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The gingiva, or gums, consist of the mucosal
tissue that lies over the mandible and maxilla inside the mouth. Structure
Gingiva are part of the soft tissue lining of the mouth. They surround the teeth and
provide a seal around them. Compared with the soft tissue linings of the lips and cheeks,
most of the gingivae are tightly bound to the underlying bone which helps resist the
friction of food passing over them. Thus when healthy, it presents an effective barrier
to the barrage of periodontal insults to deeper tissue. Healthy gingiva are usually coral
pink, but may contain melanin pigmentation. Changes in color, particularly increased redness,
together with edema and an increased tendency to bleed, suggest an inflammation that is
possibly due to the accumulation of bacterial plaque. Overall, the clinical appearance of
the tissue reflects the underlying histology, both in health and disease. When the gingival
tissue is not healthy, it can provide a gateway for periodontal disease to advance into the
deeper tissue of the periodontium, leading to a poorer prognosis for long-term retention
of the teeth. Both the type of periodontal therapy and homecare instructions given to
patients by dental professionals and restorative care are based on the clinical conditions
of the tissue. The gingiva is divided anatomically into marginal,
attached and interdental areas. Marginal gingiva
The marginal gingiva is the terminal edge of gingiva surrounding the teeth in collar
like fashion. In about half of individuals, it is demarcated from the adjacent, attached
gingiva by a shallow linear depression, the free gingival groove. This slight depression
on the outer surface of the gingiva does not correspond to the depth of the gingival sulcus
but instead to the apical border of the junctional epithelium. This outer groove varies in depth
according to the area of the oral cavity; the groove is very prominent on mandibular
anteriors and premolars. The marginal gingiva varies in width from
0.5 to 2.0 mm from the free gingival crest to the attached gingiva. The marginal gingiva
follows the scalloped pattern established by the contour of the cementoenamel junction
of the teeth. The marginal gingiva has a more translucent appearance than the attached gingiva,
yet has a similar clinical appearance, including pinkness, dullness, and firmness. In contrast,
the marginal gingiva lacks the presence of stippling, and the tissue is mobile or free
from the underlying tooth surface, as can be demonstrated with a periodontal probe.
The marginal gingiva is stabilized by the gingival fibers that have no bony support.
The gingival margin, or free gingival crest, at the most superficial part of the marginal
gingiva, is also easily seen clinically, and its location should be recorded on a patient’s
chart. Attached gingiva
The attached gingiva is continuous with the marginal gingiva. It is firm, resilient, and
tightly bound to the underlying periosteum of alveolar bone. The facial aspect of the
attached gingiva extends to the relatively loose and movable alveolar mucosa, from which
it is demarcated by the mucogingival junction. Attached gingiva may present with surface
stippling. The tissue when dried is dull, firm, and immobile, with varying amounts of
stippling. The width of the attached gingiva varies according to its location. The width
of the attached gingiva on the facial aspect differs in different areas of the mouth. It
is generally greatest in the incisor region and less in the posterior segments, with the
least width in the first premolar area. However, certain levels of attached gingiva may be
necessary for the stability of the underlying root of the tooth.
Interdental gingiva The interdental gingiva occupies the gingival
embrasure, which is the interproximal space beneath the area of tooth contact. The interdental
papilla can be pyramidal or have a “col” shape. Attached gingiva is resistant to masticatory
forces and always keratinised. The col varies in depth and width, depending
on the expanse of the contacting tooth surfaces. The epithelium covering the col consists of
the marginal gingiva of the adjacent teeth, except that it is nonkeratinized. It is mainly
present in the broad interdental gingiva of the posterior teeth, and generally is not
present with those interproximal tissue associated with anterior teeth because the latter tissue
is narrower. In the absence of contact between adjacent teeth, the attached gingiva extends
uninterrupted from the facial to the lingual aspect. The col may be important in the formation
of periodontal disease but is visible clinically only when teeth are extracted.
Interdental Areas It is the part of gingiva which extends in
between two teeth up to the contact point.There is a facial side interdental papilla and a
lingual side interdental papilla.Interdental papilla has a summit(tip)and margins that
are concave.The tip and the margins are unattached and the central portion attached.In inflammations
the interdental papilla loses its concavity. Characteristics of healthy gingiva
Color Healthy gingiva usually has a color that has
been described as “coral pink.” Other colours like red, white, and blue can signify inflammation
or pathology. Although described as the colour coral pink, variation in colour is possible.
This can be the result of factors such as: thickness and degree of keratinization of
the epithelium, blood flow to the gingiva, natural pigmentation, disease and medications.
Since the colour of the gingiva can vary, uniformity of colour is more important than
the underlying color itself. Excess deposits of melanin can cause dark spots or patches
on the gums, especially at the base of the interdental papillae. Gum depigmentation is
a procedure used in cosmetic dentistry to remove these discolorations.
Contour Healthy gingiva has a smooth arcuate or scalloped
appearance around each tooth. Healthy gingiva fills and fits each interdental space, unlike
the swollen gingiva papilla seen in gingivitis or the empty interdental embrasure seen in
periodontal disease. Healthy gums hold tight to each tooth in that the gingival surface
narrows to “knife-edge” thin at the free gingival margin. On the other hand, inflamed gums have
a “puffy” or “rolled” margin. Texture
Healthy gingiva has a firm texture that is resistant to movement, and the surface texture
often exhibits surface stippling. Unhealthy gingiva, on the other hand, is often swollen
and less firm. Healthy gingiva has an orange-peel like texture to it due to the stippling.
Reaction to disturbance Healthy gums usually have no reaction to normal
disturbance such as brushing or periodontal probing. Unhealthy gums, conversely, will
show bleeding on probing and/or purulent exudate. Clinical significance
The gingival cavity microecosystem, fueled by food residues and saliva, can support the
growth of many microorganisms, of which some can be injurious to health. Improper or insufficient
oral hygiene can thus lead to many gingival and periodontal disorders, including gingivitis
or peridontitis, which are major causes for tooth failure. Recent studies have also shown
that anabolic steroids are also closely associated with gingival enlargement requiring a gingivectomy
for many cases. Gingival recession is when there is an apical movement of the gingival
margin away from the biting surface. It may indicate an underlying inflammation such as
periodontitis or pyorrhea, a pocket formation, dry mouth or displacement of the marginal
gingivae away from the tooth by mechanical, chemical, or surgical means. Gingival retraction,
in turn, may expose the dental neck and leave it vulnerable to the action of external stimuli,
and may cause root sensitivity. Additional images See also Gum graft
Head and neck anatomy Periodontitis
References External links
Periodontal disease Further reading
Willmann, Donald. PERI 5081 – Freshman Periodontics. UTHSCSA, 2006. 2.3.1

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