GINGIVA IN HEALTH

1. GOOD MORNING

2. GINGIVA
IN HEALTH
Presented By
DR.SWAPNA.EDIGA

3. Oral Mucosa can be classified
 Funtionally as ,
 Masticatory mucosa
 GINGIVA
 Hard palate
 Lining Mucosa
 Lip,cheek,alveolar
mucosa,floor of the
mouth,soft palate
 Specialised Mucosa
 Dorsum of tongue ,Taste buds
 Structurally as,
 Keratinised Mucosa
 Masticatory Mucosa
 Vermillion border of lip
 Non-Keratinised Mucosa
 Lining Mucosa
 Specilised Mucosa

4. DEFINITION - GINGIVA
The part of oral mucosa that covers the alveolar processes of
the jaws and surrounds the necks of teeth.
Carranza 10 ed.

5. DEVELOPMENT OF PERIODONTIUM
1. Tissue Interactions – Instructive influence, Restriction
(Cell Determination) , Permissive Influence.
2. Specific Developmental Events
3. Development of Gingival Sulcus and Epithelial attachment

6. TISSUE INTERACTIONS
 Instructive influence
Mesenchyme instructing epithelium to become tooth buds.
 Restriction
Once instructed cannot enter other pathway-CELL DETERMINATION
 Permissive influence
Growth & differention requires the presence of mesenchyme

7. Specific Developmental Events
 4-5 weeks of gestation - Primitive Stomatodeum
 37 days – Primary Epithelial Band
 42-48 days – Dental Lamina
 55 days to 32 weeks – Dental organ; Dental papilla; Dental
follicle;Cervical loop; Hertwig root sheath.
 PDL fibres, Sharpey fibres, Alveolar bone, ACTIVE ERUPTION

8. Gingival sulcus - Epithelial Attachment
 Inner Enamel Epithelium – Reduced Ameloblasts –
Hemidesmosomes __Reduced Enamel Epithelium.
 REE + Outer Enamel Epithelium---Primary Epithelial
Attachment.
 PEA + Oral Epithelium __Secondary Epithelial Attachment.
 Takes place between 1-2 years.
 Splitting & Recession of SEA (PASSIVE
ERUPTION)__Gingival sulcus

9. PASSIVE TOOTH ERUPTION & GINGIVAL POSITION
REF CARRANZA 10 ed PG. 64

10. DENTO GINGIVAL JUNCTION & SEAL
 JE Collar like band of non-keratinised sq. epithelium
 Length - 0.25 to 1.35mm ; Thickness – (coronal) 10 to 29 cells;(apical) 1 to 2 cells.
 Attached to tooth by internal basal lamina; to connective tissue by external basal
lamina.
 SPECIAL FEATURES
 Size of cells – Large
 Intercellular space – Wide
 No. of Desmosomes – Less
 SEAL
 Barrier against plaque bacteria
 Host defence – GCF; inflammatory cells
 Repair – Rapid turn-over
 Endocytic capacity of cells – Protection
 Sites of Signal Transduction – Hemidesmosomes- Gene Expression

11. To REMEMBER
 Juntional Epithelium__________Enamel organ
 Sulcular & oral Epithelium________Oral mucosa
 JE is physically attached to tooth by HEMIDESMOSOMES
 Thickness of oral epithelium – 0.2-0.3mm
 JE + Gingival fibres _ Functional unit _ Dento Gingival Unit

12. DEFINITIONS
Active Eruption
Movement of the teeth in the direction of the occlusal plane by
actual displacement
Passive Eruption
Exposure of the teeth by apical migration of the gingiva
Clinical Crown
That part of the crown that is denuded of gingiva and is exposed in
the oral cavity
Anatomic Crown
That part of crown that is covered by enamel
Clinical root
That part of the root that is covered by the investing tissues
Anatomic Root
That part of the root that is covered by cementum

13. CUTICULAR STRUCTURES OF TOOTH
Def: Thin acellular structure with a homogenous matrix, sometimes
enclosed within clearly demarcated linear borders.
Classification: Listgarten in 1970
1.Developmental coatings
2.Acquired coatings
Developmental coatings
1.Reduced Enamel Epithelium
2.Coronal Cementum
3.Dental Cuticle
Acquired coatings
Exogenous origins of saliva , bacteria, calculus, stains etc.

