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Clinical Features of Gingivitis
(Plaque-induced gingivitis)
Khalid S. Hassan
BDS,MSc,PhD ,Assist. Prof.
Department of PDS,...
Clinical Criteria of Healthy Gingiva
coral pink (alveolar mucosa is red )Color:-1
-Variation in color [degree of keratiniz...
•Course and Duration:
Acute gingivitis: painful condition,
sudden onset, and short duration.
Sub-acute gingivitis: less se...
Chronic Gingivitis
Def. It is a simple and long-standing inflammation of
the gingiva (gingivitis may exist for years
witho...
Chronic localized marginal
gingivitis
Chronic generalized marginal
gingivitis
Generalized diffuse gingivitis
Etiology:-
1-Local initiating factor (Dental Plaque).
2- Local predisposing factors.
3- Systemic factors
* Puberty
* Pregn...
Etiology of Periodontal Diseases
Bacterial plaque Host response Reparative tissue capacity
Factors upset the
balance By
In...
Bacteria associated with
Gingivitis
Gr+ve species
S. Sangus
S. Mitis
S. Intermedius
S. Oralis
A . Viscosus
A . Naeslundii
...
Clinical Features
1- Color: - Red V.D. of capillary bed, keratinization
- Bluish-red b1. stasis
- Cyanotic 02 tension
N.B:...
Factors affecting the color
• Endogenous Factors ( systemic factors):
- melanin , bilirubin or iron.
- examples : Addison ...
Metallic Pigmentation
Bismuth Lead Mercury Others
Bluish-black
pigmentation
of gingival
margin(liner)
-Liner pig. of
gingi...
Bismuth gingivitis ( bluish black
line on margin)
Due to
edema
and
inflam.
infiltrate
•2-Contour:
-Free gingiva thick and rounded
-Att. gingiva loss of interradicular
groov...
Plaque-induced gingivitis
Fibrotic gingival inflammation
Crater-licke depression papilla (NUG)
3-Consistency:- Soft( Spongy) and
edematous (in fibrosis firm)
Chronic gingivitis:
Clinical changes Histopathology
Pits on...
4- Surface texture:- Loss of stippling due to
-Stagnation of circulation
-Accumulation of inflammatory exudates
-Degenerat...
•6- Gingival Bleeding on Probing:-
- indicates an inflammatory lesion in the
epith. and CT.
- due to - Ulceration of sulcu...
Acute gingival bleeding
• Caused by injury or occur spontaneously in
acute gingival disease.
• Laceration of the gingiva b...
Gingival Bleeding Associated with
Systemic Factors
• Occurs spontaneously or after irritation.
• Excessive and difficult t...
How do to determine
bleeding on probing
Insertion of a probe in gingival
sulcus
Bleeding appears 30 second after probing
Generalized gingival bleeding on
probing
•7-Pain:
- Chronic gingivitis is usually painless
unless complicated by acute
exacerbation.
- Chronically inflamed gingiva...
•Stillman’s Cleft:
-Described by Stillman.
-Is apostrophe-shaped indentation on
gingival margin.
- Is a specific type of g...
•McCall’s Festoons:
Enlargement of the gingival margin in the
canine and premolar area on the facial
surface.
In the early...
Histopathology:-
1- Inflammatory cell infiltration
2- Ulceration of sulcular epi.
3-Inter and intra-cellular edema.
4- Fib...
Chronic gingivitis
Chronic gingivitis
Chronic gingivitis
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Chronic gingivitis

