958/", "what_it_supports": "2017 World Workshop (AAP/EFP) definition of gingivitis as plaque-induced inflammation without attachment loss, and the split into plaque-induced versus non-plaque-induced gingival diseases.", "url_status": "live" }, { "id": "chapple-2018", "title": "Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop", "url": "https://pubmed.ncbi.nlm.nih.gov/29926499/", "what_it_supports": "Clinical case definition (bleeding on probing thresholds), distinction from periodontal health and from periodontitis, and gingivitis on an intact versus a reduced periodontium.", "url_status": "live" }, { "id": "who-oral-health", "title": "Oral health fact sheet", "url": "https://www.who.int/news-room/fact-sheets/detail/oral-health", "what_it_supports": "Global prevalence, public-health framing of gingival inflammation as part of periodontal disease burden, and WHO oral-health policy context.", "url_status": "live" }, { "id": "nidcr-gum-disease", "title": "Gum Disease", "url": "https://www.nidcr.nih.gov/health-info/gum-disease", "what_it_supports": "Patient-facing clinical picture, reversibility with plaque control, progression risk to periodontitis, and common modifying factors.", "url_status": "live" } ], "structure": { "bundles": [ { "id": "gingival-case-boundary", "name": "Gingival case boundary", "description": "Establish what tissue is inflamed and what the gingivitis label means in this periodontal context.", "rationale": "The agent must distinguish a gingival state from other oral inflammation and from destructive periodontal disease.", "layers": [ { "id": "tissue-and-case-identification", "name": "Tissue and case identification", "description": "Locate affected gingiva and distinguish site findings from person-level classification.", "findings": [ { "id": "gingival-site-and-case-status", "name": "Gingival site and case status", "description": "Record affected natural-tooth sites, working diagnosis and the definition used to assign a whole-mouth case.", "questions": [ { "text": "Which tooth sites and gingival regions are affected, and are any observations actually around implants or elsewhere in the oral mucosa?", "kind": "boundary", "id": "gingival-site-and-case-status-q01" }, { "text": "Does the evidence establish individual inflamed sites, a whole-mouth gingivitis case or only suspected inflammation under the selected definition?", "kind": "definition", "id": "gingival-site-and-case-status-q02" }, { "text": "Who made the assessment, when, and from which examination or report?", "kind": "provenance", "id": "gingival-site-and-case-status-q03" } ] } ] }, { "id": "periodontal-support-context", "name": "Periodontal support context", "description": "Interpret gingival inflammation against current attachment findings and previous periodontal disease.", "findings": [ { "id": "support-loss-and-history", "name": "Support loss and history", "description": "Retain probing, attachment and relevant existing imaging evidence, including the attributed cause of any reduced support.", "questions": [ { "text": "What do site-level probing depths, gingival margin positions and attachment measurements show?", "kind": "measurement", "id": "support-loss-and-history-q01" }, { "text": "Is periodontal support intact or reduced, and what evidence identifies the cause and any history of periodontitis?", "kind": "provenance", "id": "support-loss-and-history-q02" }, { "text": "Do current findings require assessment through the periodontitis model before a gingivitis-only interpretation is acceptable?", "kind": "boundary", "id": "support-loss-and-history-q03" } ] } ] } ] }, { "id": "inflammation-pattern-and-measurement", "name": "Inflammation pattern and measurement", "description": "Represent the location, extent and observable expression of gingival inflammation.", "rationale": "A single label or bleeding percentage cannot capture examination limitations, local intensity and patient experience.", "layers": [ { "id": "bleeding-map-and-coverage", "name": "Bleeding map and coverage", "description": "Preserve bleeding observations and the conditions under which they were collected.", "findings": [ { "id": "interpretable-bleeding-extent", "name": "Interpretable bleeding extent", "description": "Record bleeding sites, examined sites, exclusions and technique before deriving an extent category.", "questions": [ { "text": "How many sites bled, how many were examined and which teeth or sites were excluded?", "kind": "measurement", "id": "interpretable-bleeding-extent-q01" }, { "text": "What probe, probing technique and bleeding observation interval were used, and was the examination full-mouth or partial?", "kind": "provenance", "id": "interpretable-bleeding-extent-q02" }, { "text": "Does