clinical features of gingivitis

CLINICAL FEATURES OF GINGIVITIS

PARTHA PROTIM SINGHAB.D.S. FINAL YEAR

ROLL NO.-29

INDEX TYPES OF GINGIVITIS GINGIVA IN HEALTH AND DISEASE GINGIVAL BLEEDING ON PROBING COLOUR CHANGES IN THE GINGIVA CHANGES IN THE CONSISTENCY OF

GINGIVA CHANGES IN THE SIZE OF THE GINGIVA SURFACE TEXTURE CHANGES IN THE POSITION OF THE

GINGIVA GINGIVAL RECESSION CHANGES IN GINGIVAL CONTOUR

Introduction

Inflammation of gingiva is termed as gingivitis. The plaque microorganisms can exert its effect on periodontium by releasing certain products (e.g. collagenase,hyaluronidase,protease,chondroitin sulfatase), which can cause damage to the epithelial and connective tissue constituents. The intercellular spaces between the junctional epithelial cells are destroyed and may permit the bacterial products or bacteria themselves to gain access into the connective tissue.

Normal anatomy of Gingiva

TYPES OF GINGIVITIS Depending on course and duration Depending on distribution

Depending on the course and distribution:1) Acute gingivitis is of sudden onset and short duration;

and can be painful.2) Subacute gingivitis is a less severe phase of acute

infection.3) Recurrent gingivitis reappears either after treatment or

disappears spontaneously.4) Chronic gingivitis is show in onset, of long duration,

usually painless and the most commonly occuring gingival condition.

Depending on the distribution

If the condition is involving a single tooth or group of tooth, it is called localized gingivitis. While generalized gingivitis involves entire mouth.

According to distribution, gingivitis could be marginal, papillary, or diffuse. If the inflammation is limited to the marginal gingiva, the condition is termed as marginal gingivitis. In papillary gingivitis, the inflammation is limited to the interdental papilla. When the inlammation spreads to attached gingiva also, it is termed as diffuse gingivitis, i.e. involving marginal, papilla and attached gingiva.

Papillary, marginal and diffuse gingivitis can occur as localized or generalized conditions.

Gingival bleeding on probing

1. Significance of gingival bleeding.2. Etiological factors responsible for

gingival bleeding.3. Associated microscopic changes.

Significance of gingival bleeding on probing

i. It is one of the earliest visual signs of inflammation.

ii. It can appear earlier then colour changes or any other visual signs of inflammation.

iii. It also provides an additional advantage, by being a more objective sign that requires less subjective estimation by the examiner.

iv. Gingival bleeding on probing also helps us to determine whether the lesions is in an active or inactive state. In inactive lesion, there will be little or on bleeding on probing, whereas active lesions bleed more readily on probing.

v. The severity and ease with bleeding can be provoked- indicates the integrity of the inflammation.

Etiological factors responsible for gingival bleeding on probing

Etiological factors can be divided into-1. Local factors:-

a.Those factors that ressults in acute bleeding. b.Those factors that cause chronic or recurrent bleeding.

2. Systemic factors.

Acute bleeding: It is caused due to-

1. Toothbrush trauma.2. Impaction of sharp pieces of hard food.3. Gingival burns from hot foods or chemicals.4. In conditions such as acute necrotizing ulcerative gingivitis(ANUG)Chronic Bleeding: The most common cause are-5. Chronic inflammation due to the presence of plaque and calculus.6. Mechanical trauma, e.g. from toothbrushing, tooth picks or food

impaction.7. Biting into solids foods such as apple.Systemic factors:- Include various systemic diseases such as vitamin

K deficiency, platelet disorders such as thrombocytopenia purpura, other coagulation defects such as hemophilia, leukemia and others.

Bleeding could also be as a result of excessive administration of drugs such as salicytes and anticoagulants such as dicumarol and heparin.