14. MACROSCOPIC ANATOMY OF GINGIVA
 GINGIVA extends from the dentogingival junction to the alveolar
mucosa.
 ANATOMICAL DIVISIONS
 Marginal Gingiva
 Attached Gingiva
 Interdental Papilla
REF COLOR ATLAS OF DENTAL MEDICINE PG.07

15. MARGINAL GINGIVA
 Terminal edge border of Gingiva surrounding the teeth in a
collar like fashion. Keratinised; Non stippled
 Demarcated from attached gingiva by FREE GINGIVAL
GROOVE
 Forms the soft tissue wall of gingival sulcus
 Width – 1mm
 Location – 1.5 to 2 mm coronal to CEJ
 Pale pink ; Dull surface ; Firm consistency ; Rounded Margin
 DEF: That portion of the gingiva which is un attached & forms
the wall of the gingival crevice in health. It is contiguous with
the attached gingiva

16. GINGIVAL GROOVE
 Shallow Groove that runs parallel to & at a distance of 0.5 to 2mm from
the gingival margin.Both on facial and oral aspects. Present in 50% of cases.
 GM to GG = GM to JE
 Presence of GG is not related to health
 Dependant on the fan – shaped arrangement of the supra alveolar fibres
running from cementum into the gingiva
 GINGIVAL FESTOONS The contours of the gingiva & oral mucosa over
the roots of teeth that tend to follow cervical lines.

17. GINGIVAL SULCUS
Shallow space crevice around the tooth bounded by the surface of
the tooth on one side & the epithelium lining of free gingival
margin on the other side.
V- Shaped
Depth : Ideal – 0mm
Probing : 2 to 3mm
Histologic : 0 to 6mm(1.8mm)
Width : 0.15mm
DEF: A Shallow fissure bet. the marginal gingiva
&the enamelcementum.Bounded by the tooth on
One side, crevicular epithelium on the other &
The coronal end of JE at its most apical point

18. INTER DENTAL GINGIVA
First described by Cohen in 1959
Occupies the gingival embrasure –
interproximal space beneath the
Contact point region.
Shape:1.contact relations
2.width of approximal tooth
surfaces
3. course of CEJ
Lateral borders & tip - marginal gingiva
Intervening portion – attached gingiva
REF COLOR ATLAS OF DENTAL MEDICINE PG.07

19. COL REF COLOR ATLAS OF
DENTAL MEDICINE PG.09
 A VALLEY LIKE DEPRESSION OF THE INTERDENTAL GINGIVA
WHICH CONNECTS THE FACIAL & LINGUAL PAPILLA &
conforms to the shape of the interproximal contact area
 HISTOLOGY : Thin non keratinised epithelium ; sends numerous
extensions into underlying CT
 COL exaggerated on inflammed, hyperemic gingiva
 DEF: That portion of gingiva that occupies the interproximal
spaces. The interdental extension of gingiva

20. REF CARRANZA 10 ED PG.48
JAN LINDHE 5 ED PG.07

21. ATTACHED GINGIVA
 DEF : That portion of the gingiva which is firm, dense &
tightly bound to the underlying periosteum & bone
 40% of adult gingiva shows stippling.
REF James Avery 3 ed , 268

22. Width of the attached gingiva
Maxilla Mandible
Incisors premolars Incisors premolar
3.5 to 4.5mm 1.9 mm 3.3 to 3.9mm 1.8 mm

23. Significance of Attached Gingiva for the maintenance of
Periodontal health
 To protect the periodontium from injury caused by frictional
forces encountered during mastication.
 To dissipate the pull on the gingival margin created by the muscles
of the adjacent alveolar mucosa.
 Gives support to the marginal gingiva
 Provides solid base for movable alveolar mucosa
 Helps to prevent soft tissue recession and attachment loss
 Helps in connective tissue attachment

24. GINGIVAL DIMENSIONS
 Morphology of gingiva related to
 1. dimension of alveolar process
 2. form anatomy of teeth
 3. events during tooth eruption
 4. inclination & position of erupted teeth
 Types of gingival architecture
 1. pronounced scalloped type
 2.flat biotype
 Dimensions of interdental papilla – epithelium, CT , entire supra
alveolar CT (1mm)

25. MICROSCOPIC ANATOMY OF GINGIVA
 Bulk of Gingiva – CT
 Scattered within fibrous network - cells – neural & vascular
elements.
 These are immersed in highly hydrated ground substance through
which soluble substances can diffuse.
 These are protected by epithelial covering.

