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