Preventive Periodontics

2. Clinical Features of Gingivitis
(Plaque-induced gingivitis)
Khalid S. Hassan
BDS,MSc,PhD ,Assist. Prof.
Department of PDS, Periodontics

3. Clinical Criteria of Healthy Gingiva
coral pink (alveolar mucosa is red )Color:-1
-Variation in color [degree of keratinization, vascularity, pigmentation and thickness of epi).
-Contour:-2
-Free gingiva thin and end in a knife like edge
-Attach gingiva scalloped elevations related to roots and depression in the
interradicular areas interradicular groove.
-Interdental papillae pointed and fill the inter proximal space under contact area.
-papillae (OrangeinterdentalStippling in attach. gingiva and base of-:textureSuface-3
peel appearance)
(Firmly attached to the teeth and underling alveolarresillentFirm and-:Consistency-4
bone except free gingiva).
mm-3mm not exceed2-5.0-Depth of gingival sulcus:-5
.transudate:Type of gingival fluid-6

4. •Course and Duration:
Acute gingivitis: painful condition,
sudden onset, and short duration.
Sub-acute gingivitis: less severe than
acute gingivitis.
Recurrent gingivitis: reappear after
treatment.
Chronic gingivitis: comes in slowly, is
of long duration, and painless.

5. Chronic Gingivitis
Def. It is a simple and long-standing inflammation of
the gingiva (gingivitis may exist for years
without change to periodontitis)
Types. 1- Localized 2- Generalized
Distribution of inflammation:-
1- Papillary (localized or generalized)
2- Marginal (localized or generalized)
3- Diffuse (localized or generalized)

6. Chronic localized marginal
gingivitis

7. Chronic generalized marginal
gingivitis

8. Generalized diffuse gingivitis

9. Etiology:-
1-Local initiating factor (Dental Plaque).
2- Local predisposing factors.
3- Systemic factors
* Puberty
* Pregnancy
* Diabetes
* Vit. C deficiency

10. Etiology of Periodontal Diseases
Bacterial plaque Host response Reparative tissue capacity
Factors upset the
balance By
Increasing aggression of bacterial plaque
Decreasing defense mechanisms
Local Predisposing Factors Systemic Factors
1- Calculus
2- Material alba
3- Food debris
4- Food impaction
5- Food retention
6- Faulty dentistry
7- Malocclusion
8- Mouth breathing
9- Trauma from occlusion
* Overhanging filling
* Over and under contoured crowns
* Occlusal disharmony
* Orthodontic wires
* Rough fillings
* Open contact
1- Hormonal imbalance
2- Nutritional deficiency
3- Blood diseases
4- Genetics
5- Immunologic
6- Metallic intoxication
7- Debilitating diseases
8- Psychologic

11. Bacteria associated with
Gingivitis
Gr+ve species
S. Sangus
S. Mitis
S. Intermedius
S. Oralis
A . Viscosus
A . Naeslundii
Peptostrepococcus
Gr-ve species
F. Nucleatum
P.intermedia
Haemophilus
Capnocytophaga

12. Clinical Features
1- Color: - Red V.D. of capillary bed, keratinization
- Bluish-red b1. stasis
- Cyanotic 02 tension
N.B:- in healing by fibrosis pale pink.
-In acute gingivitis the color change may be marginal as in
NUG ,diffuse as in acute herpetic gingivostomatitis or
patch-like due to chemical irritation.
-In severe acute gingivitis, the red color change to a shiny
gray then to whitish gray due to necrosis.

13. Factors affecting the color
• Endogenous Factors ( systemic factors):
- melanin , bilirubin or iron.
- examples : Addison disease bluish black to brown.
- Peutz-jeghers syndrome melanin pigmentation.
- Albright’s syndrome melanin pigmentation.
• Exogenous Factors: - Metal dust.
- Coloring agents in food.
- Lozenges.
- Tobacco.
- Amalgam tattoo.