examination coverage justify a whole-mouth extent classification, or must it remain indeterminate?", "kind": "boundary", "id": "interpretable-bleeding-extent-q03" } ] } ] }, { "id": "appearance-and-experience", "name": "Appearance and experience", "description": "Capture tissue changes and symptoms separately from bleeding extent.", "findings": [ { "id": "local-inflammatory-expression", "name": "Local inflammatory expression", "description": "Record visible changes, spontaneous versus provoked bleeding and the effect on everyday oral function.", "questions": [ { "text": "Which sites show swelling, altered contour or colour change relative to the person's usual gingival appearance?", "kind": "measurement", "id": "local-inflammatory-expression-q01" }, { "text": "Is bleeding spontaneous or provoked, and what soreness or difficulty eating and cleaning does the person report?", "kind": "measurement", "id": "local-inflammatory-expression-q02" }, { "text": "If an intensity score is assigned, which named scale supports it and how is it kept separate from extent?", "kind": "definition", "id": "local-inflammatory-expression-q03" } ] } ] } ] }, { "id": "plaque-and-contributing-context", "name": "Plaque and contributing context", "description": "Assess plausible drivers without treating co-occurrence as proof of causation.", "rationale": "The agent needs to distinguish removable local contributors from contextual factors and uncertain causal explanations.", "layers": [ { "id": "biofilm-and-local-retention", "name": "Biofilm and local retention", "description": "Relate gingival findings to plaque, calculus and local access for cleaning.", "findings": [ { "id": "plaque-inflammation-concordance", "name": "Plaque-inflammation concordance", "description": "Compare plaque distribution with affected gingiva and record suspected retention or access problems.", "questions": [ { "text": "Where are plaque and calculus present relative to the inflamed sites, using which observation method or index?", "kind": "measurement", "id": "plaque-inflammation-concordance-q01" }, { "text": "Which restorations, appliances, tooth positions or cleaning difficulties are suspected local contributors?", "kind": "provenance", "id": "plaque-inflammation-concordance-q02" }, { "text": "What evidence supports plaque association, and what findings remain unexplained by it?", "kind": "boundary", "id": "plaque-inflammation-concordance-q03" } ] } ] }, { "id": "host-and-exposure-context", "name": "Host and exposure context", "description": "Link relevant health states and exposures without diagnosing those conditions within this model.", "findings": [ { "id": "modifier-relevance", "name": "Modifier relevance", "description": "Record the timing and evidential basis of suspected modifiers of inflammation, bleeding or gingival enlargement.", "questions": [ { "text": "Which medications, tobacco exposures, hormonal circumstances or known health conditions were present when inflammation began or changed?", "kind": "provenance", "id": "modifier-relevance-q01" }, { "text": "Could a documented modifier affect bleeding interpretation or tissue appearance, and what evidence supports that assessment?", "kind": "boundary", "id": "modifier-relevance-q02" }, { "text": "Which suspected contribution requires review by the treating dentist or relevant medical clinician?", "kind": "action", "id": "modifier-relevance-q03" } ] } ] } ] }, { "id": "atypical-presentation-and-escalation", "name": "Atypical presentation and escalation", "description": "Capture findings that challenge routine plaque-associated gingivitis and guide further assessment.", "rationale": "A familiar gingivitis label must not conceal a competing gingival disease or an urgent unresolved presentation.", "layers": [ { "id": "alternative-gingival-patterns", "name": "Alternative gingival patterns", "description": "Identify unusual morphology, distribution or response that needs a broader differential.", "findings": [ { "id": "unexplained-gingival-lesions", "name": "Unexplained gingival lesions", "description": "Describe atypical lesions without converting their appearance into an unsupported etiologic diagnosis.", "questions": [ { "text": "Are there ulcers, necrotic papillae, desquamation, vesicles, focal masses or lesions extending beyond gingiva?", "kind": "measurement", "id": "unexplained-gingival-lesions-q01" }, { "text": "Which competing explanations has a clinician considered, and what evidence supports or weakens each?", "kind": "boundary", "id": "unexplained-gingival-lesions-q02" }, { "text": "What specialist examination or targeted investigation is needed to resolve the differential?", "kind": "action", "id": "unexplained-gingival-lesions-q03" } ] } ] }, { "id": "urgency-and-care-routing", "name": "Urgency