Linear gingival erythema

Linear gingival erythema (LGE) is a periodontal condition diagnosed by its distinct clinical presentation. It was initially believed to be directly associated with HIV infection, and was therefore termed HIV-associated gingivitis (HIV-G). However, subsequent research revealed that LGE can also occur in HIV-negative immunocompromised patients, and it was thus renamed.

Linear gingival erythema (LGE), previously termed HIV-associated gingivitis, is a periodontal condition characterised by a distinct 2 to 3mm band of erythema along the free gingival margin. It often affects the anterior teeth initially, with subsequent progression to the posterior teeth. Although typically asymptomatic, some individuals may experience discomfort and bleeding upon probing. LGE is frequently observed in immunosuppressed individuals, such as those with HIV/AIDS, and is believed to result from subgingival colonisation by Candida species—particularly in patients with compromised neutrophil function. This condition can serve as an indicator of immunosuppression in affected individuals.

Clinically, LGE can be distinguished from other periodontal conditions due to its unique presentation. In contrast to plaque-induced gingivitis, LGE is not significantly associated with local factors such as plaque or calculus and often persists even after professional mechanical plaque removal. Additionally, LGE does not exhibit the ulceration and necrosis characteristic of necrotising gingival diseases, which are characterised by interdental papilla destruction, severe pain and spontaneous bleeding. Its frequent association with immunocompromised states and poor response to conventional oral hygiene measures further sets it apart from other forms of gingival disease.

Although more common in individuals with HIV infection, LGE has also been reported in HIV-negative immunocompromised individuals.

The prevalence of LGE among HIV-positive individuals varies widely across studies, ranging from 0% to 48%. This wide variation likely stemmed from the frequent misdiagnosis of LGE as gingivitis. A study found that 25% of HIV-positive children exhibited LGE at baseline and two-year follow-up.

There is limited data regarding the prevalence of LGE among HIV-negative individuals. However, a case report revealed the occurrence of LGE in a 13-year-old HIV-negative individual who exhibited the typical clinical signs of LGE, which were resistant to plaque-removal therapies. Microbiological investigation suggested that a Candida fungal species was the underlying cause.

LGE is commonly associated with oral candidiasis. In a study involving HIV-positive homosexual men, a statistically significant relationship was found between the presence of intraoral candidiasis and LGE: 42.9% of individuals with candidiasis exhibited LGE, compared to 12.7% of those without candidiasis.

LGE often serves as an early marker of periodontal disease progression in HIV-positive individuals. Studies indicate that patients with LGE have reduced levels of T-lymphocytes (CD3+) and macrophages (CD68+), impairing the adaptive immune response. The compromised immune system allows opportunistic infections to thrive, increasing susceptibility to oral microbial imbalances.