Association of Upper Lip Coverage with Gingival Inflammation: A Cross-Sectional Study


  •   Manpreet Kaur

  •   Rajinder Kumar Sharma

  •   Shikha Tewari

  •   Nishi Tanwar


Objective: As dryness is reported to be associated with inflammatory conditions in different body parts, incomplete coverage by upper lip may be responsible for gingival inflammation. The objective of the study was to assess status of gingival inflammation with reference to upper lip coverage.

Materials and methods: Patients with plaque-induced gingivitis consisting of 38 individuals with incomplete upper lip coverage (ILC) and 38 individuals with complete upper lip coverage (CLC) were enrolled. Plaque index (PI), gingival index (GI) and bleeding on probing (BOP) were recorded in whole dentition excluding third molars. Bleeding/plaque ratio was also calculated for different regions of dentition. Logistic regression analysis was applied to examine association between BOP at labial sites of maxillary anterior teeth and upper lip coverage.

Results: Significantly higher PI, GI, BOP scores and BOP/plaque ratio were noted at labial sites of maxillary anterior teeth in ILC group as compared to CLC group (p=.001, p=.011, p=.004 and p=.016 respectively). Significantly higher scores of BOP were found at labial sites than palatal sites of ILC group (p=.003). Regression analysis revealed that maxillary anterior labial sites in ILC group were 1.51 times more likely of having BOP (adjusted odds ratio 1.51, 95% confidence interval (CI) 1.13-2.03, p=.006).

Conclusion: Incomplete upper lip coverage of maxillary gingiva is associated with higher periodontal inflammatory parameters at labial sites of maxillary anterior teeth.

Keywords: gingiva, gingivitis, inflammation


Page RC. Oral health status in the United States: Prevalence of inflammatory periodontal diseases. J Dent Educ. 1985; 49(6):354-367.

Stevenson W, Chauhan SK, Dana R. Dry eye disease. An immune-mediated ocular surface disorder.Arch Ophthalmol. 2012;130(1):90-100.

Lio PA. Efficacy of a moisturizing foam in skin barrier regeneration and itch relief in subjects prone to atopic dermatitis. J Drugs Dermatol. 2016;15(11): s77-s80.

Schario M, Lunnemann L, Stroux A, Reisshauer A, Zuberbier T, Blume-Peytavi U, et al.Children with dry skin and atopic predisposition: daily use of emollients in a participant-blinded, randomized, prospective trial. Skin Pharmacol Physiol. 2014;27(4):208–216.

Anderson SD, Holzer K. Exercise-induced asthma: is it the right diagnosis in elite athletes? J Allergy Clin Immunol. 2000;106(3):419-428.

Gulati MS, Grewal N, Kaur A. A comparative study of effects of mouth breathing and normal breathing on gingival health in children. J Indian Soc PedodPrev Dent. 1998;16(3):72-83.

Kolawole KA, Otuyemi OD, Oziegbe EO. The relationship between malocclusion, lip competence and gingival health in a group of schoolchildren.Rev ClínPesqOdontol. 2010;6(3):239-247.

Sutcliffe P. Chronic anterior gingivitis. An epidemiological study in schoolchildren. Br Dent J. 1968;125(2):47-55.

Wagaiyu EG and Ashley FP. Mouthbreathing, lip seal and upper lip coverage and their relationship with gingival inflammation in 11-14 year old schoolchildren. J Clin Periodontol. 1991;18(9):698-702.

Naini FB. Lip seals. Letters to editor. Br Dent J. 2010;209(3):106.

Geiger AM, Wasserman BH, Turgeon LR. Relationship of Occlusion and Periodontal Disease Part VI.— Relation of Anterior Overjet and Overbite to Periodontal Destruction and Gingival Inflammation. J Periodontol. 1973;44(3):150-157.

Armitage GC. Development of a Classification Systemfor Periodontal Diseases and Conditions. Ann Periodontol. 1999;4(1):1-6.

Eke PI, Page RC, Wei L, Thornton-Evans G, Genco RJ. Update of the Case Definitionsfor Population-Based Surveillanceof Periodontitis. J Periodontol. 2012;83(12): 1449-1454.

Silness J, Loe H. Periodontal disease in pregnancy.II. Correlation between oral hygieneand periodontal condition. Acta Odontol Scand. 1964;22(1):121-135.

Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity.Acta Odontol Scand. 1963;21(6):533-551.

Lang NP, Adler R, Joss A, Nyman S. Absence of bleeding on probing. An indicator of periodontal stability.J Clin Periodontol. 1990;17(10):714-721.

Addy M, Dummer PMH, Hunter ML, Kingdom A, Shaw WC. A study of the association of fraenal attachment, lip coverage and vestibular depth with plaque and gingivitis. J Periodontol. 1987;58(11):752-757.

DiSabato-Mordarski T, Kleinberg I. Measurement and comparison of the residual saliva on various oral mucosal and dentition surfaces in humans. Arch Oral Biol. 1996;41(7):655-665.

Jacobson L. Mouthbreathing and gingivitis. 1. Gingival conditions in children with epipharyngeal adenoids. J Periodontal Res. 1973;8(5):269-277.

Bhatia A, Sharma RK, Tewari S, Narula SC. A randomized clinical trial of salivary substitute as an adjunct to scaling and root planing for management of periodontal inflammation in mouth breathing patients.J Oral Sci. 2015;57(3):241-247.

Lite T, DiMaio DJ, Burman LR. Gingival pathosis in mouth breathers: A clinical and histopathologic study and a method of treatment. Oral Surg Oral Med Oral Pathol. 1955;8(4):382-391.

Mandel ID. The functions of saliva.J Dent Res. 1987;66(Spec Iss):623-627.

Mizutani S, Ekuni D, Tomofuji T, Azuma T, Kataoka K, Yamane M, et al. Relationship between xerostomia and gingival condition in young adults. J Periodontal Res. 2015;50(1):74–79.

Klingsberg J, Cancellaro LA, Butcher EO. Effects of Air Drying on Rodent Oral Mucous Membrane: A Histologic Study of Simulated Mouth Breathing. J Periodontol. 1961;32(1):38-42.

Kaur M, Sharma RK, Tewari S, Narula SC. Influence of mouth breathing on outcome of scaling and root planing in chronic periodontitis. BDJ Open. 2018 Nov 9;4:17039. doi: 10.1038/s41405-018-0007-3.

International Dry Eye Workshop (DEWS). The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye Workshop. Ocul Surface.2007;5(2):75–92.

Lemp MA. Report of the National Eye Institute/industry Workshop on clinical trials in dry eye. CLAO J. 1995;21(4):221–232.

Schätzle M, Löe H, Lang NP, Bürgin W, Anerud A, Boysen H. The clinical course of chronic periodontitis. J Clin Periodontol. 2004;31(12):1122-1127.

Lang NP, Joss A, Orsanic T, Gusberti FA, Siegrist BE. Bleeding on probing. A predictor for the progression of periodontal disease? J Clin Periodontol. 1986;13(6):590-596.

van der Velden U, Winkel EG, Abbas F. Bleeding/plaque ratio. A possible prognostic indicator for periodontal breakdown. J Clin Periodontol. 1985;12(10):861-866.


How to Cite
Kaur, M., Sharma, R. K., Tewari, S., & Tanwar, N. (2020). Association of Upper Lip Coverage with Gingival Inflammation: A Cross-Sectional Study: Lip coverage and gingival inflammation. European Journal of Dental and Oral Health, 1(6).