and care routing", "description": "Make escalation decisions traceable to the actual presentation and an applicable clinical pathway.", "findings": [ { "id": "escalation-basis", "name": "Escalation basis", "description": "Record concerning symptoms, their evolution and the clinician or protocol responsible for urgency decisions.", "questions": [ { "text": "Is there rapidly worsening pain or swelling, uncontrolled bleeding, fever, impaired swallowing or inability to maintain oral intake?", "kind": "measurement", "id": "escalation-basis-q01" }, { "text": "Which applicable triage protocol or clinician assessment determines the urgency and destination of care?", "kind": "provenance", "id": "escalation-basis-q02" }, { "text": "What referral or immediate-care action is indicated, and has it been arranged or completed?", "kind": "action", "id": "escalation-basis-q03" } ] } ] } ] }, { "id": "care-response-and-recurrence", "name": "Care response and recurrence", "description": "Connect agreed care to measurable changes in gingival state.", "rationale": "The model must support decisions about response, persistence and recurrence without assuming that every case resolves identically.", "layers": [ { "id": "gingival-care-plan", "name": "Gingival care plan", "description": "Record actions directed at the assessed contributors and the person's ability to carry them out.", "findings": [ { "id": "agreed-actions-and-feasibility", "name": "Agreed actions and feasibility", "description": "Link home plaque control, professional care and contributor review to specific findings and patient constraints.", "questions": [ { "text": "What home-cleaning approach and professional care have been agreed for the affected sites?", "kind": "action", "id": "agreed-actions-and-feasibility-q01" }, { "text": "Which dexterity, discomfort, appliance, support or access barriers could prevent the plan from being followed?", "kind": "boundary", "id": "agreed-actions-and-feasibility-q02" }, { "text": "Who authorized any adjunctive product or procedure, for what indication and with what review point?", "kind": "provenance", "id": "agreed-actions-and-feasibility-q03" } ] } ] }, { "id": "reassessment-and-state-transition", "name": "Reassessment and state transition", "description": "Judge change using comparable observations and preserve uncertainty where follow-up is incomplete.", "findings": [ { "id": "resolution-persistence-or-recurrence", "name": "Resolution, persistence or recurrence", "description": "Compare site findings, symptoms and contributor control before assigning an updated gingival state.", "questions": [ { "text": "How have bleeding, swelling, symptoms and plaque changed at comparable sites since the baseline examination?", "kind": "measurement", "id": "resolution-persistence-or-recurrence-q01" }, { "text": "What recorded criterion supports improvement, resolution, persistence or recurrence, and are the examinations comparable?", "kind": "definition", "id": "resolution-persistence-or-recurrence-q02" }, { "text": "If inflammation persists or new attachment concerns appear, should the care plan change or the differential and periodontal assessment be reopened?", "kind": "action", "id": "resolution-persistence-or-recurrence-q03" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Plaque-induced gingivitis (most common, localized or generalized)", "Gingivitis modified by systemic factors (pregnancy, puberty, diabetes, leukemia)", "Drug-influenced gingivitis / gingival enlargement (phenytoin, cyclosporine, calcium-channel blockers)", "Necrotizing gingivitis (formerly ANUG)", "Non-plaque-induced gingival diseases (viral, fungal, genetic, autoimmune, traumatic)", "Desquamative gingivitis (clinical presentation, often mucous-membrane pemphigoid or lichen planus)", "Malnutrition-associated gingivitis (notably vitamin C deficiency)", "Puberty-associated gingivitis" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of gingivitis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "scheme": "ICD-10-CM", "value_or_pattern": "K05.0 (acute gingivitis); K05.1 (chronic gingivitis); K05.00/K05.01 plaque vs non-plaque acute; K05.10/K05.11 plaque vs non-plaque chronic", "note": "WHO ICD-10 uses K05.0/K05.1; US ICD-10-CM further splits plaque-induced vs non-plaque-induced." }, { "scheme": "ICD-11", "value_or_pattern": "DA0C (Gingivitis and periodontal diseases) with DA0C.0 Gingivitis and related conditions", "note": "ICD-11 nests gingivitis under diseases of the periodontal tissues; exact leaf codes should be confirmed in the ICD-11 browser." }, { "scheme": "SNOMED CT", "value_or_pattern": "54840006 |Gingivitis (disorder)|", "note": "Parent concept; many child concepts exist (acute, chronic, necrotizing, pregnancy, etc.)