26. GINGIVAL EPITHELIUM
 Keratinised ______ Oral Epithelium
 Non Keratinised ________ Sulcular & Junctional Epithelium
REF CARRANZA 10 ED PG.52

27. GINGIVAL KERATINISATION
 Need of Keratinisation ?
 Physical Barrier to infections & underlying gingival attachment
 Protection against mechanical forces
 Selective interchange with oral environment
 Signalling functions in host defence
 Architectural integrity

28.  Keratinisation takes place by two processes
 1. Epithelial proliferation ___ MITOSIS________Increase in the
number of cells in the progenitor compartment by cell division.
 2. Epithelial Maturation ______process by which a living epithelial
cell in the progenitor compartment matures and eventually changes
into the flattened dead cell in the stratum corneum.

29. PROCESS OF KERATINISATION
Epithelial Proliferation
(bottom of epithelial ridges) PROGENITOR CELLS
Slow dividing stem cells Amplifying cells

30.  By Mitosis produce 2 daughter cells
 Older cell enters maturing compartment
 Other cell recycles in the progenitor population
 It takes 1 month for the keratinocyte to traverse the epithelium
and reach outer epithelium to be shed from stratum corneum
 This mitosis is affected by,
 Time of the day
 Stress
 Inflammation

31. EPITHELIAL MATURATION
 Stratum Basale _____ Progenitor compartment
 Stratum Spinosum
 Stratum Granulosum _________ Maturation compartment
 Stratum corneum ________Superficial Cornified Compartment
 It takes one month for an epithelial cell to traverse the
maturation compartment & to be shed from Stratum corneum

32. LAYERS OF EPITHELIUM
James Avery 3 ed 249

33. Stratum Basale
 Differention involves
progressions of morphological
and biochemical events
 Cuboidal cells
 They synthesize some
proteins of the basal lamina
 Keratinocytes are formed in
this layer by the divisions of
the stem cells
 Basale cells are connected to
the basal lamina by
hemidesmosomes and with
each other by desmosomes

34. Stratum Spinosum
 Cells are irregular, polyhedral
and larger than basal cells and10
to 20 layer thick
 The intercellular bridges are
larger and distended thus
desmosomes are prominent
giving a pricky appearance
James Avery 3 ed , 268

35.  Of the four layer the spinous layer is most active in protein
synthesis
 this layer contains numerous dense granules keratinosomes or
odland bodies
 It contains more mature keratinocytes

36. Stratum Granulosum
 Cells are flat and wider, this layer
is so named because of the
presence of keratohyaline
granules
 This layer still synthesize protein
 More dense tonofilaments
 Uppermost layer consists odland
bodies, they contain large amount
of acid phosphatase which is
closely related to the degree of
the keratinization
James Avery 3 ed , 268

37. STRATUM CORNEUM James Avery 3 ed , 268
 Cells are larger and flatter,
does not synthesis protein
 Keratohyaline granules and
other cell organelles
disappear.
REF GRANT 6 ED PG.27

38.  Ortho Keratinisation
 No nuclei in corneal layer.
 Well defined Granular layer.
 Para Keratinisation
 Retained pyknotic nuclei
 Keratohyaline granules dispersed
 Gingiva ortho keratinised in
 15% ; para keratinised in
 75% & non keratinised in 10%
 of the areas

