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Gingiva
- 2. GINGIVA Dr. MANISHA SINHA 1ST YEAR MDS
- 3. CONTENTS INTRODUCTION DEFINITIONS PARTS OF GINGIVA MICROSCOPIC FEATURES CHARACTERISTICS OF DIFFERENT AREAS OF GINGIVAL EPITHELIUM RENEWAL OF GINGIVAL TISSUES CUTICULAR STRUCTURES ON TOOTH
- 4. GINGIVAL FLUID GINGIVAL CONNECTIVE TISSUE REPAIR OF GINGIVAL CONNECTIVE TISSUE BLOOD SUPPLY, LYMPHATICS AND NERVE SUPPLY CORRELATION OF CLINICAL AND MICROSCOPIC FEATURES CLINICAL CONSIDERATIONS Age changes CONCLUSION REFERENCES
- 5. Oral Mucosa Masticatory mucosa (subjected to high compression & friction as in gingiva & hard palate) Specialized mucosa (specifically in the regions of the taste buds on the dorsum of the tongue) Lining mucosa (not subjected to high levels of friction) Lines other parts of oral mucous membrane
- 6. The gingiva is the part of the oral mucosa that covers the alveolar processes of the jaws and surrounds the necks of the teeth • Acc. To textbook by Carranza The gingiva is that part of the masticatory mucosa which covers the alveolar process and surrounds the cervical portion of the teeth • Acc. To textbook by Jan Lindhe
- 7. The fibrous investing tissue, covered by keratinized epithelium, that immediately surrounds a tooth and is contiguous with its periodontal ligament and with the mucosal tissues of the mouth • Glossary of Periodontal Terms 2001
- 11. After enamel formation is complete, enamel is covered with REE . When tooth penetrates oral mucosa, REE unites with oral mucosa and transformed into JE. JE PROCEEDS IN APICAL DIRECTION, FORMING A SHALLOW GROOVE, THE GINGIVAL SULCUS
- 12. Absolutely normal/ideal = 0 mm Histologic sections = 1.8 mm Clinical probing depth = 2-3 mm
- 14. Maxilla Incisor region = 3.5 - 4.5 mm First premolar region = 1.9 mm Mandible Incisor region = 3.3 – 3.9 mm First premolar region = 1.8 mm
- 16. VISUAL METHOD FUNCTIONAL METHOD
- 27. GINGIVAL EPITHELIUM BASED ON MORPHOLOGIC AND FUNCTIONAL POINT OF VIEW: ORAL EPITHELIUM SULCULAR EPITHELIUM JUNCTIONAL EPTHELIUM
- 62. JUNCTIONAL EPITHELIUM ORAL EPITHELIUM Relative size of the cells compared to tissue volume is large Relative size of the cells compared to tissue volume is smaller Intercellular space relative to the tissue volume is wider Intercellular space relative to the tissue volume is narrower No. of desmosomes is less No. of desmosomes is more
- 63. HIGHER RATES LOWER RATES Morning Evening Non keratinized Keratinized Gingivitis Healthy gingiva
- 64. AREA TURNOVER RATE Palate, tongue and cheek 5-6 days Gingiva 10-12 days (may increase with age) Junctional epithelium 1-6 days
- 65. Cuticular structures Dev origin coatings Part of tooth development Acquired coatings Exogenous origin
- 68. Connectivetissue Collagen fibres (60%) Fibroblasts (5%) Vessels, nerves, matrix (35%)
- 90. As the age increases the width of the band of anatomical attached gingiva continues to increase due to continuous compensatory eruption of tooth/teeth. As a result the width of attached gingiva will continue to increase unless there is a concurrent reduction in height of gingival tissue due to Periodontal breakdown. Effects of Aging on Gingival Epithelium
- 91. Epithelium Thinning of epithelium Decreased keratinization gingival connective tissue Coarser and denser Rate of maturation changes Cellular elements Rate of collagen synthesis Soluble-insoluble collagen Mechanical strength Denaturaing temperature collagen stbilization Age changes
Editor's Notes
- Marginal gingiva is demarcated from attached gingiva by a shallow linear depression called free gingival groove. The gingival zenith is the most apical aspect of free gingival margin.
- Bounded by the surface of tooth on one side and the epithelium lining free gingiva on the other. It is V SHAPED. And it barely permits the entrance of probe.
- BETWEEN CIRCUMFERENCE OF TOOTH AND GINGIVA THAT ENCIRCLES THE NEWLY ERUPTED TIP OF CROWN. GINGIVAL SULCUS DEEPENS AS A RESULT OF SEPERATION OF REE FROM ACTIVELY ERUPTING TOOTH AND JE ATTAINS ITS POSITION AT CEJ OF FULLY ERUPTED TOOTH.
- ATTACHED GINGIVA EXTENDS TO RELATIVELY LOOSE AND MOVABLE MUCOSA FROM WHICH IT IS DEMARCATED BY MUCOGINGIVAL JUNCTION.
