Hi, I am Dr Komal Ghiya, I am uploading some of my own presentations regarding dentistry for educational purposed and I hope you like this presentation on Gingiva health and disease.

1. GINGIVA:HEALTH AND DISEASE
KOMAL GHIYA
DEPARTMENT OF PEDODONTIA AND PREVENTIVE DENTISTRY

2. INDEX
 COMPONENTS OF PERIODONTIUM
 CLASSIFICATION
 DIFFERENTIATING FEATURES OF CHILDREN
AND ADULTS
 GINGIVITIS IN CHILDREN
 PERIODONTAL DISEASES IN CHILDREN

3. COMPONENTS OFPERIODONTIUM

4.  MARGINAL GINGIVA:TERMINAL EDGE OR
BORDER OF THE GINGIVA SURROUNDING THE
TEETH IN COLLAR LIKE FASHION
 GINGIVAL SULCUS:SHALLOW CREVICE OR
SPACE AROUND THE TOOTH BOUNDED BY
THE SURFACE OF THE TOOTH ON ONE SIDE
AND THE EPITHELIUM LINING THE FREE
MARGIN OF THE GINGIVA ON THE OTHER
SIDE
 ATTACHED GINGIVA:CONTINUOUS WITH
MARGINAL GINGIVA
 MUCOGINGIVAL JUNCTION:THE FACIAL
ASPECT OF THE ATTACHED GINGIVA EXTENDS
TO RELATIVELY LOOSE AND MOVABLE
ALVEOLAR MUCOSA AND IS DEMARCATED BY
MUCOGINGIVAL JUNCTION

5. CLASSIFICATION
OFGINGIVAL
DISEASE
 GINGIVAL DISEASE
 DENTAL PLAQUE INDUCED GINGIVAL
DISEASE
 NON PLAQUE INDUCED GINGIVAL LESIONS
 CHRONIC PERIODONTITIS:
 LOCALIZED
 GENERALIZED
 AGGRESSIVE PERIODONTITIS
 LOCALIZED
 GENERALIZED

6.  PERIODONTITIS AS A MANIFESTATION
OF SYSTEMIC DISEASE
 ASSOCIATED WITH HEMATOLOGICAL
DISORDERS
 ASSOCIATED WITH GENETIC
DISORDERS
 NOT OTHERWISE SPECIFIED
 NECROTIZING PERIODONTAL DISEASES
 NECROTIZING ULCERATIVE GINGIVITIS
 NECROTIZING ULCERATIVE
PERIODONTITIS
ABSCESSES OF PERIODONTIUM
 GINGIVAL ABSCESS
 PERIODONTAL ABSCESS
 PERICORONAL ABSCESS

7.  PERIODONTITIS ASSOCIATED WITH
ENDODONTIC LESIONS
 COMBINED PERIODONTIC-ENDODONTIC
LESIONS
 DEVELOPMENTAL OR ACQUIRED
DEFORMITIES AND CONDITIONS
 LOCALIZED TOOTH RELATED FACTORS
THAT MODIFY OR PREDIPOSE TO PLAQUE
INDUCED GINGIVAL
DISEASES/PERIODONTITIS
 MUCOGINGIVAL DEFORMITIES AND
CONDITIONS AROUND TEETH
 MUCOGINIGIVAL DEFORMITIES AND
CONDITIONS ON EDENTULOUS RIDGES
 OCCLUSAL TRAUMA

8. DIFFERENTIATINGFEATURESOFCHILDRENANDADULTS
CHARACTERISTIC
S
CHILDREN ADULT
COLOR PALE PINK CORAL PINK
SURFACE SMOOTH STIPPLED
GINGIVA THICK AND ROUND KNIFE EDGED
FREE GINGIVA KERATINIZED SADDLE AREA NON KERATINIZED INTERDENTAL
COL
INTERDENTAL
GINGIVA
INTERDENTAL CLEFTS NOT PRESENT
ATTACHED
GINGIVAL
RETROCUSPID PAPILLA RETROCUSPID PAPPILA NOT
PRESENT
SULCUS DEPTH 2.1-2.3 mm 2-3 mm
ALVEOLAR
MUCOSA
RED,THIN,VASCULAR PINK
PDL WIDE NARROW
COLLAGEN
BUNDLES
MORE HYDRATED,LESS
DIFFERENTAITED
MORE DIFFERENTIATED