39. REF MOUTH AND PERIORAL TISSUES SCULLY PG . 139

40. NON KERATINOCYTES OF GINGIVAL
EPITHELIUM
 LANGERHANS CELLS
 MELANOCYTES
 MERKEL CELLS

41. LANGERHANS CELLS
Described by Langerhans in
1868
 Dendritic cells present
 suprabasally
 Origin : are modified monocytes
 derived from bone marrow
 Contain elongated granules
They have marked ATP activity
Absent in junctional epithelium
Gold chloride impregnation is the
classic method for studying LH cells
The concentration of LH cells
increased in the inflammation

42. MERKEL CELL
Described by Merkel in 1875
 Origin : neural crest and epithelial origin
 They are connected with other cells by
 desmosomes
 Basal or suprabasal distribution
 Merkel in 1875 described these
 cells as specialized cells found near the tips of rete ridges
James Avery 3 ed pg 270
 These cells can be identified by
1. Electron microscopy
2. With the help of fluorescence dye QUINACRINE which is taken up by neuroendocrine
granules

43. MELANOCYTE
 Are dendritic cells
 Basal and spinous distribution
 The ratio of melanocytes to the keratin producing epithelial cell is
constant and is 1:36 cells

44. Divisions of Gingival Epithelium
 Oral Epithelium
 Sulcular Epithelium
 Junctional Epithelium
REF ROSE AND MEALEY PG.05
Carranza 6 ed ,12

45. GINGIVAL FIBRES
 Type 1 Collagen Fibres
 Reticulin Fibres
 Elastic Fibres
 Oxytalin Fibres

46.  Collagen fibers of gingival connective tissue as revealed by
immunostain-ing with an anti-type I collagen antibody. Collagen
fibers are distributed throughout the connective tissue, however,
they are not present in the epithelium .
Reticulin fibers:
Present in epithelium connective
tissue & endothelium -CT interface
Elastic fibers:
Present in association with the blood
vessels
Are absent in the gingiva coronal to
the mucogingival junction
Oxytalan fibres are scarce in gingiva
and are immature fibers (150 A dia )
Present numerously in periodontal
ligament

47. FUNCTIONS OF GINGIVAL FIBRES
 To brace the marginal gingiva firmly against the tooth
 To provide the rigidity necessary to withstand the forces of
mastication without being deflected away from the tooth surface
 To unite the free marginal gingiva with the cementum of the root
and the adjacent attached gingiva.

48. Circular—maintain contour and position of free marginal gingiva
Dentogingival—provide gingival support
Alveologingival—attach gingiva to bone
Periostogingival—attach gingiva to bone
Transeptal---maintain relationships of adjacent teeth protect interproximal
bone
Transgingival—secure alignment of teeth in arch
Interpapillary—provide support for interdental gingiva
Intercircular—stabilize teeth in arch
Intergingival—provide support and contour of
attached gingiva

49. REF COLOR ATLAS OF DENTAL MEDICINE PG. 12 & 13

50. Cellular compartment
 Fibroblasts 65%
Fibroblasts are elongated or spindle shaped with oval shape nucleus
The principal function of fibroblasts is to synthesize and maintain the
components of the extracellular matrix of the connective tissue
REF JAN LINDHE 5 ED PG.19

51. Mast Cells :
Numerous in the connective tissue of the oral mucosa and gingiva
These are responsible for the production of certain component of
matrix
Also produce vasoactive substances which can affect the function of
the microvascular system and control the flow of blood through
the tissue
REF JAN LINDHE 5 ED PG20

52. Macrophages and Histiocytes :
Are present in the gingival connective tissue as components of the
mononuclear phagocyte system (reticuloendothelial system) and
are derived from blood monocytes.
REF JAN LINDHE 5 ED PG.20

53. Inflammatory Cells :
 Neutrophils can be seen in relatively high numbers in both the
gingival connective tissue and the sulcus
 Small foci of plasma cells and lymphocytes are found in the
connective tissue near the base of the sulcus
 These inflammatory cells usually are present in small amounts in
clinically normal gingiva.

