This document provides an overview of the clinical features of gingivitis. It discusses gingival bleeding on probing as a key clinical sign of gingivitis. Local factors like plaque, calculus and trauma as well as systemic factors like certain medications and diseases can cause gingival bleeding. The color of inflamed gingiva changes from normal coral pink to red or bluish-red due to increased vascularization and reduced keratinization. Types of gingivitis are classified based on duration, distribution, and description. Chronic gingivitis is the most common form characterized by a slow onset and long duration without pain.

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CLINICAL FEATURES OF
GINGIVITIS
DONE BY
DR.S.S.YASMIN PARVIN, POSTGRADUATE STUDENT
DEPARTMENT OF PERIODONTICS
MADHA DENTAL COLLEGE AND HOSPITAL

2. CONTENTS:
1.COURSE AND DURATION
2.DESCRIPTION
3.CLINICAL FINDINGS
. GINGIVAL BLEEDING ON PROBING
. GINGIVAL BLEEDING CAUSED BY LOCAL
FACTORS
.GINGIVAL BLEEDING ASSOCIATED
WITH SYSTEMIC FACTORS.
4.COLOUR CHANGES IN GINGIVA

3. CONTENTS:
5.COLOUR CHANGES ASSOCIATED WITH
SYSTEMIC FACTORS
6.CHANGES IN CONSISTENCY OF GINGIVA
7.CHANGES IN SURFACE TEXTURE OF
GINGIVA
8.CHANGES IN POSITION OF GINGIVA
9.CHANGES IN GINGIVAL CONTOUR.

4. DEFINITION OF GINGIVA:

5. STRUCTURE OF GINGIVA:

6. HEALTHY GINGIVA:

7. HEALTHY GINGIVA:

8. HEALTHY GUMS VS UNHEALTHY GUMS:

9. GINGIVAL LANDMARKS:

10. DEFINITION OF GINGIVITIS:
• INFLAMMATION OF GINGIVA IS
TERMED AS GINGIVITIS.
•Gingivitis is a non-
destructive disease that
occurs around the teeth

11. CLINICAL FEATURES OF GINGIVITIS
MAY BE CHARACTERISED BY THE
PRESENCE OF FOLLOWING CLINICAL
SIGNS:
• 1.REDNESS AND SPONGINESS OF THE
GINGIVAL TISSUE.
• 2.BLEEDING ON PROVOCATION.
• 3.CHANGES IN CONTOUR
• 4.PRESENCE OF PLAQUE OR CALCULUS
WITH NO RADIOGRAPHIC EVEDIENCE OF
CRESTAL BONE LOSS.

12. GINGIVITIS:

13. TYPES OF GINGIVITIS:
DEPENDING ON COURSE AND
DURATION
DEPENDING ON
DISTRIBUTION

14. DEPENDING ON
COURSE &
DURATION:
1.ACUTE GINGIVITIS
2.SUBACUTE
GINGIVITIS
3.RECURRENT
GINGIVITIS
4. CHRONIC
GINGIVITIS
DEPENDING ON
DISTRIBUTION:
1.MARGINAL
2.PAPILLARY
3.DIFFUSE
4.LOCALIZED
5.GENERALIZED

15. TYPES OF GINGIVITIS:BASED ON
COURSE AND DURATION:
• ACUTE GINGIVITIS:
• - SUDDEN ONSET
• -SHORT DURATION
• -PAINFUL
• SUB-ACUTE : LESS SEVERE FORM OF ACUTE
GINGIVITIS.
• RECURRENT GINGIVITIS:
• REAPPEARS AFTER HAVING BEEN ELIMINATED
BY TREATMENT
• -OR DISAPPEARS SPONTANEOUSLY

16. TYPES OF GINGIVITIS:BASED ON
COURSE AND DURATION:
• CHRONIC GINGIVITIS:
• -MOST OFTEN ENCOUNTERED FORM
• -SLOW IN ONSET
• -LONG DURATION
• -PAINLESS CONDITION
• -UNLESS COMPLICATED BY ACUTE OR SUBACUTE
EXACERBATION
• FLUCTUATING DISEASE IN WHICH INFLAMMATION
PERSISTS OR RESOLVES
• AND THE NORMAL AREAS BECOME INFLAMED