." }, { "scheme": "MeSH", "value_or_pattern": "D005891", "note": "Medical Subject Headings term Gingivitis." }, { "scheme": "UMLS CUI", "value_or_pattern": "C0017563", "note": "Maps gingivitis across ICD, SNOMED, MeSH and other vocabularies." }, { "scheme": "Wikidata", "value_or_pattern": "Q1123260", "note": "Item for gingivitis; confirm label before reuse as a persistent identifier." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of gingivitis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-standards-and-regulation", "name": "Standards and regulation", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions - American Academy of Periodontology (AAP) and European Federation of Periodontology (EFP)", "ICD-10 / ICD-11 disease coding - World Health Organization", "CDC/AAP periodontal disease surveillance case definitions (clinical attachment and probing measures used in population surveys)", "ADA clinical practice resources on gingivitis and periodontitis - American Dental Association", "National dental-practice acts and hygiene regulations (jurisdiction-specific) governing who may diagnose and treat gingival disease" ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of gingivitis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Routine dental examination: gingival colour, contour, and bleeding on probing (BOP) recorded in periodontal charting", "Public-health screening and school/military oral-health programmes as a marker of oral hygiene", "Pregnancy dental care: pregnancy-associated gingivitis is common and is managed with plaque control rather than deferral of care", "Primary-care and pharmacy encounters: patients present with bleeding on brushing; advice and referral to dentistry", "Periodontal maintenance: distinguishing residual gingivitis on a reduced periodontium from recurrent periodontitis", "Hospital/oncology and transplant settings: drug-influenced gingival enlargement and neutropenic necrotizing gingivitis" ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of gingivitis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "quantity": "Bleeding on probing (BOP) - sites positive", "typical_range": "Gingivitis case: BOP ≥10% of sites (localized 10-30%; generalized >30%); periodontal health <10%", "unit": "% of probed sites" }, { "quantity": "Probing depth", "typical_range": "Typically ≤3-4 mm without apical migration of the junctional epithelium; deeper pockets suggest periodontitis or pseudopockets from swelling", "unit": "mm" }, { "quantity": "Clinical attachment loss (CAL)", "typical_range": "0 mm relative to the cemento-enamel junction on an intact periodontium (by definition no attachment loss attributable to periodontitis)", "unit": "mm" }, { "quantity": "Gingival index (Löe-Silness) site score", "typical_range": "0 (normal) to 3 (severe inflammation, ulceration, spontaneous bleeding); gingivitis usually 1-2", "unit": "ordinal score 0-3" }, { "quantity": "Plaque index / visible plaque", "typical_range": "Site-level presence; higher plaque scores correlate with BOP but are not the disease itself", "unit": "ordinal score or % sites" }, { "quantity": "Gingival crevicular fluid volume", "typical_range": "Elevated versus health; research use more than chairside", "unit": "µL" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of gingivitis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Progression to periodontitis with irreversible attachment and bone loss if plaque biofilm and inflammation persist", "Under-diagnosis when BOP is not systematically recorded, especially in smokers (who bleed less despite inflammation)", "Overtreatment: scaling and surgery aimed at periodontitis when only gingivitis (no attachment loss) is present", "Necrotizing gingivitis: rapid papillary necrosis, pain, fetor; may extend to necrotizing periodontitis, especially with HIV, malnutrition, or smoking", "Drug-influenced enlargement impairing hygiene and trapping plaque, creating a self-reinforcing cycle", "Systemic contribution: gingival inflammation is associated with (not proven to cause) poorer glycaemic control and adverse pregnancy outcomes in observational literature", "Misattribution of bleeding to gingivitis when the cause is blood dyscrasia, vitamin C deficiency, or desquamative autoimmune disease" ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of gingivitis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "High-income settings: gingivitis is usually charted with BOP percentages and managed in general dental practice; periodontitis screening is protocolised", "Low- and middle-income settings: untreated plaque-induced gingivitis is highly prevalent; WHO reports periodontal disease