Course and duration
Changes in gingiva
In general, clinical features of gingivitis may be
characterized by presence of any of the following clinical
Redness and sponginess of the gingival tissue
Bleeding on provocation
Changes in contour
Presence of plaque or calculus with no evidence of bone
Histological examination reveals ulcerated epithelium.
Classification Of Gingivitis
Course and duration
Acute gingivitis - can occur with sudden onset and short duration.
Recurrent gingivitis – reappears after treatment
Chronic gingivitis – slow in onset and of long duration
Localised – confined to single tooth or a group
Generalized – involves entire mouth
• Marginal – involves gingival margin
• Papillary – involves interdental papilla and extends into gingival
margin. Earliest signs of gingivitis occur in the papillae.
• Diffuse – affects marginal, attached gingiva and interdental
Gingival diseases in individual cases can be described using the
Localised marginal gingivitis
Localised diffuse gingivitis
Localised papillary gingivitis
Generalised marginal gingivitis
Generalized diffuse gingivitis.
• Systematic approach is required.
• An orderly examination of gingiva for colour, contour,
consistency, position, and ease and severity of bleeding and
BlEEding On PROBing
2 earliest signs of gingival inflammation preceding established
Gcf production increased
Bleeding on probing ( easily detectable )
• Bleeding varies in severity, duration, and ease of provocation.
• Easily detected clinically and therefore is of value for early
diagnosis and prevention of advanced gingivitis
• Bleeding appears earlier than other visual signs of
• It is a more objective sign that requires less subjective
estimation by the examiner
• It is widely used to measure disease prevalance and
progression, to measure outcome of the treatment, and to
motivate patients with home care.
• Interestingly numerous studies show that smoking suppresses
the gingival inflammatoryresponse.
GinGival bleedinG caused by local
Contributing factors to plaque retention like
• Anatomic and developmental tooth variations, caries, frenum
pull, iatrogenic factors, mal positioned teeth, mouth breathing,
overhangs, partial dentures, lack of attached gingiva, and
chronic and recurrent bleedinG
long standing inflammation
Mechanical trauma.. Eg: tooth brushing, food impaction
Bleeding provoked …
dilated engorged capillaries
Thinned out ulcerated gingiva
ACUTE BLEEDING …
-Injury or acute gingival disease
Laceration of the gingiva
- biting on sharp pieces of food.
- toothbrush trauma
- burns from hot foods or chemicals
• Acute necrotizing ulcerative gingivitis
blood vessels exposed to the surface by necrosed epithelium so
spontaneous bleeding or bleeding on slight provocation
Bleeding associated with systemic changes
Spontaneous or after irritation…
-varied etiology and manifestations…
“haemostatic system failure”
bleeding in the skin , internal organs other
other causes …
administration of anticoagulants, harmonal replacement therapy,
oral contraceptives, pregnancy and menstrual cycle
Normally… coral pink effected by
increased vascularity. --Red or pale pink
venous stasis --- bluish hue
Colour changes differ in nature and distribution
• Marginal (acute necrotising ulcerative ging)
• Diffuse (herpetic gingivostomatitis)
• Patchlike (chemical reactions )
Heavy metals absorbed systemically…
…discolor the gingiva.
Pigmentation can be seen as
Black or bluish line ( gingival contour )
Isolated blotches (interdentally marginal or attached gingiva )
Metal pigments …
Vessel rupture ( inflammatory)
Increased vascular permeability
Seepage of metal into surrounding tissue ( sub epithelial c.t.)
…NOT DUE TO TOXICITY…
simply TREAT the Inflammation…
CoLor Changes – systemiC faCtors
- Non specific
- Further diagnostic efforts
- Referral to specialist
Yellowish color oral mucosa ( apart from sclera)
• Tobacco --- hyperkeratosis, increase in melanin pigmentation
• Metal dust… coal.
• Coloring agents. In foods , lozenges
Amalgam implantation – localised bluish black areas
Firm and Resilient.
• In chronic gingivitis the consistency of the gingiva is
determined by the relative predominance of the
-Oedematous (destructive )
- Combination of either
Clinical and Histopathological Correlations
Soggy puffiness that pits on
Infiltration of Inflammatory exudate
Marked softness & friability with
ready fragmentation on exploration
with probe & pinpoint surface areas
of redness and desquamation
Degeneration, inflammation &
Epithelium- thinned, degenerated,
edema, leukocyte invasion.
C.T- inflamed, engorged
Fibrosis, epithelial proliferation with long
standing chronic inflammation.
Acute forms of Gingivitis
Diffuse puffiness and softening
Diffuse edema, fatty infiltration in
Sloughinfgwith grayish, flakelike
particles of debris adhering to eroded
composed of bacteria, PMNs &
degenerated epithelial cells in fibrinous
Intercellular & intracellular edema
Degeneration of nucleus and
Rupture of vessel wall
substances derived from the tooth.
foreign body reaction
crystalline substances in the gingiva seen at times (origin not
Loss of stippling (… early sign )
in chronic inflammation…
1) Smooth , shiny
2) Firm and nodular ( also found in drug induced
- “peeling off” of the surface occurs in the
- leathery texture … hyperkeratosis.
Position of the gingiva.
Actual : position of the epithelial attachment.
Apparent : level of the crest of the gingival margin.
2 types of recession …
-visible clinically visible.
-hidden can only be estimated by insertion of a
recession refers to position of the gingiva
- NOT the condition of the gingiva.
ETIOLOGY OF RECESSION.
Age: physiologic process…?
(8% incidence in children.
100% in persons aged 50 and above)
No convincing evidence…
- gradual apical shift : cumulative effect of minor
pathologic involvement and repeated direct trauma.
-Faulty tooth brushing
-Friction from soft tissues ( gingival ablation)
Faulty Tooth brushing.
brushing - gingival health
vigorous tooth brushing - adverse effects to the position of
Most prominently placed teeth.
Root bone angle
higher the root : bone angle … less recession
and vice versa.
Mesio-distal curvature of the tooth…
e.g . Canine
Gingiva “rests” or takes the support of the bone
rotated or tilted teeth labially placed
thinned out cortical plate
mild masticatory stresses
e.g. tooth brushing.
Sensitivity ( erosion of the cementum)
Hyperemia of pulp.
Oral hygiene problems .
peculiar inflammatory changes….
generally found in gingival enlargements