1. Nield-Gehrig CH 10 Perry CH 6
Gingival Disease
Nield-Gehrig CH 10
Perry CH 6

2. Gingival Description

3. 6 Gingival Characteristics
Color
Size
Position of margin
Shape of margins and papillae
Texture and consistency
Bleeding and/or exudate

4. Learning to Look at the Gingiva

5. Healthy Gingiva Tissue fits snugly around the tooth
Pointed papillae fill embrasure spaces
Firm and resilient
Little or no gingival crevicular fluid (GCF)

6. Normal Variations of Color

7. Gingivitis The mildest and most common form of periodontal disese
Gingivitis – inflammation of the gingiva causing tissue to become edematous and erythematous…bleeds easily on provocation.

8. Tissue Color In Gingivitis
Acute inflammation = increased blood flow = RED tissue
Chronic inflammation = bluish-red or purplish – red

9. Changes in Disease

10. Gingival Bleeding on Probing
The two earliest signs of ginigval inflammation preceding established gingivitis are:
1. Increased gingival crevicular fluid production rate
GCF = inflammatory exudate
Recently – development of tests for the detection or prediction of periodontal disease using the components, origin, and function of GCF
Drugs in GCF – tetracycline and Metronidazole
2. Bleeding from the gingivl sulcus on gentle probing

11. Gingival Bleeding
In gingival inflammation, histopathologic alterations that result in abnormal gingival bleeding include dilation and engorgement of the capillaries and thinning or laceration of the sulcular epithelium.
Because the capillaries are engorged and closer to the surface, and the thinned, degenerated epithelium is less protective, stimuli that are normally innocuous cause rupture of the capillaries and gingival bleeding.
The severity of the bleeding and the ease of its provocation depend on the intensity of the inflammation.
In cases of moderate or advanced periodontitis, the presence of bleeding on probing is considered a sign of active tissue destruction.

12. Gingival Bleeding Associated with Systemc Changes
In some systemic disorders, gingival hemorrhage occurs spontaneously or after irritation and is excessive and difficult to control.
Vascular abnormalities – Vit. C deficiency or allergy
Platelet disorders – thrombocytopenic purpura
Hypprothrombinemia – Vit. K deficiency
Other coagulation defects – hemophilia, leukemia,
Deficient platlet thromboplastic factor (PF3) resulting from uremia, multiple myeloma and ostrubella purpura.

13. Gingival Bleeding Associated with Systemc Changes
Hormonal replacement therapy
Oral contraceptives
Pregnancy
Menstral cycle
Diabetes
Medications:
Anticonvulsants
Antihypertensive calcium channel blockers
Immunosuppressant drugs
aspirin

14. Change in Size in disease

15. Tissue Size in Gingivitis
Increase in tissue fluid causes enlargement of the marginal and interproximal gingival tissues (Edema)
Change can be localized to a few areas or affect the whole mouth (generalized)

16. Change in Position in Margin

17. Change in Position of Margin

18. Change in Shape of Margin

19. Bulbous Papilla

20. Cratered Papilla

21. Missing and Blunted Papilla

22. Changes in the Consistency In Gingival Disease
Both chronic and acute inflammations produce changes int the normal firm and resilient consistency of the gingiva.
Chronic gingivitis = edematous – (destructive) and fibrotic –
(repairative) changes coexist
The consistency of the gingiva is determined by their relative pedominance.

23. Spongy Tissue

24. Surface Texture Changes in Disease
The surface of normal gingiva usually exhibits numerous small depressions and elevations = stippling
In chronic inflammation the surface is either smooth and shiny or firm and nodular
This depends on whether the dominant changes are exudative or fibrotic

25. Smooth, Shiny Tissue Can be: exudative
Epithelial atrophy in atrophic gingivitis
Chronic desquamative gingivitis can also have peeling of the surface

26. Smooth, Shiny Tissue

27. Changes in surface texture chronic gingivitis
Hyperkeratosis results in a leathery texture (example = chronic gingival disease in a smoker)
Fibrotic = firm nodular
Drug induced gingival overgrowth also produces a nodular surface

28. Nodular Tissue

29. Assess the Following Color Size Position of gingival margin
Shape of margins and papillae
Use air and probe to determine texture
Consistency
Check for bleeding

30. More on Size
Gingival Enlargement or gingival overgrowth are the current terms used to describe an increase in the size of the gingiva
“hypertrophic gingivitis” or “gingival hyperplasia” may have erroneous pathologic connotations
Gingival enlargement is a purely clinical term

31. Gingival enlargement can be classified according to etiologic factors and pathologic changes
I. Inflammatory enlargement
A. Chronic
B. Acute
II. Drug-induced enlargement
III. Enlagements associated with systemic diseases or conditions
IV. Neoplastic enlargement (gingival tumors)
V. False enlargement

32. Criteria of location
Localized: limited to the gingiva adjacent to a sengle tooth or group of teeth.
Generalized: involving the gingiva throughout the mouth
Marginal: confined to the marginal gingiva
Papillary: Confined to the interdental papillae
Diffuse: Involving the marginal and attached gingivae and papillae.
Discrete: An isolated sessile or pedunculated, tumorlike enlargement.

37. Non-Plaque –Induced Gingival diseases
Bacterial origin –
Neisseria gonorrhea – associated lesions
Treponema pallidum – associated lesions
Streptococcal species – associated lesions
RARE – Non-plaque is RARE

39. Non-Plaque-induced gingival diseases of viral origins
RARE – Non-plaque is RARE
Acute herpetic gingivostomatitis
Recurrent oral herpes
Varicella-zoster infections

40. Primary Herpetic Gingivostomatitis
Caused by herpes simplex virus type 1 (HSV-1)
Most often occuring in infants and children under 6 years
In most people the primary infection is asymptomatic
As part of the primary infection, the virus ascends through sensory and autonomic nerves, where it persists as latent HSV in neuronal ganglia that innervate the site
In 1/3 of the world’s population secondary manifestations result from various stimuli

42. NUG
Punched-out, craterlike depressions at the crest of the interdental papillae
Gray, pseudomembranous slough
Linear erythema
Spontanious gingival hemorrhage
Fetid odor

44. Gingival Diseases Modified by Malnutrition
Most clinical studies have not shown a relationship between the development of gingival diseases and malnutrition with the possible exception of severe vitamin C deficiency.

46. Lichen Planus
Inflammatory mucocutaneous disorder that may involve mucosal surfaces and the skin.
Current evidence suggests that lichen planus is an immunologically mediated mucocutaneous disorder in which host T lymphocytes play a central role.