Microscopic changes associated with gingival bleeding on probing

1. In the epithelium: Thinning and microulcerations of the sulcular epithelium is seen.

2. In the connective tissue: Dilation and engorgement of the capillaries takes place.

Gingival bleeding on probing

Colour changes in the gingiva

Colour of the gingiva is an important clinical sign of gingival diseases. Normally, gingiva appears to be coral pink. The factors that are responsible for this are tissue vascularity, degree of keratinization and thickness of the epithelium. Generally, colour of the gingiva may change to red, to bluish red to pale pink. When there is increased vascularity or reduced epithelial keratinization, the gingiva becomes more red. The colour becomes pale when vascularization is reduced or epithelial keratinization increases. Venous statis gives a bluish hue to the gingiva. Systemically absorbed heavy metals may also cause gingival pigmentation, e.g. bismuth, arsenic, mercury, lead and silver. Abnormal melanin pigmentation of the gingiva may be observed in conditions like Addison’s disease, peutz-jeghers syndrome, Addison’s disease and Von Recklinghauson’s disease.

Colour changes in the gingiva

Changes in the consistency of gingiva

Normal gingiva exhibits a firm and resilient consistency. Factors that are responsible are cellular and fluid content and collagenous nature of lamina propria. In disease conditions, it can be soggy and edematous or firm; and leathery consistency.

Changes in the consistency of gingiva

Changes in the size of the gingiva

Normal size depends on the sum of the bulk cellular and intercellular elements, and their vascular supply. In disease, the size is increased, which can be termed as gingival enlargement. The factors responsible for this are increase in fibers and decrease in cells as in non-inflammatory type. Whereas in inflammatory type there will be increase in cells and decrease in fibers.

Changes in the size of the gingiva

Surface Texture

Under normal conditions, gingiva appears to be stippled(orange peel appearance) due to attachment of gingival fibers to the underlying bone. Microscopically, alternate rounded protuberance and depressions in the gingival layer may rise to stippled appearance. Stippling is absent in disease conditions. Hence, the gingiva may appear smooth and shiny.

Stippling

Changes in the position of gingiva

Normally, the gingiva is attached to the tooth at the cementoenamel junction. In disease, the position can be shifted either coronally (pseudo-pocket) or apical to the cementoenamel junction (gingival recession)

Gingival Recession

Defination:- Gingival recession is defined as the exposure of the root surface by an apical shift in the position of the gingiva.

Types:-In gingival recession, there are two types i.e.

visible, which is clinically and hidden, which is covered by gingiva and can only be measured with probe. Gingival recession may also be localized and generalized.

Classification of Gingival Recession

Two classification systems are available:-

1) According to Sullivan & Atkins: Shallow-narrow, shallow-wide and deep-wide.

2) According to PD Miller’s: Class-I ,Class-II, Class III, Class IV.

Prognosis of class I & II is good to excellent.Class III: Only partial coverage can be

expected.Class IV: Poor prognosis.

Etiology of gingival recession

Plaque-induced gingival inflammation is the primary etiological factor responsible for gingival recession; next common cause is faulty tooth-brushing. Other secondary factors on gingival recession are broadly categorized as-

i. Anatomic factorsii. Habitsiii. Iatrogenic factorsiv. Physiologic factors

Clinical significance of gingival recession

1) The exposed root surface may be extremely sensitive.

2) Hyperemia of the pulp may result due to gingival recession.

3) Interproximal recession creates oral hygiene problems thereby resulting in plaque accumulation.

4) Finally, it is aesthetically unacceptable.

Gingival Recession

Changes in gingival contour

Normally, marginal gingiva is scalloped and knife edges, whereas interdental papilla in the anterior region is pyramidal and posteriorly tent-shaped. The factors that maintain normal contour are, shape of the teeth and its alignment in the arch, location and size of the proximal contact and dimensions of the facial and lingual gingival embrasures. In diseased conditions, the marginal gingiva may become rounded or rolled, whereas interdental papilla can become blunt and flat. Stillman’s clefts are apostrophe shaped indentations extending from and into the gingival margin varying distance on the facial surface.

They are two types-1) Simple Cleft: Cleavage in a single direction.2) Compound Cleft: Cleavage in more than one direction.

REFERENCE

Carranza's Clinical PeriodontologyEssentials of Clinical

Periodontology and Periodontics-Shantipriya Reddy

Internet