This document describes the histopathological stages of gingivitis from initial to established lesions. Stage I occurs within 1 week and shows vascular changes and PMN predominance. Stage II occurs within 6-12 days and shows erythema, bleeding, and lymphocyte predominance with collagen destruction around inflammatory cells. Stage III occurs within 2-3 weeks and shows congested blood vessels, increased plasma cells, and breakdown of hemoglobin. The clinical findings of gingivitis include bleeding, color changes, texture changes, and localized or generalized distribution. Advanced gingivitis can lead to periodontitis through pathways of inflammation from the gingiva into the supporting periodontal tissues.

1. GingivitisGingivitis

2. Normal PeriodontiumNormal Periodontium

3. GingivitisGingivitis
Histopathologic StagesHistopathologic Stages
Stage I (Initial Stage)Stage I (Initial Stage)
Vascular changes,Vascular changes,
dilation of capillariesdilation of capillaries
and increase bloodand increase blood
flowflow
Occur in 1 weekOccur in 1 week
Mainly PMNsMainly PMNs
predominate.predominate.
Increase in gingivalIncrease in gingival
fluidfluid

8. Stage II gingivitis (Early LesionStage II gingivitis (Early Lesion))
Erythema due toErythema due to
increase in capillaryincrease in capillary
loops between reteloops between rete
pegs.pegs.
Bleeding on probingBleeding on probing
LymphocytesLymphocytes
predominatepredominate
Rete pegs in JERete pegs in JE
Collagen destructionCollagen destruction
around inflam. cellsaround inflam. cells

9. Stage IIStage II
6-12 days6-12 days

11. Destruction around InflammatoryDestruction around Inflammatory
cellscells

12. Lysosomes by PMNsLysosomes by PMNs

13. Stage III (Established LesionStage III (Established Lesion((
Congested bloodCongested blood
vesselsvessels
Breakdown ofBreakdown of
hemoglobinhemoglobin (bluish(bluish
hue to red color(hue to red color(
Increase in number ofIncrease in number of
plasma cellsplasma cells

14. Stage IIIStage III
2-3 WEEKS2-3 WEEKS

17. Junctional Epithelium in stage IIIJunctional Epithelium in stage III
Wide intercellularWide intercellular
spaces filled withspaces filled with
lysosomeslysosomes
Prominent rete pegsProminent rete pegs
and destroyed basaland destroyed basal
laminalamina
Collagenase enzymeCollagenase enzyme
produced by bacteriaproduced by bacteria
and PMNs destroyand PMNs destroy
collagencollagen

19. Clinical Findings in GingivitisClinical Findings in Gingivitis
Bleeding on probingBleeding on probing
Color changesColor changes
Changes inChanges in
consistencyconsistency
Surface textureSurface texture

20. DistributionDistribution
Localized gingivitisLocalized gingivitis
GeneralizedGeneralized
MarginalMarginal
PapillaryPapillary
DiffuseDiffuse

21. GENERALIZEDGENERALIZED

29. ConsistencyConsistency

30. FirmFirm

31. Thank YouThank You

32. Changes in contourChanges in contour
Stillman’s cleftsStillman’s clefts
McCall’s festoonsMcCall’s festoons

33. Advanced LesionAdvanced Lesion

34. Adult PeriodontitisAdult Periodontitis
Inflammation of theInflammation of the
supportingsupporting
periodontal tissues asperiodontal tissues as
a result of transition ofa result of transition of
inflammation from theinflammation from the
gingiva.gingiva.

35. Pathways of Gingival inflammationPathways of Gingival inflammation
from the gingiva into supportingfrom the gingiva into supporting
periodontal tissuesperiodontal tissues

36. Clinical Features of PeriodontitisClinical Features of Periodontitis
Signs and symptoms of gingivitisSigns and symptoms of gingivitis
Periodontal pocket formationPeriodontal pocket formation
Tooth mobilityTooth mobility
Furcation involvementFurcation involvement
Alveolar bone lossAlveolar bone loss

37. Periodontal PocketPeriodontal Pocket
Pathologically deepened gingival sulcusPathologically deepened gingival sulcus
Careful probing is the reliable method forCareful probing is the reliable method for
its detectionits detection

38. Clinical SignsClinical Signs
Enlarged bluish gingivaEnlarged bluish gingiva
Red blue vertical zoneRed blue vertical zone
Break in continuity of interdental papillaBreak in continuity of interdental papilla
Gingival bleedingGingival bleeding
Exudate from gingival marginExudate from gingival margin
Mobility and extrusion of teethMobility and extrusion of teeth
Development of diastemaDevelopment of diastema

39. SymptomsSymptoms
Localized pain or sensation of pressureLocalized pain or sensation of pressure
after eatingafter eating
A foul tasteA foul taste
Tendency to suck material fromTendency to suck material from
interproximal spacesinterproximal spaces
Itchiness in the gumItchiness in the gum
Sensitivity to heat and coldSensitivity to heat and cold

40. Classification of PeriodontalClassification of Periodontal
PocketsPockets
Simple, Compound, ComplexSimple, Compound, Complex

41. True or false pocketsTrue or false pockets
Suprabony Or InfrabonySuprabony Or Infrabony

42. Bone Destruction Pattern inBone Destruction Pattern in
Periodontal DiseasePeriodontal Disease
Horizontal Bone lossHorizontal Bone loss
Vertical or angularVertical or angular
defectsdefects

43. Clinical Features of GingivitisClinical Features of Gingivitis
Course and DurationCourse and Duration
Acute gingivitisAcute gingivitis
(ANUG(ANUG((
Subacute gingivitisSubacute gingivitis
(less severe(less severe((
Chronic gingivitisChronic gingivitis
–Comes slowly andComes slowly and
of long durationof long duration