54. FUNCTIONS OF LAMINA PROPRIA
 The gingival connective tissue serves primarily to protect the root
surface and alveolar bone from the external oral environment
 It aids in the support and fixation of teeth within their alveolar
housing and provides adequate support for the epithelial tissues
 In carrying out its protective role, the gingival tissues provides
the stage upon which the host response acts out its role of
surveillance, interception and removal of foreign materials

55. INTERCELLULAR MATRIX
 Epithelium
 Cells in close approximity
 Anchoring fibrils form part of attachment complex
 Type 8 collagen in the attachment complex of JE
 Glycoproteins,proteoglycans,lipids,water &intercalated cell surface
molecules.
 B1 integrins,ICAM -1
 ROLE
 1.cell adhesion
 2.adhesion to tooth & basement membrane
 3.regulation of diffusion

56. CONNECTIVE TISSUE MATRIX
 COLLAGENOUS PROTEINS
 Proteoglycans____ uronic acid (Glycosaminoglycans) Heparan
sulphate
 Glyco proteins ____ fibronectin , osteonectin
 Integrins

57. REF JAN LINDHE 5 ED PG. 24

58. ULTRA - STRUCTURE OF GINGIVA
(x70,000 magnification)
 Epithelial – connective tissue interface
 Cellular organelles - Epithelium
 Epithelial – tooth surface interface
 Connective tissue Fibres

59. Epithelial – connective tissue interface
 Stratum Basale – Basal cell – Basement membrane – Lamina Propria
 BM _______ Lamina Lucida (400 A) & Lamina Densa
 Lamina Densa __________ Anchoring Fibrils(1 micron in length)
 Lamina Densa ___________ Hemi Desmosomes
 Cytoplasm of Basal cell ________ Tonofilaments

60. REF SCULLY PG.133

61. EPITHELIUM
 Adjacent cells in various layers are connected by
DESMOSOMES
 Prickle cell layer _____ Short fine cytoplasmic process
 Melanocytes ________ Lower portion of S. Spinosum.
Contain melanin granules. No tonofilaments.
Hemidesmosomes.
 Keratinocytes _______ Large number of tonofilaments
 Stratum Granulosam _________ Keratohyaline bodies.

62. TONOFILAMENTS
 Fibrous proteins – Ribosomes –diameter 8 nm
 Intermediate filaments – cell structure
 Chemically – Cyto Keratins
 Tonofilaments aggregation – Tono bundles

63. DESMOSOMES
 Circular oval – attachment plaques – tonofilaments
 Proteins – desmoplakin; plakoglobin
 2 adjoining hemidesmosomes
 – center granulated material
 Outer leaflet, inner leaflet,
 attachment plaque
 Other protein – Cadherin
 HEMIDESMOSOMES
 KERATOHYALINE GRANULES
REF JAN LINDHE 5 ED PG.14

64. ADAPTATIONS
 1. Physical Barrier – Cohesiveness
 2. Mechanical Barrier – dissipate forces

65. COLLAGEN FIBRE
 Smallest unit – TROPHOCOLLAGEN (3000 A length ; 15 A dia.)
 3 polypeptide helix - 1000 amino acids
 Glycine ; Proline ; Hydroxy proline
 Trophocollagen – protofibrils – collagen fibres – Cross banding
periodicity 700 A - COLLAGEN BUNDLES

66. REF JAN LINDHE 5 ED PG. 21

67. REF SCULLY PG. 135

68. Histo chemistry
 Gives the chemical composition & Enzyme systems of normal
gingiva
 CT – PAS positive heteropolysaccharide intercellular ground
substance & Glycogen
 In epithelium glycogen is inversely related to keratinisation
 PAS positive thin basement membrane
 PAS negative acid mucopolysaccharides , hyaluronic acid ,
chondroitin sulphate A,B &C – between epithelial cells
 RNA more in basal cells
 RNA &DNA activity seen more in gingival margin & JE
 Other components – sulfhydryls, disulphides , phospolipids &
cholestral

69. ENZYMES
 Alkaline phosphatase – keratinised & parakeratinised layers
 Acid phosphatase – surface & prickle cell : related to
keratinisation nucleotide reductases – all layers except in keratin
layers
 Acetylcholinestarase – CT
 Esterase – basal & granular layers
 G6PD – increased from basal to superficial layers
 Succinic dehydrogenase – increased in superficial layers
 Cytochrome oxidase – JE & sulcular epithelium

70. Correlation of normal clinical and microscopic
features
Colour
Coral pink & is produced by
 Vascular supply
 The thickness and degree of keratinization of the epithelium.
 The presence of pigment-containing cells.

