Carranza's Clinical Periodontology, Chapter 15, Clinical features of gingivitis

1. CLINICALFEATURESOF
GINGIVITIS
Maede
Aminbeidokhti

2. Classification Of Gingivitis
 Course and duration
 Acute gingivitis - can occur with sudden onset and short duration.
 Recurrent gingivitis – reappears after treatment
 Chronic gingivitis – slow in onset and of long duration
 Distribution
Localised – confined to single tooth or a group
Generalized – involves entire mouth
•
•
•
Marginal – involves gingival margin
Papillary – involves interdental papilla and extends into gingival
margin. Earliest signs of gingivitis occur in the papillae.
Diffuse – affects marginal, attached gingiva and interdental
papillae.

7. CliniCal findings
•
•
Systematic approach is required.
An orderly examination of gingiva
BlEEding On PROBing
2 earliest signs of gingival inflammation preceding established
gingivitis.
•
•
Gcf production increased
Bleeding on probing ( easily detectable
(

8. •
•
Easily detected clinically and therefore is of value for early
diagnosis and prevention of advanced gingivitis
Bleeding appears earlier than other visual signs of
inflammation.
• It is a more objective sign that requires less subjective
estimation by the examiner
• Interestingly numerous studies show that smoking suppresses
the gingival inflammatoryresponse.

9. ACUTE BLEEDING …
-Injury or acute gingival disease
Laceration of the gingiva
- biting on sharp pieces of food.
- toothbrush trauma
- toothpicks
- burns from hot foods or chemicals
• Acute necrotizing ulcerative gingivitis
blood vessels exposed to the surface by necrosed epithelium so
spontaneous bleeding or bleeding on slight provocation
occurs.

10. Bleeding associated with systemic changes
Spontaneous or after irritation…
-varied etiology and manifestations…
-underlying cause
“haemostatic system failure”
bleeding in the skin , internal organs other
Tissues….
vascular abnormalities
platelet disorders
hypoprothrombinemia
coagulation defects
multiple myeloma
other causes …

13. Gingival bleeding on probing

14. color chanGes
coral pink effected by
•
•
Normally…
vascularity
Keratinisation
--- Red or pale pink
Chronic
increased vascularity.
reduced keratinisation.
venous stasis --- bluish hue
Acute
Colour changes differ in nature and distribution
•
•
•
Marginal (acute necrotising ulcerative ging)
Diffuse (herpetic gingivostomatitis)
Patchlike (chemical reactions )

17. metallic piGmentation
Heavy metals absorbed systemically…
occupational
therapeutic
household
…discolor the gingiva.
bismuth
lead
Hg
Ag

18. Pigmentation can be seen as
• Black or bluish line ( gingival contour (
• Isolated blotches (interdentally marginal or attached gingiva (
Metal pigments …
Systemically absorbed.
Perivascular accumulation
Vessel rupture ( inflammatory)
Increased vascular permeability
Seepage of metal into surrounding tissue ( sub epithelial c.t.)
…NOT DUE TO TOXICITY…

21. Bismuth gingivitis. linear black
discoloration of the gingiva in a
patient receiving bismuth
therapy.
Discoloration of the gingiva
caused by embedded metal
particles (amalgam(

22. Treatment…?
simply TREAT the Inflammation…
CoLor Changes – systemiC faCtors
- Non specific
- Further diagnostic efforts
- Referral to specialist
Endogenous pigmentations
MELANIN
BILIRUBIN
IRON

23. Melanin
Physiologic pigmentation.
Pathologies…
Addison’s disease
Peutz-Jegher’s disease
Albright’s syndrome
Bile pigment.
Yellowish color oral mucosa ( apart from sclera)
Other causes..
Diabetes
Pregnancy
Blood dyscrasias
Anemia
Polycythemia etc

24. exogenous
•
•
•
•
Metal dust… coal.
Coloring agents. In foods , lozenges
Tobacco --- hyperkeratosis, increase in melanin pigmentation
Amalgam implantation – localised bluish black areas
Discoloration of the
gingiva caused by
embedded metal
particles (amalgam(

25. ConsistenCy
Normally..
Firm and Resilient.
• In chronic gingivitis the consistency of the gingiva is
determined by the relative predominance of the
following changes
-Oedematous
-Fibrotic
)destructive)
(reparative(
- Combination of either

26. CaLCified masses…
- isolated
- groups
traumatically lodged..
substances derived from the tooth.
root remnants,
calculus
cementum fragments
cementicles.
Associated with…
chronic inflammation
fibrosis
foreign body reaction
)origin notcrystalline substances in the gingiva seen at times
known(…

27. surfaCe texture
Loss of stippling ( early sign (
in chronic inflammation…
1)Smooth , shiny
2)Firm and nodular ( also found in drug induced
gingival enlargement)
- “peeling off” of the surface occurs in the
desquamative gingivitis.
- leathery texture … hyperkeratosis.

28. Position of the gingiva.
Recession
-actual position
-apparent position.
Actual : position of the epithelial attachment.
Apparent : level of the crest of the gingival margin.
2 types of recession …
clinically visible.
can only be estimated by insertion of a
-visible
-hidden
probe.

30. recession refers to position of the gingiva
- NOT the condition of the gingiva.
May be
- localised.
- generalised

31. ETIOLOGY OF RECESSION.
Age: physiologic process…?
(8% incidence in children.
100% in persons aged 50 and above)
No convincing evidence…
- gradual apical shift : cumulative effect of minor
pathologic involvement and repeated direct trauma.
Factors responsible….
( gingival ablation)
-Faulty tooth brushing
-Tooth malposition
-Friction from soft tissues
-Gingival inflammation
-Frenal pull.

32. Changes in Gingival Contour
 The term Stillman’s clefts has been used to describe a specific
type of gingival recession that consists of a narrow,
triangular-shaped gingival recession. As the recession
progresses apically, the cleft becomes broader, thereby
exposing the cementum of the root surface.

33.  The term McCall festoons
has been used to describe a
rolled, thickened band of
gingiva that is usually seen
adjacent to the cuspids
when recession approaches
the mucogingival junction.