Post on 29-Aug-2014
Vanissa / 1006667661
Swollen gums Soft, puffy gums Receding gums
• Occasionally, tender gums
Gums that bleed easily when you brush or floss • sometimes seen as redness or pinkness on your
brush or floss
A change in the color of your gums • from a healthy pink to dusky red
Bad breath
In general, clinical features of gingivitis: • Redness and sponginess of gingival tissue
• Bleeding on provocation
• Presence of calculus or plaque
With no radio evidence of crestal bone loss
Histologic exam: • Inflamed gingival tissue reveals ulcerated
epithelium
Gingivitis can occur with sudden onset and
short duration and can be painful.
Recurrent Gingivitis: • reappears after having been eliminated by treatment
or disappeared spontaneously
Chronic Gingivitis: • Slow onset, long duration
• Painless
• Most often encountered
• Fluctuating disease (inflammation persist/resolve)
Gingival margins are edematous, smooth and discolored
Localized Gingivitis: • confined to single / group of teeth
Generalized Gingivitis: • involves the entire mouth
Localized marginal gingivitis
Localized diffuse gingivitis
Localized papillary gingivitis
Generalized diffuse gingivitis
Localized, intensely red area facial of tooth #7 & dark pink marginal changes
Generalized marginal and papillary gingivitis
Involves marginal, papillary and attached gingiiva
Systematic approach is required • Clinician should focus on subtle tissue
alterations -> diagnostic significance
• Orderly exam of gingiva:
Color
Contour
Consistency
Position
Ease and severity of bleeding
Pain
Varies in severity, duration and ease of provocation
BOP is easily detected clinically – value of early
diagnosis and prevention of more advanced
gingivitis
BOP appears earlier than change in color / visual signs of
inflammation
Bleeding is more objective sign
Probing pocket depth measurements are of limited value for
assessment of extent and severity of gingivitis.
Gingival recession results in reduction of probing depth ->
inaccurate assessment of periodontal status
In general, gingival bleeding on probing indicates
an inflammatory lesion both in epithelium and
connective tissue that exhibits specific histologic
differences compared with healthy gingiva.
Absence of BOP = low risk of future attachment
loss.
Presence of gingivitis can be considered as a risk factor for
periodontal attachment loss that may lead to tooth loss.
Interestingly, cigarette smoking suppresses the gingival
inflammatory response and exerts suppressive effect on
BOP
Increase in gingival BOP in patients who quit smoking
• Other than plaque retention that may lead to gingivitis, there are: Anatomic and developmental tooth variations
Caries
Frenum pull
Iatrogenic factors
Malpositioned teeth
Mouth breathing
Overhangs
Partial dentures
Lack of attached gingiva and recession
Orthodontic treatment and fixed retainers
Most common cause of abnormal gingival
BOP is chronic inflammation
The bleeding is chronic or recurrent and is
provoked by mechanical trauma
(toothbrushing, toothpicks or food
impaction) or biting into solid foods – such
as apples.
In gingival inflammation,
histopathologic alterations
result in abnormal gingival
bleeding include:
Dilation and engorgement of
capillaries
Thinning or ulceration of
sulcular epithelium
• In some systemic disorders, gingival haemorrhage occurs spontaneously and is difficult to control.
• These hemorrhagic diseases have the common feature of a hemostatic mechanism failure
result in abnormal bleeding in the skin, internal organs, and other tissues – including oral mucosa.
• Hemorrhagic disorders with abnormal gingival bleeding Vascular abnormalities
Hormonal replacement therapy, oral contraceptives, pregnancy, menstrual cycle also affect gingival bleeding
Several medications – antihypertensive calcium channel blockers cause gingival enlargement.
Normal gingival colour : “coral pink” Gingiva becomes red Gingiva becomes pale Chronic inflammation intensifies red or bluish red
color • because of vascular proliferation
Venous statis contributes a bluish hue. Color changes from:
In severe acute inflammation, red color gradually becomes a dull, whitish gray (tissue necrosis)
Interdental papillae
Gingival margin
Attached gingiva
Metals produce black or bluish line in gingiva
following the contour of margin.
Bismuth therapy:
Not result of systemic toxicity
Occurs only in area with increased permeability of irritated blood
vessels permits seepage of metal into surrounding tissue
Endogenous oral pigmentation: • Melanin, bilirubin, iron
• Disease that increase melanin pigmentation:
Addison’s disease: isolated patches of discoloration
of bluish black to brown
Peutz-Jeghers syndrome
Albright’s syndrome and Recklinghausen’s disease
• Bile: oral mucosa may acquire yellowish colour
• Iron: blue gray pigmentation of oral mucosa
• Soggy puffiness that pits on pressure
• Marked softness and friability; area of redness & desquamation
• Firm, leathery consistency
Chronic Gingivitis
• Diffuse puffiness and softening
• Sloughing with grayish debris adhering to eroded surface
• Vesicle Formation
Acute Form of
Gingivitis
Calicified Masses in the Gingiva • Calcified material removed from tooth and
traumatically displaced into the gingiva during
scaling (root remnants, cementum fragments,
cementicles)
Toothbrushing • Promoting keratinization of oral epithelium
• Enhancing capillary gingival circulation
• Thickening alveolar bone
Severity of
recession:
determined by
actual position of
gingiva, not its
apparent position
Stillman’s clefts: narrow, triangular-shaped gingival
recession