17. CHRONIC GINGIVITIS:

18. TYPES OF GINGIVITIS: BASED ON
DESCRIPITION:
• 1.LOCALIZED GINGIVITIS:
• -CONFINED TO GINGIVA OF SINGLE TOOTH OR
GROUP OF TEETH.
• 2.GENERALIZED GINGIVITIS:
• -INVOLVES THE ENTIRE MOUTH
• 3.MARGINAL GINGIVITIS:
• -INVOLVES GINGIVAL MARGIN
• -MAY INVOLVE A PORTION OF THE CONTIGUOUS
ATTACHED GINGIVA

19. TYPES OF GINGIVITIS: BASED ON
DESCRIPITION
• 4.PAPILLARY GINGIVITIS:
• -INVOLVES INTERDENTAL PAPILLAE
• -OFTEN EXTEND INTO THE ADJACENT PORTION
OF GINGIVAL MARGIN
• -PAPILLAE ARE MORE FREQUENTLY INVOLVED
THAN THE GINGIVAL
• 5.DIFFUSE GINGIVITIS:
• -INVOLVES GINGIVAL MARGIN
• -ATTACHED GINGIVA
• -INTERENTAL PAPILLAE

20. NAMES OF GINGIVAL DISEASES
• 1.LOCALIZED MARGINAL GINGIVITIS:
• CONFINED TO ONE OR MORE AREAS OF
MARGINAL GINGIVA.
• 2.LOCALIZED DIFFUSE GINGIVITIS:EXTEND
FROM MARGINS TO MUCCOBUCCAL FOLD IN
A LIMITED AREA.
• 3.LOCALIZED PAPILLARY GINGIVITIS:
• CONFINED TO ONE OR MORE INTERDENTAL
SPACES IN A LIMITED AREA.

21. NAMES OF GINGIVAL DISEASES
• 4.GENERALIZED MARGINAL GINGIVITIS:
• INVOLVES GINGIVAL MARGIN IN REALTION
OF ALL TEETH.THE INTERDENTAL PAPILLAE
ARE USUALLY AFFECTED.
• 5.GENERALIZED DIFFUSE GINGIVITIS:
• INVOLVES THE ENTIRE GINGIVA., ALVEOLAR
MUCOSA ,MUCOGINGIVAL JUNCTION IS
OBLITERATED.

22. GENERALIZED MARGINAL GINGIVITIS:

23. LOCALIZED DIFFUSE GINGIVITIS:

24. GENERALISED PAPILLARY GINGIVITIS:

25. GENERALISED MARGINAL & PAPILLARY
GINGIVITIS:

26. GENERALISED DIFFUSE GINGIVITIS:

27. CHRONIC DIFFUSE GINGIVITIS:

28. CHRONIC LOCALIZED MARGINAL
GINGIVITIS:

30. STAGES OF GINGIVITIS:

32. STAGES OF INFLAMMATION

34. PATHOLOGY OF GINGIVITIS:

35. EARLIEST SIGN OF GINGIVITIS:
• INCREASED GINGIVAL
CREVICULAR FLUID
PRODUCTION RATE.
• BLEEDING ON PROBING FROM
GINGIVAL SULCUS.

36. GINGIVAL BLEEDING ON PROBING

37. GINGIVAL BLEEDING ON PROBING:
• 1.SIGNIFICANCE OF GINGIVAL
BLEEDING ON PROBING
• 2.ETIOLOGICAL FACTORS
• 3.ASSOCIATED MICROSCOPIC
FEATURES

38. BLEEDING ON PROBING:

39. GINGIVAL BLEEDING ON PROBING
GINGIVAL BLEEDING CAUSED
BY LOCAL FACTORS
GINGIVAL BLEEDING ASSOCIATED
WITH SYSTEMIC FACTORS

40. GINGIVAL BLEEDING ON PROBING
• 1.EARLIEST VISUAL SIGN OF INFLAMMATION
• 2.OBJECTIVE SIGN THAN LESS SUBJUCTIVE
ESTIMATION BY EXAMINER
• 3.ACTIVE LESION- BLEEDING ON PROBING
INACTIVE LESION – NO BOP
• 4.SEVERITY AND EASE OF INFLAMMATION –
INTENSITY OF INFLAMATION.

