“Gingiva” Dr.Muhammad Wasif Haq

What is Oral Mucosa? Mucous membrane epithelium of oral cavity. Divided into three types on basis of “Function”: -Masticatory mucosa: Gingiva & Hard palate. -Specialized mucosa: Dorsum of tongue. -Lining mucosa: Remainder of oral cavity e.g. inner surface of cheeks, soft palate

Lining Mucosa Masticatory Mucosa Specialized Mucosa

Gingiva & Types Gingiva: Soft tissue adjacent to the cervical portion of the teeth. Commonly called ‘gums’. Divided into three types on basis of “Location”.

(A) Marginal Gingiva Most coronally positioned portion of gums, surrounding the tooth in a ‘collar like’ fashion. Not attached to the tooth, hence called as ‘free’ or ‘unattached gingiva’. Forms the soft tissue wall of the gingival sulcus. 1 mm wide. Marginal Gingiva: Surrounds the tooth in a ‘collar’ like fashion.

(B) Attached Gingiva Apical to marginal gingiva. Firmly bound to the tooth and underlying periosteum. Width dependant upon : (i) Type of tooth involved, (ii) Buccolingual position in arch, (iii) Location of frena and muscle attachment. “Greatest width in incisor region: Can anyone tell why?” Maxillary anterior: 3.5-4.5 mm, Maxillary pre-molars: 1.99 mm. Mandibular anterior: 3.3-3.9 mm, Mandibular pre-molars: 1.88 mm

(C) Interdental Gingiva In the interproximal area; usually ‘Triangular” in shape. Shape dependant upon: (i) Contours of teeth, (ii) Degree of recession. Flat contours- Narrow and short. Convex contours- Broad and high. Gingival col: Where facial and lingual I.D.G. peaks unite, a depression. If teeth overlap, what happens to interdental gingiva??? What happens in diastemia?

Doing nothing is very hard; you never know when you are going to finish up.

>>Differences Between Gingivae>>

Free Gingiva Attached Gingiva Interdental Gingiva Location: Coronally positioned around tooth. Unattached. Apical to free gingiva. Firmly attached to the tooth & underlying bone. Between the contact surfaces of teeth. Color: Coral pink Coral pink, physiogical pigmentaion. No difference Contour: Knife edge Tapered If proximal contacts flat- Narrow and short. If convex- Wide & high. Consistency: Firm Texture: Smooth “Orange peel” Central portion-Stippled Marginal border- Smooth Keratinization: Keratinized. Keratinized. Function: Surrounds teeth, forms wall of sulcus Withstands mechanical forces of brushing & prevents movement of free gingiva. Prevents food stagnation.

Gingival Sulcus, Mucogingival junctional and junctional epitheilum Gingival sulcus: Space between the marginal gingiva and teeth. Normal depth: 1.88 mm (+ 0-6 mm) Non-Keratinized. Contains gingival/crevicular fluid : Importance? Mucogingival junction: Where “a”levolar mucosa and “a”ttached gingiva unite. Junctional epithelium: Circular arrangement of epithelial cells at the bottom of the sulcus which attaches the tooth and sub-epithelial connective tissue. Non-keratinized.Length 0.71-1.35 mm

Gingival Sulcus, Mucogingival junctional and junctional epitheilum

Histology of Gingiva (a) Epithelium (b) Connective tissue. Keratinized areas: Attached and marginal gingiva. Non-Keratinized areas: Sulcular and junctional epithelium. Connective tissue: Connective tissue of gums “Lamina Propria” (Latin word meaning layer, plate) Two layers: (i) Papillary (adjacent to epithelium), (ii) Reticular (adjacent to periosteum)

Do you know what are ‘rete pegs?’ Rete Pegs: Projections of epithelium into connective tissue.

What Does Connective Tissue Contain? Collagen Fibers (Bind & hold together tissues). Intercellular ground substance (Mucopolysaccharides & glycoproteins> Regulate distribution of water, electrolytes & metabolites). Cells (Plasma cells, Fibroblasts, Mast Cells, Lymphocytes). Blood supply, nerve supply & lymphatic vessles.

Facially:Incisors & Cuspids: Labial branch of infra-orbital nerve. Blood supply Nerve Supply Lymphatic Drainage 1. Supra-periosteal arteries: Along facial, lingual/ palatal surfaces of alveolar bone Maxillary teeth: Facially:Incisors & Cuspids: Labial branch of infra-orbital nerve. Palatally: Nasopalatine nerve. Drainage of lymphatics from connective tissue papillae into “SUBMAXILLARY LYMPH NODES”. 2. Interdental arteries: Inside the interproximal bone. Maxillary posterior teeth: Bucally: Superior alveolar nerve. Palatally: Anterior palatal nerve. 3. Periodontal ligament arterioles: Extend in gingiva and anastomose with capillaries in sulcus Mandibular teeth: Facially: Anterior teeth: Mental nerve. Bucally: Posterior teeth: Long buccal nerve. Lingually: Lingual nerve.