among the most common NCDs, with limited specialist periodontology", "Necrotizing gingivitis historically clustered in malnourished children in parts of Africa (noma/cancrum oris pathway) and in stressed young adults in wartime or institutional settings", "Tobacco: smoking is globally common as a modifier; some regions have high smokeless-tobacco use that also inflames gingiva", "Pregnancy gingivitis counselling and timing of dental care differ by obstetric and dental-system norms", "Classification language: older 'acute/chronic' ICD-10 labels remain in billing in some countries; clinics using the 2017 AAP/EFP scheme speak of plaque-induced vs non-plaque-induced and localized vs generalized by BOP%" ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of gingivitis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "name": "Periodontitis", "difference": "Periodontitis shows clinical attachment loss and alveolar bone loss; gingivitis does not. A reduced but stable periodontium with BOP can still be gingivitis, not periodontitis, if there is no current additional attachment loss." }, { "name": "Periodontal health", "difference": "Health: BOP <10% of sites, no erythema/edema of inflammation, no attachment loss from periodontitis. Gingivitis: BOP ≥10% with inflammatory signs, still without periodontitis-related attachment loss." }, { "name": "Gingival enlargement (fibrous hyperplasia) without primary gingivitis", "difference": "Drug-, hormone-, or genetically driven overgrowth can exist with or without secondary plaque-induced inflammation; biopsy and drug history separate idiopathic/fibrous enlargement from purely inflammatory gingivitis." }, { "name": "Desquamative gingival lesions (oral lichen planus, mucous-membrane pemphigoid, pemphigus vulgaris)", "difference": "Painful epithelial sloughing, often with extra-gingival mucosal lesions; diagnosis by biopsy and immunofluorescence, not by plaque score alone." }, { "name": "Necrotizing periodontitis / noma (cancrum oris)", "difference": "Necrotizing gingivitis is limited to gingiva (papilla necrosis, pain, fetor); necrotizing periodontitis adds attachment and bone loss; noma extends through mucosa and facial tissues." }, { "name": "Periodontal abscess or endo-periodontal lesion", "difference": "Localized swelling, suppuration, and often a deep isolated pocket or non-vital tooth; gingivitis is a marginal, usually generalized inflammatory state without an acute abscess." }, { "name": "Herpetic gingivostomatitis", "difference": "Acute viral (HSV) disease with vesicles/ulcers on gingiva and often non-keratinized mucosa, fever and lymphadenopathy, especially in children; plaque-induced gingivitis lacks vesicles and systemic viral prodrome." }, { "name": "Haematological gingival bleeding (leukaemia, thrombocytopenia, vitamin C deficiency/scurvy)", "difference": "Bleeding out of proportion to plaque, possible petechiae or pallor; blood count, smear, and nutritional history separate these from ordinary plaque-induced gingivitis." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of gingivitis this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "With no registry definition recorded, should this entry encompass necrotizing and non-plaque-associated gingival inflammation directly, or represent their gingival manifestations while linking to separate condition models?", "Which case-definition version and examination protocol should govern clinical versus epidemiological use, especially for partial-mouth examinations and previously treated periodontitis?", "Which validated measures best capture gingivitis intensity and patient impact without conflating them with the percentage of bleeding sites?", "What evidence supports reassessment intervals and resolution criteria across different causes, age groups and periodontal backgrounds?", "Which jurisdiction-specific triage and referral criteria should govern atypical lesions, disproportionate bleeding and rapidly worsening presentations?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 18, "questions": 38 } }, "draft": { "generator": "vr.draft.v3", "status": "draft-generated", "researched": false, "archetype": "disease or condition", "method": "Written from the archetype playbook - what this kind of thing needs beyond identity and provenance - and from the structure that recurred across 6,333 models already researched by two engines. Applied to this entry by rule. No source was read for this thing and no claim here is researched. This entry carries no facets of its own, so they were inferred from its domain - a guess about a whole domain applied to one thing.", "facetsInferred": true, "nextPass": "A researcher replaces this draft with a sourced specification. Treat every sentence