41. GINGIVAL BLEEDING ON PROBING:
• BLEEDING ON PROBING IS WIDELY USED BY
CLINICIANS AND EPIDOMOLOGISTS TO
MEASURE DISEASE PREVALENCE AND
PROGRESSION , TO MEASURE OUTCOMES OF
TREATMENT AND TO MOTIVATE PATIENTS
WITH HOMECARE.

42. GINGIVAL BLEEDING ON PROBING:
• INDICATES
• 1.INFLAMMATORY LESION BOTH IN THE
EPITHELIUM AND CONNECTIVE TISSUE THAT
EXHIBITS HISTOLOGIC
DIFFERENCESCOMPARED WITH HEALTHY
GINGIVA.

43. GINGIVAL BLEEDING ON PROBING:
• NOT A GOOD DIAGNOSTIC INDICATOR FOR
CLINICAL ATTACHMENT LOSS
• ITS ABSENCE IS AN EXCELLENT NEGATIVE
PREDICTOR OF FUTURE ATTACHMENT LOSS.
• THEREFORE THE ABSENCE OF GINGIVAL
BLEEDING ON PROBING IS DESIRABLE AND
IMPLIES A LOW RISK OF FUTURE CLINICAL
ATTACHMENT LOSS.

44. GINGIVAL BLEEDING IN SMOKERS:
• CIGARETTE SMOKING SUPPRESSES THE
GINGIVAL INFLAMMATORY RESPONSE.
• SMOKING WAS FOUND TO EXERT A STRONG
CHRONIC, DOSE- DEPENDANT SUPPRESSIVE
EFFECT ON GINGIVAL BLEEDING ON
PROBING.
• ALSO THERE IS INCREASE IN GINGIVAL
BLEEDING ON PROBING IN PATIENTS WHO
QUIT SMOKING.

45. GINGIVAL BLEEDING ON PROBING:
GINGIVAL BLEEDING
CAUSED BY LOCAL
FACTORS
GINGIVAL BLEEDING
ASSOCIATED WITH
SYSTEMIC CHANGES

46. GINGIVAL BLEEDING ON PROBING
• ETIOLOGICAL FACTORS:
• 1.LOCAL FACTORS
A.ACUTE
1.TOOTHBRUSH
TRAUMA
2.IMPACTION
3.GINGIVAL BURNS
4.ANUG
B.CHRONIC
1.PLAQUE AND
CALCULUS
2.MECHANICAL
TRAUM3.BITING
INTO SOLID FOODS

47. GINGIVAL BLEEDING ON PROBING
2.SYSTEMIC FACTORS OF GINGIVAL
BLEEDING:
PLATELET
DISORDERS
A.THROMBOCY
TOPENIC
PURPURA
A. HAEMORRHAGIC
DISEASES –
VITAMIN C
DEFICIENCY,
VITAMIN K
DEFICIENCY,
COAGULATION
DEFECTS:
HEMOPHILIA
LEUKEMIA

48. GINGIVAL BLEEDING CAUSED BY
LOCAL FACTORS
• 1.ANATOMIC AND DEVELOPEMENTAL TOOTH
VARIATIONS.
• 2.CARIES
• 3.FRENUM PULL.
• 4.IATROGENIC FACTORS.
• 5.MALPOSISTENED TEETH
• 6.MOUTH BREATHING
• 7.OVERHANGS
• 8.PARTIAL DENTURES.
• 9.LACK OF ATTACHED GINGIVA
• 10.RECESSION

49. CHRONIC AND RECURRENT BLEEDING
• COMMON CAUSE OF ABNORMAL BLEEDING
IS CHRONIC INFLAMMATION.
• BLEEDING IS CHRONIC OR RECURRENT AND
IS PROVKED BY MECHANICAL TRAUMA SUCH
AS TOOTHBRUSHING, TOOTHPICKS, FOOD
IMPACTIONS, BITING INTO SOLID FOODS
SUCH AS APPLE.