9. POLYPEPTIDE CHAINS NORMAL CROSS LINKING TIGHT CROSS LINKING
GROUND SUBSTANCE LOW RATIO TO COLLAGEN
TO GROUND SUBSTANCE
GROUND SUBSTANCE TO
COLLAGEN RATIO NORMAL
FIBRES GINGIVAL FIBRES ARE
IMMATURE
MATURE AND ORGANIZED
TRABECULAE THICK TRABECULAE WITH
LARGE MARROW SPACES
MORE TRABECULAE WITH
LESS MARROW SPACES

10. GINGIVITIS INCHILDREN
STAGES DAYS VASCULAR
CHANGES
PREDOMINANT
IMMUNE CELLS
CLINICAL
FINDINGS
STAGE 1 2-4 Permeablity of
vascular bed
PMNs Gingival fluid flow
STAGE 2 4-7 Vascular
proliferation
Lymphocytes Erthema,bleeding
on probing
STAGE 3 14-21 Stage2+blood
statsis
Plasma cells and b
lymphocytes
Change in color,
size,texture etc
STAGE 4  Month Degeneration Plasma cells Loss of connective
tissue attachment
and alveolar bone

11. ASSESSMENTOFGINGIVITIS ANDPERIODONTITIS
 Indices for gingiva
1. Papillary marginal attachment index
2. Gingival index
3. Sulcular bleeding index
4. Papillary bleeding index
 Indices for periodontal diseases
1. Russel’s periodontal index
2. Periodontal disease index
3. CPITN
4. CPI
5. Gingival periodontal index
6. Gingival bone count index

12. TYPESOFGINGIVITIS INCHILDREN
 PLAQUE INDUCED GINGIVITIS
 POOR ORAL HYGIENE,FOOD DEBRIS,PLAQUE
,MICROORGANISMS ALSO ACCUMULATE AND
PROCESS OF INFLAMMATION
 ERUPTION GINGIVITIS
 AROUND AN ERUPTING PERMANENT TOOTH

13.  GINGIVITS DUE TO HABIT
 MOUTHBREATHING HABIT

14. INFECTIVE GINGIVITIS
 HERPETIC GINGIVOSTOMATITIS:
 CHILDREN LESS THAN 3 YEARS
 HSV 1
 PRODROMAL
PHASE:MALAISE,FEVER,VOMITING,IRRITABILITY,VESI
CLES,
 ULCERS WITH ERYTHEMATOUS MARGINS
 SELF LIMITING
 MANAGEMENT:BED REST,PLENTY OF
FLUID,MAINTENANCE OF GOOD ORAL HYGIENE
 ANALGESICS,TOPICAL ANESTHETIC GEL

15.  ACUTE NECROTIZING ULCERATIVE GINGIVITIS
 STARTS AT INTERDENTAL PAPILLAE,SPREADING ALONG GIN
MARGINS
 NECROTIC ODOUR
 TREATMENT:HYDROGEN PEROXIDE
 ORAL HYGIENE
 DIET

16.  PUBERTAL GINGIVITIS
 PRIMARY DENTITION COMPARED WITH MIXED
AND PERMANENT DENTITIONS
 HORMONAL GINGIVITIS

17.  PLASMA CELL GINGIVITIS
 CHARACTERIZED BY
DIFFUSE AND MASSIVE
INFILTRATION OF PLASMA
CELLS INTO
SUBEPITHELIAL GINGIVAL
TISSUE

18. PERIODONTAL DISEASESINCHILDREN
 EARLY ONSET PERIODONTITIS
 LOSS OF ATTACHMENT >3 mm
 LACK OF PRECISE CRITERIA
 GENERALLY AGREED 1 st MOLAR
AND INCISOR ,MUST BE AFFECTED
AND UPTO ONE OR TWO OTHER
TEETH MAY BE AFFECTED