- DISTANCE BETWEEN MUCOGINGIVAL JUNCTION AND THE PROJECTION ON EXTERNAL SURFACE OF THE BOTTOM OF GINGIVAL SULCUS. WIDTH OF ATTACHED GINGIVA INCREASES WITH AGE AND IN SUPRAERUPTED TEETH. LINGUAL ASPECT TERMINATES AT JUNCTION WITH LINGUAL ALVELOR MUCOSA. PALATAL ASPECT TERMINATES WITH EQUALLY FIRM RESILIENT PALATAL MUCOSA.
- it can be examined by placing a probe horizontally flat against the mucosal surface and sliding it coronally.
- EMBRASURE- INTERPROXIMAL SPACE BENEATH THE AREA OF TOOTH CONTACT. CAN BE PYRAMIDAL OR HAVE A COL SHAPE. PYRAMIDAL – THERE IS ONE PAPILLA WITH ITS TIP IMMEDIATELY BENEATH CONTACT POINT. COL- A DEPRESSION THAT CONNECTS A FACIAL AND A LINGUAL PAPILLA AND CONFORMS SHAPE OF INTERPROXIMAL CONTACT.
- EMBRASURE- INTERPROXIMAL SPACE BENEATH THE AREA OF TOOTH CONTACT. CAN BE PYRAMIDAL OR HAVE A COL SHAPE. PYRAMIDAL – THERE IS ONE PAPILLA WITH ITS TIP IMMEDIATELY BENEATH CONTACT POINT. COL- A DEPRESSION THAT CONNECTS A FACIAL AND A LINGUAL PAPILLA AND CONFORMS SHAPE OF INTERPROXIMAL CONTACT.
- Keratinocytes are the principal cells of epithelium. St basale – germinativum, proliferation of keratinocytes take place by mitosis.st spinosum- prickle cell layer, st granulosm- granular cell layer, st corneum- keratinized cell layer DIFFERENTIATION CONSISTS OF A SEQUENCE OF BIOCHEMICAL AND MORPHOLOGIC EVENTS THAT OCCUR IN CELL AS IT MIGRATES FROM BASAL LAYER. The fully cornified keratinocytes that form the outermost layer are constantly shed off and replaced by new cells.
- PYKNOTIC NUCLEI IN STARTUM CORNEUM. CYTOKERATIN ARE MAJOR COMPONENT IN nonkeartinized EPITHELIA.
- Serve to provide mechanical linkages and distribute forces over a wide area, func as stress bearing, impt in maintaining cell shape. K1 keratin polypeptide of 68 kd is the main component of stratum corneum. CHARACTERISED BY THEIR ISOELECTRIC POINT AND THEIR MOLECULAR WEIGHT. LOW MOL WE- K19 40 KD
- Serve to provide mechanical linkages and distribute forces over a wide area, func as stress bearing, impt in maintaining cell shape
- For e.g. suprabasal layers of masticatory mucosa – CK 1 and 10, lining - 4, 13
- CORNEOCYTES ARE FORMED BY BUNDLES OF KERATIN TONOFILAMENTS EMBEDDED IN AN AMOPHOUS MATRIX OF FILLAGGRIN AND A RESISTANT ENVELOPE.
- TRICARBOXYLIC CYCLE MORE ACTIVE IN BASAL AND PARABASAL CELL. PROXIMITY OF BLOOD SUPPLY FACILITATE ENERGY PRODUCTION.
- IT’S AN ENZYME FOR PENTOSE SHUNT. IT PROVIDES A LARGE AMOUNT OF INTERMEDIATE PRODUCT FOR PRODUCTION OF RNA.
- These desmosomes have a typical structure consisting of two dense attachment plaques into which tonofibrils insert and an intermediate , electron dense line in extracellular compartment. Tonofilaments radiate in brush like fashion from attachment plaques into cytoplasm of cell
- ARE DENDRITIC CELLS LOCATED IN BASAL N SUPRABASAL CELL LAYER. SYNTHESIZE MELANIN IN ORGANELLES CALLED PREMELANOSOMES OR MELANOSOMES. are found interspersed between the keratinocytes of the epithelium and produce considerable amounts of melanin
- ARE DENDRITIC CELL AT ALL SUPRABASAL LAYER. BELONG TO MONONUCLEAR PHAGOCYTE SYSTEM AS MODIFIED MONOCYTES DERIVED FROM BONE MARROW. ANTIGEN PRESENTING CELL has birbeck GRANULES which HAS ADENOSINE TRIPHOSPHATASE ACTIVITY.
