Gingival Disease

Nield-Gehrig CH 10Perry CH 6

Gingival Description

6 Gingival Characteristics

Color Size Position of margin Shape of margins and papillae Texture and consistency Bleeding and/or exudate

Healthy Gingiva

Tissue fits snugly around the tooth Pointed papillae fill embrasure spaces Firm and resilient Little or no gingival crevicular fluid

(GCF)

Normal Variations of Color

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.

Tissue Color In Gingivitis

Acute inflammation = increased blood flow = RED tissue

Chronic inflammation = bluish-red or purplish – red

Changes in Disease

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

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.

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.

Gingival Bleeding Associated with Systemc Changes Hormonal replacement therapy Oral contraceptives Pregnancy Menstral cycle Diabetes Medications:

Anticonvulsants Antihypertensive calcium channel blockers Immunosuppressant drugs aspirin

Change in Sizein disease

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)

Change in Position in Margin

Change in Position of Margin

Change in Shape of Margin

Bulbous Papilla

Cratered Papilla

Missing and Blunted Papilla

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.

Spongy Tissue

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

Smooth, Shiny Tissue

Can be: exudative Epithelial atrophy in atrophic gingivitis Chronic desquamative gingivitis can also

have peeling of the surface

Smooth, Shiny Tissue

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

Nodular Tissue

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

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

Gingival enlargement can beclassified 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

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.

Non-Plaque –Induced Gingival diseases

Bacterial origin – Neisseria gonorrhea – associated lesions Treponema pallidum – associated lesions Streptococcal species – associated

lesions

RARE – Non-plaque is RARE

Non-Plaque-induced gingival diseases of viral origins

RARE – Non-plaque is RARE Acute herpetic gingivostomatitis Recurrent oral herpes Varicella-zoster infections

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

NUG

Punched-out, craterlike depressions at the crest of the interdental papillae

Gray, pseudomembranous slough Linear erythema Spontanious gingival hemorrhage Fetid odor

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.

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.