50. • SITES THAT BLEED ON PROBING HAVE A
GREATER AREA OF INFLAMED CONNECTIVE
TISSUE THAN SITES THAT DO NOT BLEED
,THAT IS CELLS RICH , COLLAGEN POOR
TISSUE.
• CELLULAR INFILTRATE OF SITES THAT BLEED
ON PROBING IS PREDOMINANTLY
LYMPHOCYTIC- CHARACTERISTIC OF STAGE II
EARLY GINGIVITIS.

51. •SEVERITY OF BLEEDING
AND THE EASE OF ITS
PROVOCATION DEPEND
ON THE INTENSITY OF THE
INFLAMMATION.

52. • VESSELS ARE DAMAGED AND RUPUTURED.
• INTERRELATED MECHANISM INDUCE HOMEOSTAIS.
• VESSEL WALL CONTRACT , BLOOD FLOW DIMINISHED
• BLOOD PLATELETS ADHERE TO THE EDGES OF THE
TISSUE

53. • FIBROUS CLOT IS FORMED, WHICH
CONTRACTS AND RESULTS IN
APPROXIMATION OF THE EDGES OF THE
INJURED TISSUE.
• BLEEDIND RECURS WHEN AREA IS IRRITATED.

54. • ACUTE EPISODES OF GINGIVAL BLEEDING ARE
CAUSED BY INJURY & CAN OCCUR
SPONTANEOUSLY IN GINGIVAL DISEASE.
• LACERATION OF THE GINGIVA BY
TOOTHBRUSH BRISTLES DURING AGGRESSIVE
TOOTHBRUSHING OR BY SHARP PIECES OF
HARD FOOD CAN CAUSE GINGIVAL BLEEDING
EVEN IN THE ABSENCE OF GINGIVAL
DISEASES.

55. • GINGIVAL BURNS FROM HOT FOODS OR
CHEMICAL INCREASE THE EASE OF GINGIVAL
BLEEDING.
• IN ANUG-ENGORGED BLOOD VESSELS IN THE
INFLAMED CONNECTIVE TISSUE ARE
EXPOSED BY ULCERATION OF THE NECROTIC
SURFACE EPITHELIUM.

56. GINGIVAL BLEEDING ASSOCIATED
WITH SYSTEMIC CHANGES:
• SOME SYSTEMIC DISEASE – GINGIVAL
HAEMORRHAGE OCCURS SPONTANEOUSLY OR
AFTER IRRITATION AND IS EXCESSIVE AND
DIFFICULT TO CONTROL.
HAEMORRHAGIC DISORDERS:
VASCULAR ABNORMALITIES:
1.VITAMIN C DEFICIENCY
ALLERGY
SCHONLEIN-HENOCH PURPURA
PLATELETS DISORDERS:
1.THROMBOCYTOPENIA PURPURA
HYPOPROTHROBINEMIA
1.VITAMIN –K DEFICIENCY
OTHER COAGULATION DEFECTS:
1.HAEMOPHILIA
2.LEUKEMIA
3.CHRISTMAS DISEASE
DEFICIENT PLATELET
THROMBOPLASTIC FACTOR(PF3)-
FROM UREMIA
MULTIPLE MYELOMA
POSTRUBELLA PURPURA

57. GINGIVAL BLEEDING AFFECTED BY
THE FOLLOWING:
1.ORAL CONTRACEPTIVES.
2.HORMONAL REPLACEMENTAL THERAPY
3.PREGNANCY.
4.MENSTRUAL CYCLE.
5.CHANGES IN ANDROGENIC HARMONE.
6.FLUCTUATING ESTROGEN/PROGESTERONE
LEVELS STARTING AS EARLY AS PUBERTY.
7.PATHOLOGIC ENDOCRINE CHANGES- eg:
DIABETES.

