GINGIVA Macroscopic features

macroscopic/ clinical features of gingiva
With video clips
Short video descriptions
Lecture for 3rd BDS students
Periodontology
Periodontics aspect
Clinical features of the gingiva

1. GINGIVA MACROSCOPIC FEATURES Dr. Sai Lakshmi C II year PG Dept. of Periodontology

2. Objectives Definition Parts of gingiva Macroscopic features I mportance of gingiva Summary FAQs

3. Division of Oral Mucosa Masticatory mucosa Specialised mucosa Lining Mucosa

4. Dynamic structure composed of the tissues supporting and investing the teeth. Periodontium Attachment apparatus

5. Gingiva is that part of oral mucosa which covers the alveolar processes of the jaws and surrounds the necks of teeth. Clinical/ Macroscopic Microscopic -Carranza The fibrous investing tissue, covered by keratinized epithelium, which immediately surrounds a tooth and is contiguous with its periodontal ligament and with the mucosal tissues of the mouth. -AAP 1992

6. Parts of Gingiva MARGINAL GINGIVA INTERDENTAL GINGIVA ATTACHED GINGIVA

7. M arginal gingiva Free Gingiva/ Unattached Gingiva Border of gingiva D emarcated by free gingival groove F orms the soft tissue wall of the Gingival s ulcus

8. “The terminal edge / border of the gingiva surrounding the teeth in collar-like fashion .” Marginal gingiva V aries in width : 0.5 – 2mm > translucent appearance No stippling , mobile or free from the underlying tooth surface 1.5 – 2 mm coronal to CEJ

9. Free gingival groove A shallow line or depression on the gingival surface at the junction of the free and attached gingiva .

10. Gingival Sulcus The space between the free gingiva and the tooth surface “ Shallow crevice/space around the tooth bounded by the surface of tooth on one side & the epithelium lining the free gingival margin on the other side.” V – shaped

11. Histologic sections - 1.8 mm Clinically- 2 – 3mm ⁎ ‘PD’ = distance from the gingival margin to the deepest part of the probable crevice Probing Depth of gingival sulcus  measured using a periodontal probe

12. Interdental gingiva Definition: it is the ‘ part of gingiva that occupies the gingival embrasures ’, which is the interproximal space beneath the area of tooth contact. Shape : interdental gingiva have two shapes : pyramidal -shape col -shape

13. Shape depends on: Contact point Presence or absence of recession Course of CEJ

14. Firm and resilient Tightly bound to underlying periosteum of alveolar bone Continues with marginal gingiva & extends to the mucogingival junction on the facial and lingual aspects of mandible & facial and palatal aspects of maxilla Attached gingiva Glossary of periodontal terms 1972 “Attached gingiva is that portion of gingiva that extends from the base of gingival crevice to mucogingival junction.”

15. Width of attached gingiva It is the distance between the mucogingival junction and the projection on the external surface of the bottom of the gingival sulcus or periodontal pocket . Greater - incisal region 3.5- 4.5 mm in maxilla 3.3 – 3.9 mm in mandible Narrower – posterior segment 1.9 mm in maxillary 1 st premolar 1.8 mm in mandibular 1 st premolar

16. Mucogingival junction (MGJ) Definition : Junction between attached gingiva & alveolar mucosa. Location : on all gingival surfaces except the palatal surface Clinical Relevance : Important anatomic landmark for determining the "width" of keratinized gingiva; flap designs, gingival grafts, etc.

17. Measuring Width of Attached gingiva 1. Measurement Method 2. Tension test 3. Visual method AG = KG - MG 4. Roll test Lugol’s iodine solution

18. On lingual aspect of mandible  the attached gingiva terminates at the junction of the lingual alveolar mucosa, which is continuous with the mucous membrane lining the floor of the mouth.

19. On the palatal aspect of maxilla  No mucogingival junction in the palatal aspect.

20. Function & importance of attached gingiva Dissipates functional and masticatory stresses ( eg. toothbrushing trauma) Act a barrier to chemical and thermal stimuli Prevents Recession. Improves esthetics, patient comfort and ease of hygiene Slow down the rate of periodontal destruction

21. Inadequate attached gingiva Facilitates subgingival plaque formation Favor attachment loss and soft tissue recession Favors accumulation of food particles during mastication Impede proper oral hygiene measures

22. Alveolar mucosa The facial aspect of attached gingiva extends to the relatively loose and movable alveolar mucosa & is demarcated by MGJ .

23. Clinical features / Macroscopic features

24. Colour Normally coral pink in color. produced by -Vascular supply -Thickness & degree of keratinization of epithelium -Presence of pigment containing cells. Alveolar mucosa – red, smooth & shiny

25. Physiologic pigmentation (Melanin) deep purplish discoloration or as irregularly shaped brown and light brown patches may appear as early as 3 hours after birth.

26. Contour Normal contour : (a) scalloped and knife-edged , (b) whereas the interdental papilla, anterior region  pyramidal posteriorly  tent-shaped Factors responsible: Shape of teeth and their alignment Location and size of proximal contact Dimensions of facial and lingual embrasures

27. Gingival Zenith Most apical point of the gingival outline.

28. Consistency The gingiva is firm & resilient , with the attached part tightly anchored to the teeth and underlying alveolar bone. The gingival fibers contribute to the firmness of the gingival margin. Checked by palpation using a blunt instrument or digital pressure.

29. Surface texture Stippling is generally present to varying degrees on vestibular surfaces of the attached gingiva. “orange peel” appearance  stippling Best viewed by drying the gingiva. seen in- Attached gingiva & central portion of interdental gingiva; It is a feature of healthy gingiva.

30. Size Depends on- sum of bulk of cellular and intracellular elements, and their vascular supply. Normal In disease- increased  ‘gingival enlargement.’

31. Position The normal position: 1mm above CEJ Factors that maintain Position of the teeth in the arch. Root-bone angle Mesio-distal curvature of tooth surface.

32. Role of gingiva Connects soft tissue to hard tissue, establishing a seal around the teeth Provides sensation for control of biting & chewing Controls oral microbes Protects the PDL & alveolar bone Attaches firmly to the bone thus supporting the tooth

33. Knowing the normal gingival architecture in health is important to differentiate between health and disease state of an individual. Hence it is significant to understand the morphological and clinical alterations in the gingiva during disease state which helps us to identify the intensity and prognosis of a particular disease. Importance of gingiva

34. The clinical appearance of the tissue reflects the underlying histology, both in health and disease. The gingiva is the tissue that surrounds and protects the teeth and underlying bone. The gingiva is attached to the tooth, forming a seal that protects the underlying bone and helps provide a barrier against infection

35. Good oral hygiene keeps this seal intact, while bad oral hygiene can result in damage to the gingiva, leading to gingivitis. Bad oral hygiene leads to the buildup of bacterial plaques, which cause inflammation and onset of gingivitis. If left untreated , gingivitis can lead to periodontitis, a condition where the seal between the gingiva and the tooth becomes loose, which may lead to infection and tooth breakdown.

36. Learning outcomes

37. Queries

38. Reference- Carranza’s Clinical Periodontology, 11 th edition

39. Previously asked questions What is periodontium? Discuss in detail about anatomical features of healthy gingiva. Discuss the macroscopic features of normal gingiva. Describe attached gingiva. Define width of attached gingiva and methods of its measuring. Define “col”. Write in detail about interdental gingiva/papilla.

40. 41 THANK YOU