below as a proposal to argue with.", "purpose": "Give an agent a durable, checkable way to recognise a gingivitis, record what state it is in, and decide what may be done with it.", "whatItIs": "Enable an AI agent to record and assess gingival inflammation, distinguish gingivitis from neighbouring conditions, and support appropriate clinician-directed care and reassessment.", "characteristics": { "substance": "information", "origin": "conceptual", "agency": "inert" }, "whatYouCanDoWithIt": [ "read and interpreted" ], "distinguishingFeatures": [ "Names folded into this entry, which a task may need to split apart again: plasma cell gingivitis, Desquamative gingivitis, Vincent's angina, gingival pocket.", "4 finer distinctions are held as aliases rather than separate entries, because telling them apart needs a task that asks for it.", "Described in 60 Wikipedia languages, which is a measure of how widely the thing is known, not of how important it is." ], "openQuestionsForResearch": [ "Which of the bundles below does a real task actually need, and which are ceremony?", "What does this thing have that the facets do not capture at all?", "Which neighbouring kind is most often confused with a gingivitis, and on what evidence are they told apart?" ], "whatItIsMadeOf": "content that has to be carried by something else", "physicalCharacter": [ "Does nothing on its own; everything it does, something else did to it.", "These come from the domain this entry sits in rather than from the entry itself, so treat them as a first guess about the whole domain applied to one thing." ], "whatCanBeDoneWithIt": [ "read it and act on what it says" ], "howItIsRecognised": [ "Recognised by criteria applied to signs and findings, not by appearance. Two conditions can look identical and be distinguished only by test." ], "relatedModels": [ { "relation": "covers", "note": "Finer kinds folded into this entry because telling them apart needs a task that asks for it. Each is a model waiting to be split out when one does.", "targets": [ "plasma cell gingivitis", "Desquamative gingivitis", "Vincent's angina", "gingival pocket" ] } ], "standing": "Described in 60 Wikipedia languages, which measures how widely it is written about rather than how important or how common it is. 4 finer distinctions are held inside this entry as names rather than as separate models.", "structure": { "bundles": [ { "id": "identity-and-classification", "name": "Identity, naming and classification", "description": "How an agent tells one gingivitis from another, and a gingivitis from things that resemble it.", "rationale": "Recognition comes before every other claim. Without stable identity nothing else in the model can be trusted to be about the same thing twice.", "layers": [ { "id": "naming-and-identifiers", "name": "Names and identifiers", "description": "The names this thing goes by and the identifiers that survive translation and time.", "findings": [ { "id": "preferred-name-and-aliases", "name": "Preferred name, aliases and local names", "description": "Which name to use, which names mean the same thing, and which merely sound similar.", "questions": [ { "id": "preferred-name-and-aliases-q01", "text": "What identifies and describes the name of a gingivitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "preferred-name-and-aliases-q02", "text": "Who or what asserted this about the name of a gingivitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "preferred-name-and-aliases-q03", "text": "What may an agent decide or do once the name of a gingivitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] }, { "id": "stable-identifiers", "name": "Stable identifiers and external keys", "description": "Identifiers that keep pointing at this kind of thing across systems and languages.", "questions": [ { "id": "stable-identifiers-q01", "text": "What identifies and describes an identifier for a gingivitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "stable-identifiers-q02", "text": "Who or what asserted this about an identifier for a gingivitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "stable-identifiers-q03", "text": "What may an agent decide or do once an identifier for a gingivitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "classification-and-granularity", "name": "Classification and granularity", "description": "Where a gingivitis sits among kinds, and how finely a task needs to cut it.", "findings": [ { "id": "kind-and-parents", "name": "Kind, parents and neighbouring kinds", "description": "The classes this thing belongs to and the ones it is next to.", "questions": [ { "id": "kind-and-parents-q01", "text": "What identifies and describes the kind of a gingivitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "kind-and-parents-q02", "text": "Who or what asserted this about the kind of a gingivitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "kind-and-parents-q03", "text": "What may an agent decide or do once the kind of a gingivitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] }, { "id": "distinguishing-features", "name": "Distinguishing features", "description": "What separates a gingivitis from the things most often confused with it.", "questions": [ { "id": "distinguishing-features-q01", "text": "What identifies and describes what distinguishes a gingivitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "distinguishing-features-q02", "text": "Who or what asserted this about what distinguishes a gingivitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "distinguishing-features-q03", "text": "What may an agent decide or do once what distinguishes a gingivitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "state-and-lifecycle", "name": "State and lifecycle", "description": "The states a gingivitis passes through and the events that move it between them.", "rationale": "Most decisions about a thing depend on what state it is in now, which is a claim with a time on it, not a property.", "layers": [ { "id": "lifecycle-stages", "name": "Lifecycle stages", "description": "From coming into existence to ceasing to be one of these.", "findings": [ { "id": "stages-and-transitions", "name": "Stages and transitions", "description": "The stages worth naming and what moves a gingivitis between them.", "questions": [ { "id": "stages-and-transitions-q01", "text": "What identifies and describes the lifecycle of a gingivitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "stages-and-transitions-q02", "text": "Who or what asserted this about the lifecycle of a gingivitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "stages-and-transitions-q03", "text": "What may an agent decide or do once the lifecycle of a gingivitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "observations-and-status", "name": "Observations and current status", "description": "What is observed about a gingivitis, how often and by whom.", "findings": [ { "id": "observation-record", "name": "Observation record", "description": "How an observation of a gingivitis is recorded so that it can be superseded rather than overwritten.", "questions": [ { "id": "observation-record-q01", "text": "What identifies and describes an observation of a gingivitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "observation-record-q02", "text": "Who or what asserted this about an observation of a gingivitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "observation-record-q03", "text": "What may an agent decide or do once an observation of a gingivitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "content-and-access", "name": "Content, encoding and access", "description": "What a gingivitis says, how it is encoded and who may read it.", "rationale": "An informational thing carries content that can be copied, versioned and withheld, none of which its physical carrier explains.", "layers": [ { "id": "content-and-encoding", "name": "Content and encoding", "description": "The content itself, its format and its language.", "findings": [ { "id": "content-and-format", "name": "Content, format and language", "description": "What a gingivitis contains and in what form it is held.", "questions": [ { "id": "content-and-format-q01", "text": "What identifies and describes the content of a gingivitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "content-and-format-q02", "text": "Who or what asserted this about the content of a gingivitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "content-and-format-q03", "text": "What may an agent decide or do once the content of a gingivitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "access-and-rights", "name": "Access, rights and retention", "description": "Who may read, copy or change it, and for how long it is kept.", "findings": [ { "id": "access-rules", "name": "Access rules and retention", "description": "The permissions attached to a gingivitis and the period it survives.", "questions": [ { "id": "access-rules-q01", "text": "What identifies and describes access to a gingivitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "access-rules-q02", "text": "Who or what asserted this about access to a gingivitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "access-rules-q03", "text": "What may an agent decide or do once access to a gingivitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "diagnosis-and-criteria", "name": "Diagnosis, criteria and coding", "description": "What makes a case of gingivitis a case, and