58. EFFECT OF MEDICATION ON GINGIVA:
• GINGIVAL ENLARGEMENT CAUSED BY
• 1.ANTO-CONVULSANTS
• 2.ANTIHYPERTENSIVE CALCIUM CHANNEL
BLOCKERS
• 3.IMMUNOSUPPRESANT DRUGS.
• WHICH CAUSE SECONDARY BLEEDING.

59. • OVER THE COUNTER CARDIOVASCULAR DRUG-
ASPIRIN IS PRESCRIBED FOR
• 1.RHEUMATOID ARTHRITIS
• 2.OSTEOARTHRITIS
• 3.RHEUMATIC FEVER
• 4.OTHER INFLAMMATORY JOINT DISEASES
• SO ITS IMPORTANT TO CONSIDER ASPIRIN EFFECT ON
BLEEDING DURING ROUTINE DENTAL EXAMINATION
TO AVOID FALSE POSITIVE READING RESULTING IN
INACCURATE PATIENT DIAGNOSIS.

60. CLINICAL FEATURES OF GINGIVA:

61. CHANGES IN COLOUR OF GINGIVA
• IMPORTANT CLINICAL SIGN
• COLOUR OF GINGIVA IS MODIFIED BY
FOLLOWING FACTORS
• 1.TISSUE VASCULARITY
• 2.DEGREE OF KERATINIZATION.
• 3.THICKNESS OF EPITHELIUM
4.PIGMENTATION WITHIN THE
EPITHELIUM.

62. COLOUR CHANGES IN GINGIVITIS:
• CHANGE IN COLOUR IS AN IMPORTANT
CLINICAL SIGN OF GINGIVAL DISEASE.
• NORMAL GINGIVAL COLOUR IS CORAL PINK-
IS PRODUCED BY THE TISSUE VASCULARITY
AND OVER LYING EPITHELIUM.

63. • GINGIVA BECOMES RED:
1.WHEN VASCULARISATION INCREASES
2.DEGREES OF EPITHELIAL KERATINIZATION IS
REDUCED OR DISAPPEARS.
GINGIVA BECOMES PALE:
1.WHEN VASCULARIZATION IS REDUCED – IN
ASSOCIATION WITH FIBROSIS OF THE
CORIUM.
2.EPITHELIAL KERATINIZATION INCREASES

64. BISMUTH GINGIVITIS

65. CHANGES IN COLOUR OF GINGIVA
• CHRONIC INFLAMMATION INTENSIFIES RED
OR BLUISH RED COLOUR BECAUSE OF
VASCULAR PROLIFERATION AND REDUCTION
OF KERATINIZATION.
• VENOUS STASIS WILL CONTRIBUTE A BLUISH
HUE.
• CHANGES START IN THE INTERDENTAL
PAPILLAE AND GINGIVAL MARGIN & SPREAD
TO ATTACHED GINGIVA.

66. • COLOUR CHANGES MAY BE MARGINAL
,DIFFUSE, PATCHLIKE DEPENDING ON THE
ACUTE UNDERLYING CONDITION.
• IN ANUG- INVOLVEMENT IS MARGINAL
• HERPETIC GINGIVOSTOMATITIS- IT IS
DIFFUSE.
• ACUTE REACTION TO CHEMICAL IRRITATION-
PATCHLIKE OR DIFFUSE.

67. COLOUR CHANGES VARY WITH
INTENSITY OF INFLAMMATION:
• INITIALLY THERE IS INCREASE IN ERYTHEMA.
• IF THE CONDITION DOES NOT WORSEN, THEN
THE GINGIVA REVERTS TO NORMAL.
• IN SEVERE ACUTE INFLAMMATION, RED
COLOUR GRADUALLY BECOMES DULL,WHITISH
GRAY.
• GRAY DISCOLOURATION PRODUCED BY TISSUE
NECROSIS IS DEMARCATED FROM THE
ADJACENT GINGIVA BY THIN ,SHARPLY DEFINED
ERYTHEMATOUS ZONE.