19.  LOCALIZED EARLY ONSET PERIODONTITIS
 HART et al DIAGNOSIS OF LOCALIZED EARLY
ONSET PERIODONTITIS IS BASED ON
ATTACHMENT LOSS OF MORE THAN 4 MM ON
AT LEAST TWO PERMANENT 1st MOLAR AND
INCISORS
 NOT MORE THAN TWO OTHER PERMANENT
TEETH ,WHICH ARE NOT 1 ST PERMANENT
MOLARS OR INCISORS SHOULD BE AFFECTED
 DEEP POCKETS,PREMATURE AND EXCESSIVE
MOBILITY OF MAXILLARY AND MANDIBULAR
PRIMARY INCISORS AND 1st PRIMARY MOLARS
ARE SEEN

20.  PREPUBERTAL PERIODONTITIS
 ASSOCIATED PLAQUE DEPOSITS ARE MODERATE
AND THERE IS LITTLE INFLAMMATION OF
GINGIVAE ,BUT BLEEDING UPON PROBING IS
PRESENT AT AFFECTED SITES

21. JUVENILE PERIODONTITIS
 FIRST MOLAR AND INCISORS
 MOBILITY,BONE LOSS
 REGIONAL
LYMPHADENOPATHY
 DEEP,DULL,RADIATING PAIN
 RADIOGRAPHIC FINDINGS
 AN ARC SHAPED LOSS OF
ALVEOLAR BONE
EXTENDING FROM DISTAL
SURFACE OF THE SECOND
PREMOLAR TO THE MESIAL
SURFACE OF SECOND
MOLAR

22.  TREATMENT:
 SUBGINGIVAL IRRIGATION WITH IODINE AND
HYDROGEN PEROXIDE
 AUGMENTATION OF SCALING AND ROOT
PLANNING WITH SURGICAL THERAPY
 ANTIBIOTIC:TETRACYCLINE

23.  NECROTIZING FORMS OF PERIODONTAL
DISEASE
 CHARACTERIZED BY GINGIVAL NECROSIS
PRESENTING PUNCHED OUT PAPILLAE
WITH GINGIVAL BLEEDING AND PAIN
 HALITOSIS AND PSUEDOMEMBRANE
FORMATION MAY BE SECONDARY
DIAGNOSTIC FEATURES
 FUSIFORM BACTERIA ,OTHER
ANAEROBIC GRAM NEGATIVE BACTERIA
AND SPIROCHETES HAVE BEEN
ASSOCIATED WITH THE GINGIVAL
LESIONS
 RELATED FACTORS MAY INCLUDE
EMOTIONAL STRESS,POOR
DIET,CIGARETTE SMOKING,SEASONAL
CHANGES AND HIV INFECTION.

24.  CHARACTERIZED BY NECROSIS OF
GINGIVAL TISSUES,PERIODONTAL
LIGAMENT AND ALVEOLAR BONE
 LESIONS ARE COMMONLY OBSERVED IN
INDIVIDUALS WITH SYSTEMC
CONDITIONS INCLUDING BUT NOT
LIMITED TO VIRAL INFECTIONS,SEVERE
MALNUTRITION AND
IMMUNOSUPPRESSION.
 NUP IS PRECEDED BY NECROTIZING
ULCERATIVE GINGIVITIS WHICH IS AN
ACUTE INFLAMMATORY CONDITION
ASSOCIATED WITH A FUSOSPIROCHETAL
MICROBIOTA

25. SCORBUTIC
GINGIVITIS
 The gingival tissues are swollen, spongy, and bleed
easily. Ecchymoses may be present in the palate,
cheeks, or floor of the mouth. Necrosis and
infection may be further complications.
 A pronounced hypochromic anemia and
hyperkeratosis of hair follicles is often present.
 Biochemical assay of the plasma ascorbic acid
level is a valuable test. The range considered
essential for good health is 0.7mg per 100c.c. to
1.40mg per 100 c.c. The recommended daily
allowances (intake) are 75mg. for males, and 70 to
150mg for female

26. GINGIVAL ENLARGEMENT
 INFLAMMATORY GINGIVAL ENLARGEMENT
 ACUTE
 CHRONIC
 DRUG INDUCED GINGIVAL ENLARGEMENT
 ENLARGEMENTS ASSOCIATED WITH
SYSTEMIC DISEASES
 CONDITIONED ENLARGEMENT
 PREGNANCY
 PUBERTY
 VITAMIN C DEFICIENCY
 NON SPECIFIC CONDITIONED
ENLARGEMENT
 SYSTEMIC DISEASE CAUSING GINGIVAL
ENLARGEMENT
 LEUKEMIA
 GRANULOMATOUS DISEASE

