Vanissa / 1006667661

Swollen

gums Soft, puffy gums Receding gums

Gums

Occasionally, tender gums

floss

that bleed easily when you brush or

sometimes seen as redness or pinkness on your

A change in the color of your from a healthy pink to dusky red Bad breath

brush or floss

gums

 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:
Gingivitis:

confined to single / group of teeth

Generalized

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
Hemorrhagic disorders with abnormal gingival

result in abnormal bleeding in the skin, internal organs, and other tissues including oral mucosa.

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 Venous statis contributes a bluish hue. Color changes from:
Interdental papillae Gingival margin Attached gingiva
because of vascular proliferation

In severe acute inflammation, red color gradually becomes a dull, whitish gray (tissue necrosis)

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: Addisons disease: isolated patches of discoloration of bluish black to brown Peutz-Jeghers syndrome Albrights syndrome and Recklinghausens disease Bile: oral mucosa may acquire yellowish colour

Iron: blue gray pigmentation of oral mucosa

Chronic Gingivitis Acute Form of Gingivitis

Soggy puffiness that pits on pressure Marked softness and friability; area of redness & desquamation Firm, leathery consistency

Diffuse puffiness and softening Sloughing with grayish debris adhering to eroded surface Vesicle Formation

 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

Stillmans clefts: narrow, triangular-shaped gingival recession