68. METALLIC PIGMENTATION:

70. COLOUR CHANGES ASSOCIATED WITH
SYSTEMIC FACTORS:

72. CHANGES IN COLOUR OF GINGIVA
• CHANGES
• 1.RED-INCREASED VASCULARITY
• 2.BLUISH –VENOUS STASIS
• 3.PALE PINK- DECREASED VASCULARITY
STARTS FROM INTERDENTAL
SPREADS TO MARGINAL AND ATTACHED
GINGIVA

73. COLOUR CHANGES IN ACUTE
GINGIVITIS:
• ERYTHEMATOUS AND BRIGHT RED.
• DUE TO INCREASED VASCULARITY
AND DECREASED KERATINIZATION.

74. COLOUR CHANGES IN CHRONIC
GINGIVITIS:
• VARYING SHADES OF RED, REDDISH
BLUE OR DEEP BLUE
• DUE TO VASCULAR PROLIFERATION
AND VENOUS STASIS.

75. METALS THAT ALTER THE COLOUR
OF GINGIVA :
• 1.BISMUTH
• 2.MERCURY
• 3.LEAD
• 4.ARSENIC
• 5.SILVER

76. AMALGAM GINGIVITIS:

77. BURTONIAN LINE
• PERIVASCULAR PRECIPITATION OF
LEAD IN THE SUBEPITHELIAL
CONNECTIVE TISSUE.
• WHICH LEADS TO DEEP BLUE OR
BLUISH RED LINEAR PIGMENTATION

78. SYSYTEMIC DISEASES CAUSING
COLOUR CHANGES IN GINGIVA :
• 1.ADDISSONS DISEASE- BLUISH
BLACK
• 2.PEUTZ –JEGHERS DISEASE- BLUISH
BLACK
• 3.ALBRIGHTS DISEASE- BLUISH
BLACK
• 4.JAUNDICE- YELLOW

79. SYSYTEMIC DISEASES CAUSING
COLOUR CHANGES IN GINGIVA :
• 5.ANEMIA- DUSKY PALLOR
• 6.LEUKEMIA- CYANOYTIC PURPLISH
AND BLUE

80. CHANGES IN SIZE OF GINGIVA

81. CHANGES IN SIZE OF GINGIVA
• NORMAL SIZE DEPENDS ON
1.CELLULAR AND INTERCELLULAR
ELEMENTS
2.VASCULAR SUPPLY
IN DISEASESD:
INCREASE IN SIZE- GINGIVAL
ENLARGEMENT

82. CHANGES IN SIZE OF GINGIVA
• FACTORS FOR INCREASE IN SIZE
• 1. INCREASE IN FIBERS
• DECREASE IN CELLS IN NON INFLAMMATORY
TYPE
• IN INFLAMMATORY TYPE
• 1.INCREASE IN CELLS
• 2.DECREASE IN FIBERS

83. CHANGES IN CONSISTENCY OF GINGIVA

84. CHANGES IN CONSISTENCY OF
GINGIVA
• NORMAL- FIRM AND RESILIENT CONSISTENCY
• FACTORS
1.CELLULAR AND FLUID CONTENT
2.COLLAGENOUS NATURE OF LAMINA PROPRIA
DISEASED GINGIVA
1.SOGGY
2.EDEMATOUS
3.LEATHERY

85. CHANGES IN TEXTURE OF GINGIVA
• NORMAL CONDITION:
• 1.STIPPLED- ORANGE PEEL APPEARANCE
• - DUE TO ATTACHMENT OF GINGIVAL FIBERS
TO UNDERLYING BONE.
• MICROSCOPIC:
• 1.ALTERNATE PROTUBERANCE AND
DEPRESSION GIVE STIPPLING APPEARANCE