71. GINGIVAL PIGMENTATION
 DEF: Variations in gingival color due to the amount of melanin
pigment present
 Controlled by genetic expression
 More in males ; dependant on race
 Appear as early as 3 hrs after birth
 More on the buccal aspect of oral mucosa

72. Consistency
Variations in Consistency of Healthy Gingiva
A. Firm, fibrous gingiva "thick" phenotype.
B.Delicate scarcely stippled gingiva "thin” phenotype
 Thicker gingiva provides better conditions for treatment and
wound healing

73. Surface texture :
The gingiva presents a textured surface similar to an
orange peel
REF CARRANZA 10 ED PG.49

74. Size
 The size of the gingiva corresponds with the sum total of
the bulk of cellular and intercellular elements and their
vascular supply

75. Contour
 The marginal gingiva envelops the teeth in collar like fashion and
follows a scalloped outline on the facial and lingual surfaces
REF JAN LINDHE 5 ED PG. 05

76. Shape
The shape of the interdental gingiva is governed by the contour of
the proximal tooth surface and the location and shape of gingival
embrassures
POSITI0N
The position of the gingival refers to the level
at which the gingival margin is attached to the tooth

77. VASCULAR SUPPLY & MICRO CIRCULATION
 1. supra periosteal arterioles
 2. vessels of periodontal ligament
 3. arterioles

78.  Superior inferior alveolar artery
 1. dental artery
 2.intraseptal artery
 2 Main anastomoses
 1. sub epithelial plexus
 2.dento gingival plexus

79. REF JAN LINDHE PG. 45

80. REF ELLY & MANSON PG. 04

81. EXTRA VASCULAR CIRCULATION
REF JAN LINDHE 5 ED PG. 47

82.  GINGIVAL LYMPHATIC DRAINAGE
Brings in the lymphatics of the connective tissue papillae. It
progresses into the collecting network external to the
periosteum of the alveolar process and then to the regional
lymphnodes (particularly the submaxillary group). In addition
lymphatics just beneath the functional epithelium extend into
the periodontal ligament and accompany the blood vessels.

83. REF JAN LINDHE 5 ED PG.47

84. Gingival innervations
 Derived from fibers arising from nerves in the periodontal
ligaments
 From the labial buccal and palatal nerves
 Receptors are seen as free endings within the papillary layer of
the lamina propria
 All are found in the free and attached gingiva

85. Repair & renewal
 Gingiva heals without scar
 Greater regenerating capacity
 Turnover rate _______10 to 12 days

86. CONCLUSION
 GINGIVA by its unique features maintains the integrity of the
dental arch.
 Gingiva is the protector of the underlying structures
 Maintenance of gingival integrity _______Best possible oral
health

87. REFERENCES
1.A.R. Tencate, 5th edition Oral Histology, Development, structure and function
2.Axelsson Diagnosis and risk prediction of periodontal diseases
3.Carranza F.A., Michael G. Newman. Clinical peridontology 8 ed
4.Carranza F.A., Michael G. Newman, Takai Clinical peridontology 10 ed
5.Carranza F.A Glickman Clinical peridontology 5, 6 ed
6.Elly and Masson. Periodontics
7.Goldman and Cohen, 6th edition. Periodontal Therapy –
8.Grant, Stern and Listgarten, Periodontics 6th edition.
9.Herbert F . Wolf et al Color Atlas of Dental Medicine 3 ed
10.James K. Avery Oral development and histology 3 ed
11.Jan Lindhe, 5th edition. Clinical Periodontology and Implant Dentistry
12. Louis . F . Rose et al Periodontics
13. Mark . P Bartold et al Molecular and Cell Biology of the Gingiva. Peridontology 2000 –
vol. 24, 2000: 28-55.
14.Scully Oral and mucosal tissues
15.S.N. Bhaskar, 11th edition. Orbans Oral Histology and Embryology

88. THANK YOU