27. INFLAMMATOR
YGINGIVAL
ENLARGEMENT
ORIGINATES AS A SLIGHT BALLONING
OF INTERDENTAL PAPILLA AND
MARGINAL GINGIVA
LOCALIZED OR GENERALZED
PROGRESS SLOWLY
DISCRETE SESSILE OR PEDUNCULATED
MASS
INTERPROXIMAL OR ATTACHED

28. DRUGINDUCED
GINGIVAL
ENLARGEMENT
PHENYTOIN
CALCIUM
CHANNEL
BLOCKERS
CYCLOSPORINE

29. PAPILLON
LEFEVRE
SYNDROME
HYPERKERATOSIS
OF PALMS AND
SOLES
PRECOCIOUS
PERIODONTAL
DESTRUCTION
SHEDDING OF
DECIDUOUS AND
PERMANENT
DENTITIONS

30.  DENTAL ASPECTS
 SWOLLEN,GINGIVAL,MIGRATION AND
MOBITLITY OF TEETH,PERIODONTAL
POCKETS,FETOR ORIS AND EXFOLIATION OF
TEETH
 TREATMENT
 METICULOUS PLAQUE CONTROL
 ADMINISTRATION OF CHLORHEXIDIENE IN
COMBINATION WITH SYSTEMIC ANTIBIOTIC
THERAPY FOR ERADICATION OF KNOWN
PERIODONTAL PATHOGENS IN CONJUNCTION
WITH RETINOIDS

31. DOWN SYNDROME
 PERIODONTAL DISEASE VERY PREVALENT AND
MORE SEVERE THAN IN AGE MATCHED
CONTROLS ESPECIALLY IN LOWER ANTERIORS
 DIFFERENCES NOT EXPLAINED BY PLAQUE
LEVELS
 RAPID PROGRESSION
 ONSET APPARENT IN DECIDUOUS DENTITION
HYPOPHOSPHATASIA
CEMENTUM HYPOPLASIA OR APLASIA
PERIODONTAL DESTRUCTION MAY AFFECT
DECIDUOUS DENTITION RESULTING IN
PREMATURE EXFOLIATION, TOOTH LOSS
VARIABLE EFFECTS ON PERMANENT DENTITION
,NOT NECESSARILY AS SEVERE

32. LEUCOCYTEDISORDERS:NEUTROPENIA,CHEDIAKHIGASHISYNDROME,LEUCOCYTEADHESION
DEFICIENCYSYNDROME
 ULCERATIVE GINGIVITS
 PERIODONTITIS
 SEVERE GINGIVITIS ,PERIODONTITIS
 TOOTH LOSS DUE TO PERIODONTAL
DESTRUCTION
 ULCERATION MUCOSA,TONGUE,HARD
PALATE
 EARLY ONSET PREPUBERTAL
PERIODONTITIS
 RAPID ATTACHMENT LOSS AND BONE
LOSS SHORTLY AFTER ERUPTION OF
DECIDUOUS DENTITION.EARLY
EXFOLIATION

33. GINGIVALAND
PERIODONTAL
ABSCESS
ENLARGEMENT OF GINGIVA ,BUT
THEY ALSO INVOLVE THE
SUPPORTING TISSUE
PERIODONTAL ABSCESS
GINGIVAL ABSCESS
LOCALIZED,PAINFUL,RAPIDLY EXPANDING
LESION THAT IS USUALLY OF SUDDEN ONSET
GENERALLY LIMITED TO MARGINAL GINGIVA OR
INTERDENTAL PAPILLA
IN EARLY STAGES IT APPEARS AS A RED
SWELLING WITH SMOOTH ,SHINY SURFACE
WITHIN 24-48 HOURS LESIONS USUALLY
BECOME FLUCTUANT AND POINTED WITH A
SURFACE ORIFICE FROM WHICH PURULENT
EXUDATE MAY EXPRESS

34. THANKYOU