86. CHANGES IN TEXTURE OF GINGIVA

87. ABNORMAL CHANGES IN SURFACE
TEXTURE DURING DISEASE:
1.LOSS OF STIPPLING
2.SMOOTH AND
SHINY
3.FIRM AND
NODULAR
4.PEELING OF
SURFACE
5.LEATHERY TEXTURE
6.MINUTELY
NODULAR SURFACE
1.GINGIVITIS [
INFLAMMATION]
2.EXUDATIVE CHRONIC
GINGIVITIS
3.FIBROTIC CHRONIC
GINGIVITIS
4.CHRONIC
DESQUAMATIVE
GINGIVITIS
5.HYPERKERATOSIS
6.NON-INFLAMMATORY
GINGIVAL HYPERPLASIA

88. STIPPLING

89. LOSS OF STIPPLING:

90. LOSS OF STIPPLING:

91. CHANGES IN TEXTURE OF GINGIVA
• DISEASED CONDITION:
• 1.STIPPLING ABSENT
• 2.APPEAR SMOOTH
• 3.APPEAR SHINY
• 4.DESTRUCTION OF GINGIVAL FIBERS
• 5FIRM AND NODULAR
• 6.PEELING OF SURFACE
• 7.LEATHERY

92. CHANGES IN CONTOUR OF
GINGIVA
• NORMAL GINGIVA:
• 1. MARGINAL GINGIVA- SCALLOPED
AND KNIFE EDGED
• 2.INTERDENTAL PAPILLA
• ANTERIOR REGION - PYRAMIDAL
• POSTERIOR REGION –TENT SHAPED

93. FACTORS AFFECTING CONTOUR OF
GINGIVA:
• NORMAL GINGIVA EXHIBITS A FIRM
AND RESILIENT CONSISTENCY
• FACTORS RESPONSIBLE ARE
• 1.CELLULAR AND FLUID CONTENT
• COLLAGENOS NATURE OF LAMINA
PROPRIA

94. CHANGES IN GINGIVAL CONTOUR IN
DISEASE PROCESS:
• 1.CHRONIC PERIODONTITIS – MARGINAL
GINGIVA ROUNDED AND ROLLED,
INTERDENTAL BECOMES ROUND AND FLAT.
• 2.ANUG-ACUTE NECROTIZING ULCERATIVE
GINGIVITIS: PUNCHED OUT CRATER LIKE
PEPRESSION AT THE CREST OF INTERDENTAL
PAPILLA EXTENDING INTO THE MARGINAL
GINGIVA.

95. CHANGES IN GINGIVAL CONTOUR IN
DISEASE PROCESS:
• 3.DESQUAMATIVE GINGIVITIS:IRREGULARLY
SHAPED DENUDED AREAS OF GINGIVA.
• 4.GINGIVAL RECESSION:EXAGGERATED
SCALLOPING.
• 5.STILLMANS CLEFT: APOSTROPHE SHAPED
INDENTATIONS FROM AND INTO THE
GINGIVAL MARGIN FOR VARYING DISTANCE
ON THE FACIAL SURFACE.
• 6.McCALLS FESTOONS:LIFE SAVER LIKE
ENLARGEMENT OF MARGINAL GINGIVA-
CANINE ,PREMOLAR FACIAL REGION.

96. CHANGES IN CONTOUR OF
GINGIVA
• DISEASED GINGIVA:
• MARGINAL GINGIVA- ROUNDED AND ROLLED
• INTERDENTAL – BLUNT AND FLAT

97. RECESSION: STILLMANS CLEFT:

98. CHANGES IN GINGIVAL CONTOUR:

99. CHANGES IN POSITION OF
GINGIVA
• NORMAL GINGIVA IS ATTACHED :
• AT THE LEVEL OF CEJ OR
• 1MM ABOVE CEJ

100. FACTORS RESPONSIBLE FOR NORMAL
POSITION OF GINGIVA:
• 1.POSITION OF TEETH IN
ARCH
• 2.ROOT BONE ANGLE
• 3.MESIODISTAL CURVATURE
OF TOOTH SURFACE

