where is gingiva located
- part of the oral mucosa surrounding crevices of teeth
- firmly attached to alveolar process and teeth
- buccal, labial, lingual, palatal,… gingiva
what is free gingiva
- above junctional epithelium and not attached to tooth or alveolar bone
what is interdental papilla
- between 2 adjacent teeth (triangle)
wha is attached gingiva
- firmly attached alveolar bone
what is stippling
- firm gingiva
- pitted (when dried)
- more on attached
- scalloped margin around teeth
what is the colour of healthy gingiva
- coral pink
- greyish - pink (fair skinned people
- pigmented in dark skin people - melanin
extends to mucogingival junction - blends without a distinct line on palate
what is the position of the gingiva on teeth related to age
- young: interdental papilla fills IPS, clinical crown < anatomical crown
- age 30-40: IDP does not always fill IPS, clinical crown = or larger than anatomical crown
- age 50-60 IDP does not fill IPS, clinical crown > anatomical crown, cementum/dentin visible
what are the 2 layer of gingiva
- connective tissue called lamina propria: finger like projections of connective tissue, which produces pitted appearance (stippling)
- epithelial layer: keratinized SSE, keratinization gives colour of gingiva (obscures vascularity making tissue pinkish). non keratinized in sulcus
what are the fibers of the PDL that penetrate the connective tissue of the gingiva
- transseptal
- alveolar crest fibers
- free gingival
what is the sulcus
- space around the tooth
- inner border is non-keratinized gingiva, is not attached to tooth/bone -> free gingiva
- 1 to 3 mm in health
- borders: tooth (inner), Stratified Squamous Epithelium (outer), JE (bottom), GM (top)
what is the junctional epithelium
- SSE (non keratinized) attached to tooth
- continuous with SS Epith of sulcus up to gingival margin
- normal and disease JE - apical migration
- normal, may be related to slow occlusal movement, however, root ward migration of the JE is a natural aging process
what is the junctional epithelium like in age
- young: less apical migration
- older: natural progression, sulcus remains shallow in health, some cementum exposed recession but no probing
what is the origin for the JE
- 4 layer enamel organ reduced to one
- during eruption, reduced enamel epithelium attaches to oral epithelium -> junctional epithelium
- JE high on tooth during eruption
- eventually will firmly attach to cementum below the CEJ after eruption (in adults)
what is the clinical significance of the JE
- keeping the sulcus epithelium and JE intact will be good perio health
- sulcus epithelium and JE not protected (non keratinized)
what does damage/disease to epithelium of gingival sulcus cause
- penetrate underlying connective tissue easily
- inflammation/swelling of connective tissue
- damage to PDL/JE
- bone resorption
- loosening tooth
what is seen in a healthy periodontium
- no inflammation
- JE intact
- sulcular epithelium
firmly against tooth
what is the significance of recession/exposed cementum and dentin
- migration of JE and GM
- cervical abrasion often present
- due to aggressive horizontal brushing, abrasive toothpaste and hard bristle
- increase risk to caries
- increase sensitivity
- patient education