14. Metallic Pigmentation
Bismuth Lead Mercury Others
Bluish-black
pigmentation
of gingival
margin(liner)
-Liner pig. of
gingival margin.
(Burtonian line)
-Steel gray
-Liner
to diffuse
grayish
gingival
pigmentation
-Ulceration
of gingiva
-e.g.: phosphorous,
arsenic & chromium
-Bluish gray line.
-Necrosis of alveolar
bone loosening of
teeth
-Inflammation and
ulceration of gingiva.

15. Bismuth gingivitis ( bluish black
line on margin)

17. Due to
edema
and
inflam.
infiltrate
•2-Contour:
-Free gingiva thick and rounded
-Att. gingiva loss of interradicular
grooves
-Interdental papilla blunt ,bulbous,
convex labiolingually & bulging out inbetween
the embrasure.
NB.- Interdental papilla in NUG Crater like depression.
- In the interproximal space appear as flat papilla.

18. Plaque-induced gingivitis

19. Fibrotic gingival inflammation

20. Crater-licke depression papilla (NUG)

21. 3-Consistency:- Soft( Spongy) and
edematous (in fibrosis firm)
Chronic gingivitis:
Clinical changes Histopathology
Pits on pressure infiltration by fluid and
cells of inflammatory
exudates.
Softness and friability degeneration of CT
and epi.
Firm fibrosis and epi. Proliferation with
long-standing chronic inflammation.

22. 4- Surface texture:- Loss of stippling due to
-Stagnation of circulation
-Accumulation of inflammatory exudates
-Degeneration of gingival fibers
5- Position of gingiva:- gingival margin change to
coronal position deeping of gingival sulcus
without apical migration of epi. attachment
gingival pocket (pseudo-pocket- relative pocket).
-Actual position: is the level of the epi. attachment on the tooth.
-Apparent position: is the level of the crest of the gingival margin.
-The position of gingiva is determined by the actual position, not
the apparent position.

23. •6- Gingival Bleeding on Probing:-
- indicates an inflammatory lesion in the
epith. and CT.
- due to - Ulceration of sulcular epithelium.
- Thinning and degeneration of epi.
- Increase vascularity.
- Dilatation of the capillaries.

24. Acute gingival bleeding
• Caused by injury or occur spontaneously in
acute gingival disease.
• Laceration of the gingiva by aggressive
tooth brushing or sharp pieces of hard food
causes bleeding even in the absence of
gingival diseases.
• Spontaneous bleeding or on minor trauma
occurs in NUG.

25. Gingival Bleeding Associated with
Systemic Factors
• Occurs spontaneously or after irritation.
• Excessive and difficult to control.
• Occurs in other organs e.g. skin , internal organs.
• Examples : Vit. C deficiency.
- Thrombocytopenic purura.
- Vit K deficiency.
- Hemophilia .
- Leukemia.
- Some medications.

26. How do to determine
bleeding on probing

27. Insertion of a probe in gingival
sulcus

28. Bleeding appears 30 second after probing

29. Generalized gingival bleeding on
probing

30. •7-Pain:
- Chronic gingivitis is usually painless
unless complicated by acute
exacerbation.
- Chronically inflamed gingiva may be
painful on instrumentation (scaling
and root planning).

31. •Stillman’s Cleft:
-Described by Stillman.
-Is apostrophe-shaped indentation on
gingival margin.
- Is a specific type of gingival recession.
-Generally occur on the facial surface.
-Considered to be the result of occlusal
trauma.
-The margins of the clefts are rolled.
- Clinical significant: difficult to
maintain plaque control.

32. •McCall’s Festoons:
Enlargement of the gingival margin in the
canine and premolar area on the facial
surface.
In the early stages, the color and
consistency are normal.
Clinical significance: accumulation of food
debris leads to secondary inflammatory changes.

33. Histopathology:-
1- Inflammatory cell infiltration
2- Ulceration of sulcular epi.
3-Inter and intra-cellular edema.
4- Fibrosis in longstanding inflammation
Treatment:-
1- Thorough scaling.
2- Removal of local factors.
3- Plaque control and oral hygiene instruction.
Prognosis:- Excellent