101. CHANGES IN POSITION OF GINGIVA IN
DISEASE PROCESS:
DISEASED GINGIVA:
• SHIFTED CORONALLY-
PSEUDOPOCKET
• SHIFTED APICAL TO CEJ:
GINGIVAL RECESSION

102. GINGIVAL RECESSION:
• EXPOSURE OF ROOT SURFACE BY
AN APICAL SHIFT IN THE
POSITIN OF GINGIVA

103. CLASSIFICATION OF RECESSION:
• TWO CLASSIFICATION:
• 1.ACCORDING TO SULLIVAN AND
ATKINS:
• A. SHALLOW –NARROW
• B.SHALLOW –WIDE
• C.DEEP-NARROW
• D.DEEP-WIDE

104. • 2.ACCORDING TO PD MILLERS:
• A.CLASS-I
• B.CLASS-II
• C.CLASS-III
• D.CLASS-IV

105. PD MILLERS CLASSIFICATION OF
MILLERS:
• 1.CLASS-I: MARGINAL TISSUE RECESSION
THAT DOES NOT EXTEND TO THE
MUCOGINGIVAL JUNCTION. THERE IS NO
LOSS OF BONE OR SOFT TISSUE IN THE
INTERDENTAL AREA.
• 2.CLASS-II: MARGINAL TISSUE THAT
EXTENDS TO OR BEYOND THE
MUCOGINGIVAL JUNCTION.THERE IS NO
LOSS OF BONE OR SOFT TISSUE IN THE
INTERDENTAL AREA.

106. PD MILLERS CLASSIFICATION OF
MILLERS:
• 3.CLASS-III:: MARGINAL TISSUE THAT EXTENDS TO
OR BEYOND THE MUCOGINGIVAL JUNCTION.THERE
IS LOSS OF BONE OR SOFT TISSUE IN THE
INTERDENTAL AREA OR MALPOSITIONING OF THE
TEETH.
• 4.CLASS-IV:
MARGINAL TISSUE RECESSION THAT EXTEND TO OR
BEYOND THE MUCOGINGIVAL JUNCTION WITH
SEVERE LOSS OF BONE OR SOFT TISSUE
INTERDENTALLY / OR SEVERE MALPOSITIONING OF
THE TOOTH.

107. ETIOLOGY OF RECESSION:
• 1.PLAQUE INDUCED GINGIVAL
INFLAMMATION- PRIMARY CAUSE
• 2.FAULTY TOOTHBRUSHING
• 3.ANATOMIC FACTORS SUCH AS TOOTH
MALPOSITION, DEHISENCE, FENESTRATION,
GINGIVAL ABLATION FROM SOFT TISSUE ,LIPS
,CHEEKS.
• 4.ORTHODONTIC TOOTH MOVEMENT
• 5.PHYSIOLOGIC FACTORS- AGING

108. CLINICAL SIGNIFICANCE OF
RECESSION:
• EXPOSED ROOT SURFACE –EXTREMELY
SENSITIVE.
• HYPEREMIA OF PULP
• PLAQUE ACCUMULATION –
INTERPROXIMAL RECESSION
• AESTHETICS.

109. CHANGES IN POSITION OF GINGIVA

110. CHANGES IN POSITION OF GINGIVA

111. GINGIVAL RECESSION:

112. REFRENCES:
1. JOURNAL OF CLINICAL PERIODONTOLOGY
Volume13, Issue 5May 1986 Pages 345-355
2.JOURNAL OF CLINICAL
PERIODONTOLOGYVolume 36, Issue s10
Inflammation: is it a Threat to Your Patients?
September 2008, Stockholm, Sweden Pages: 1-
26July 2009
3.CLINICAL PERIODONTOLOGY- CARRANZA
4.ESSENTIALS OF CLINICAL PERIODONTOLOGY,
DR.SHANTIPRIYA REDDY
5.TEXTBOOK OF PERIOBASICS

113. THANK YOU