under which revision.", "rationale": "Criteria change between revisions, so a diagnosis without its coding revision cannot be compared with a later one.", "layers": [ { "id": "criteria", "name": "Diagnostic criteria", "description": "The criteria in force and who issues them.", "findings": [ { "id": "criteria-record", "name": "Criteria, issuer and revision", "description": "What must be true for a diagnosis, according to whom.", "questions": [ { "id": "criteria-record-q01", "text": "What criteria define gingivitis, issued by which body, in which revision?", "kind": "definition" }, { "id": "criteria-record-q02", "text": "What changed between revisions that would reclassify existing cases?", "kind": "boundary" } ] } ] }, { "id": "coding", "name": "Coding and terminology", "description": "The codes used to record it and their mapping.", "findings": [ { "id": "coding-record", "name": "Codes and mappings", "description": "Which classification codes apply and how they map.", "questions": [ { "id": "coding-record-q01", "text": "Which classification and terminology codes cover gingivitis, and how do they map to each other?", "kind": "definition" }, { "id": "coding-record-q02", "text": "What is lost when a case is mapped from one scheme to another?", "kind": "boundary" } ] } ] } ] }, { "id": "course-and-population", "name": "Course, population and care", "description": "How gingivitis develops, whom it affects, and what is done about it.", "rationale": "The condition, the diagnosis and the episode of care are three different things, and an agent must not merge them.", "layers": [ { "id": "course", "name": "Course and stages", "description": "Onset, progression, remission and outcome.", "findings": [ { "id": "course-record", "name": "Stages and transitions", "description": "The stages recorded and what moves a case between them.", "questions": [ { "id": "course-record-q01", "text": "What course does gingivitis typically take, and what marks each stage?", "kind": "definition" }, { "id": "course-record-q02", "text": "What separates the condition itself from an episode of care for it?", "kind": "boundary" } ] } ] }, { "id": "population", "name": "Affected populations", "description": "Who is affected, how often, and on what evidence.", "findings": [ { "id": "epidemiology", "name": "Prevalence and its basis", "description": "Rates with their population, period and source.", "questions": [ { "id": "epidemiology-q01", "text": "What prevalence or incidence is reported for gingivitis, in which population and period?", "kind": "measurement" }, { "id": "epidemiology-q02", "text": "What may an agent not conclude about an individual from a population rate?", "kind": "action" } ] } ] } ] }, { "id": "provenance-and-evidence", "name": "Provenance, evidence and time", "description": "Where every claim about a gingivitis came from and when it held.", "rationale": "A claim without a source and a time cannot be superseded, only overwritten, and an agent that overwrites loses the ability to explain itself.", "layers": [ { "id": "source-and-authority", "name": "Source and authority", "description": "Who said it, on what evidence, and how strongly.", "findings": [ { "id": "claim-provenance", "name": "Claim provenance and confidence", "description": "The authority behind each claim about a gingivitis and how confident it is.", "questions": [ { "id": "claim-provenance-q01", "text": "What identifies and describes a claim about a gingivitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "claim-provenance-q02", "text": "Who or what asserted this about a claim about a gingivitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "claim-provenance-q03", "text": "What may an agent decide or do once a claim about a gingivitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "time-and-versions", "name": "Time, versions and supersession", "description": "When a claim was true, when it was learnt, and what replaced it.", "findings": [ { "id": "validity-and-supersession", "name": "Validity period and supersession", "description": "How an old claim about a gingivitis is retired without being erased.", "questions": [ { "id": "validity-and-supersession-q01", "text": "What identifies and describes the validity of a claim about a gingivitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "validity-and-supersession-q02", "text": "Who or what asserted this about the validity of a claim about a gingivitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "validity-and-supersession-q03", "text": "What may an agent decide or do once the validity of a claim about a gingivitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] } ] }, "statistics": { "bundles": 6, "layers": 12, "findings": 14, "questions": 38 } } } }