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Preventive Periodontics

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Chronic gingivitis

  1. 1. Clinical Features of Gingivitis (Plaque-induced gingivitis) Khalid S. Hassan BDS,MSc,PhD ,Assist. Prof. Department of PDS, Periodontics
  2. 2. Clinical Criteria of Healthy Gingiva coral pink (alveolar mucosa is red )Color:-1 -Variation in color [degree of keratinization, vascularity, pigmentation and thickness of epi). -Contour:-2 -Free gingiva thin and end in a knife like edge -Attach gingiva scalloped elevations related to roots and depression in the interradicular areas interradicular groove. -Interdental papillae pointed and fill the inter proximal space under contact area. -papillae (OrangeinterdentalStippling in attach. gingiva and base of-:textureSuface-3 peel appearance) (Firmly attached to the teeth and underling alveolarresillentFirm and-:Consistency-4 bone except free gingiva). mm-3mm not exceed2-5.0-Depth of gingival sulcus:-5 .transudate:Type of gingival fluid-6
  3. 3. •Course and Duration: Acute gingivitis: painful condition, sudden onset, and short duration. Sub-acute gingivitis: less severe than acute gingivitis. Recurrent gingivitis: reappear after treatment. Chronic gingivitis: comes in slowly, is of long duration, and painless.
  4. 4. Chronic Gingivitis Def. It is a simple and long-standing inflammation of the gingiva (gingivitis may exist for years without change to periodontitis) Types. 1- Localized 2- Generalized Distribution of inflammation:- 1- Papillary (localized or generalized) 2- Marginal (localized or generalized) 3- Diffuse (localized or generalized)
  5. 5. Chronic localized marginal gingivitis
  6. 6. Chronic generalized marginal gingivitis
  7. 7. Generalized diffuse gingivitis
  8. 8. Etiology:- 1-Local initiating factor (Dental Plaque). 2- Local predisposing factors. 3- Systemic factors * Puberty * Pregnancy * Diabetes * Vit. C deficiency
  9. 9. Etiology of Periodontal Diseases Bacterial plaque Host response Reparative tissue capacity Factors upset the balance By Increasing aggression of bacterial plaque Decreasing defense mechanisms Local Predisposing Factors Systemic Factors 1- Calculus 2- Material alba 3- Food debris 4- Food impaction 5- Food retention 6- Faulty dentistry 7- Malocclusion 8- Mouth breathing 9- Trauma from occlusion * Overhanging filling * Over and under contoured crowns * Occlusal disharmony * Orthodontic wires * Rough fillings * Open contact 1- Hormonal imbalance 2- Nutritional deficiency 3- Blood diseases 4- Genetics 5- Immunologic 6- Metallic intoxication 7- Debilitating diseases 8- Psychologic
  10. 10. Bacteria associated with Gingivitis Gr+ve species S. Sangus S. Mitis S. Intermedius S. Oralis A . Viscosus A . Naeslundii Peptostrepococcus Gr-ve species F. Nucleatum P.intermedia Haemophilus Capnocytophaga
  11. 11. Clinical Features 1- Color: - Red V.D. of capillary bed, keratinization - Bluish-red b1. stasis - Cyanotic 02 tension N.B:- in healing by fibrosis pale pink. -In acute gingivitis the color change may be marginal as in NUG ,diffuse as in acute herpetic gingivostomatitis or patch-like due to chemical irritation. -In severe acute gingivitis, the red color change to a shiny gray then to whitish gray due to necrosis.
  12. 12. Factors affecting the color • Endogenous Factors ( systemic factors): - melanin , bilirubin or iron. - examples : Addison disease bluish black to brown. - Peutz-jeghers syndrome melanin pigmentation. - Albright’s syndrome melanin pigmentation. • Exogenous Factors: - Metal dust. - Coloring agents in food. - Lozenges. - Tobacco. - Amalgam tattoo.
  13. 13. Metallic Pigmentation Bismuth Lead Mercury Others Bluish-black pigmentation of gingival margin(liner) -Liner pig. of gingival margin. (Burtonian line) -Steel gray -Liner to diffuse grayish gingival pigmentation -Ulceration of gingiva -e.g.: phosphorous, arsenic & chromium -Bluish gray line. -Necrosis of alveolar bone loosening of teeth -Inflammation and ulceration of gingiva.
  14. 14. Bismuth gingivitis ( bluish black line on margin)
  15. 15. Due to edema and inflam. infiltrate •2-Contour: -Free gingiva thick and rounded -Att. gingiva loss of interradicular grooves -Interdental papilla blunt ,bulbous, convex labiolingually & bulging out inbetween the embrasure. NB.- Interdental papilla in NUG Crater like depression. - In the interproximal space appear as flat papilla.
  16. 16. Plaque-induced gingivitis
  17. 17. Fibrotic gingival inflammation
  18. 18. Crater-licke depression papilla (NUG)
  19. 19. 3-Consistency:- Soft( Spongy) and edematous (in fibrosis firm) Chronic gingivitis: Clinical changes Histopathology Pits on pressure infiltration by fluid and cells of inflammatory exudates. Softness and friability degeneration of CT and epi. Firm fibrosis and epi. Proliferation with long-standing chronic inflammation.
  20. 20. 4- Surface texture:- Loss of stippling due to -Stagnation of circulation -Accumulation of inflammatory exudates -Degeneration of gingival fibers 5- Position of gingiva:- gingival margin change to coronal position deeping of gingival sulcus without apical migration of epi. attachment gingival pocket (pseudo-pocket- relative pocket). -Actual position: is the level of the epi. attachment on the tooth. -Apparent position: is the level of the crest of the gingival margin. -The position of gingiva is determined by the actual position, not the apparent position.
  21. 21. •6- Gingival Bleeding on Probing:- - indicates an inflammatory lesion in the epith. and CT. - due to - Ulceration of sulcular epithelium. - Thinning and degeneration of epi. - Increase vascularity. - Dilatation of the capillaries.
  22. 22. Acute gingival bleeding • Caused by injury or occur spontaneously in acute gingival disease. • Laceration of the gingiva by aggressive tooth brushing or sharp pieces of hard food causes bleeding even in the absence of gingival diseases. • Spontaneous bleeding or on minor trauma occurs in NUG.
  23. 23. Gingival Bleeding Associated with Systemic Factors • Occurs spontaneously or after irritation. • Excessive and difficult to control. • Occurs in other organs e.g. skin , internal organs. • Examples : Vit. C deficiency. - Thrombocytopenic purura. - Vit K deficiency. - Hemophilia . - Leukemia. - Some medications.
  24. 24. How do to determine bleeding on probing
  25. 25. Insertion of a probe in gingival sulcus
  26. 26. Bleeding appears 30 second after probing
  27. 27. Generalized gingival bleeding on probing
  28. 28. •7-Pain: - Chronic gingivitis is usually painless unless complicated by acute exacerbation. - Chronically inflamed gingiva may be painful on instrumentation (scaling and root planning).
  29. 29. •Stillman’s Cleft: -Described by Stillman. -Is apostrophe-shaped indentation on gingival margin. - Is a specific type of gingival recession. -Generally occur on the facial surface. -Considered to be the result of occlusal trauma. -The margins of the clefts are rolled. - Clinical significant: difficult to maintain plaque control.
  30. 30. •McCall’s Festoons: Enlargement of the gingival margin in the canine and premolar area on the facial surface. In the early stages, the color and consistency are normal. Clinical significance: accumulation of food debris leads to secondary inflammatory changes.
  31. 31. Histopathology:- 1- Inflammatory cell infiltration 2- Ulceration of sulcular epi. 3-Inter and intra-cellular edema. 4- Fibrosis in longstanding inflammation Treatment:- 1- Thorough scaling. 2- Removal of local factors. 3- Plaque control and oral hygiene instruction. Prognosis:- Excellent

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