- IN DEEPER LAYER OF EPITHELIUM, HARBOUR NERVE ENDING AND ARE CONNECTED TO ADJACENT CELL BY DESMOSOMES. AS TACTILE RECEPTORS. Merkel cells are located in clusters at the tips of rete ridges of gingival oral epithelium
- BASAL LAMINA 300 TO 400 ANGSTORM THICK. It consists of lamina lucida and densa. Layer towards epithelium is lucida and towards connective tissue is densa. HEMIDESMOSOMES ABUT LUCIDA WHICH IS COMPOSED OF GLYCOPROTEIN LAMININ. LAMINA DENSA COMPOSED OF TYPE 4 COLLAGEN.
- As the tooth erupts into oral cavity, the cuboidal cells cover the newly formed crown to the level of the cementoenamel junction. These cells covering the newly formed crown originate from ameloblasts and cells of the str intermedium of the enamel organ, and are termed as REE.. As the tooth begins to erupt, the epithelial layers covering the tooth crown fuse with the oral epithelium
- . Following this, the crown becomes exposed to the oral cavity and the developing tooth now becomes fully transgingival. The newly breeched oral epithelium appears to have fused to the epithelial covering of the enamel organ and forms a continuum of epithelial tissue apically along the crown surface to the level of the cementoenamel junction.
- With continuing tooth eruption, the conversion of the reduced enamel epithelium into junctional epithelium continues, and the formation of the gingival sulcus begins to become apparent. Because the postsecretory ameloblasts of the reduced enamel epithelium are terminally differentiated, they have no capacity to divide and thus do not contribute to future generations of junctional epithelium cells. stratum intermedium of the enamel organ, retain their ability to proliferate and provide the parent source of future generations of junctional epithelial cells.
- Means it is used to describe a thin acellular structure with a homogenous matrix sometimes enclosed within clearly demarcated linear borders. Dental cuticle consists of a layer of homogenous organic material of variable thickness overlying the enamel surface. Tooth development- REE, coronal cementum, dental cuticle. Exogenous origin- saliva, bacteria,calculus,surface stains.
- CELLULAR ELEMENTS- BACTERIA, DESQUAMATED EPITHELIAL CELLS AND LEUKOCYTES ELECTROLYTES- POTASSIUM,SODIUM,AND CALCIUM ORGANIC COMPOUNDS- CARBOHYDRATES AND PROTEINS.
- Papillary layer- subjacent to epithelium that consists of papillary projection between epithelial rete pegs. Reticular layer- contiguous with periosteum of alveolar bone.
- Arterioles that emerge from crest of interdental septa. Vessels of periodontal ligament. Supra periosteal arterioles along facial and lingual surfaces of alveolar bone.
- Lighter in blond individuals with a fair complexion.
- Diffuse deep purplish discoloration or as irregularly shaped brown and light brown patches..
- ON SHAPE OF TEETH AND THEIR ALIGNMENTIN ARCH , LOCATION AND SIZE OF AREA OF PROXIMAL CONTACT AND DIMENSION OF FACIAL AND LINGUAL GINGIVAL EMBRASURE.
- CONTOUR OF PROXIMAL TOOTH SURFACE AND LOCATION AND SHAPE OF GINGIVAL EMBRASURE.
- LIKE AN ORANGE PEEL APPEARANCE. IT IS VIEWED BY DRING GINGIVA. ATTACHED GINGIVA IS STIPPLED MARGINAL GINGIVA IS NOT. CENTRAL PORTION OF INTERDENTAL PAPILLAE IS STIPPLED AND MARGINAL BORDERS ARE SMOOTH. LESS PROMINENT IN LINGUAL SIDE THAN ON FACIAL SURFACE. PRODUCED BY ALTERNATE ROUNDED PROTUBERANCE AND DEPRESIONS IN GINGIVAL SUR FACE.
- ACTIVE- MOVEMENT OF TOOTH IN DIRECTION of occlusal plane.. PASSIVE- EXPOSURE OF TEETH BY APICAL MIGRATION OF GINGIVA. Crown- portion of tooth covered by enamel. ROOT- PORTION OF TOOTH COVERED BY CEMENTUM. CLINICAL CROWN- PART OF TOOTH THAT HAS BEEN DENUDED OF ITS GINGIVA AND PROJECTS INTO ORAL CAVITY. CLINICAL ROOT- PORTION OF TOOTH COVERED BY PERIODONTAL TISSUES.
- Base of gingival sulcus and JE ARE on the enamel. Base of sulcus on enamel and part of JE on the root. Base of gingival sulcus is at the cementoenamel line. Base of SULCUS and JE ON ROOT.
- Biologic width- physiologic dimension of junctional epithelium and connective tissue above the level of alvelor crest.
- Papilla- it is a swelling on the inside of mandibular gingiva regarded as a normal anatomical variant,seen most commonly in children. Synonm- retrocuspid papule It is a smooth soft well defined round or oval swelling usualyy near canine teeth about 1 mm below free gingival margin.
- Gingiva forms an inevitable part of the periodontium. It supports the teeth and aids in maintaining the integrity of the teeth in function. The gingival tissues, with their specialized relationship to the tooth surface, constitute a major peripheral defense against microbial infections.