Gingival Diseases
Color
Size
Shape
Texture
Consistency
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This handout is provided by the CLR.
Health
light pink, coral
normal, not enlarged
scalloped knife-edged
stippled, matte, not shiny
firm and resilient
Unhealthy
red or bluish-red
enlarged or swollen
rolled/rounded margins, bulbous
rounded, shiny, smooth
spongy, edematous, boggy
Gingivits
 Inflammation of the gingiva only
 No attachment loss
 Often painless » goes unnoticed
 Bleeding of any tissue » abnormal
 First sign of gingival inflammation occurs when vessel dilate »
increases blood flow to the tissues
Healing of Gingiva After Treatment
 Reverse sequence of inflammation
 Inflammatory cells re replaced by collagen » lay down a collagen
layer making a dense connective tissue
- Does not allow penetration by probe » decreased probe
depths
 Color of the tissue returns to pink
 Stippling may return
- If serum no longer leaks into tissue and causes edema
 Tissue will become firm and resilient rather than enlarged and
bulbous
Plaque Induced Gingival Diseases
 Most common form of gingivitis is associated with plaque
 Directly related to amount of plaque on the tooth surface and the
amount of time plaque remains undisturbed
 Plaque is non-specific but highly organized
- Changes from GR + to GR – in just a few days
 Distribution of Lesions
- Gingivitis can be generalized or localize
- There is no loss of connective tissue
- Descriptions of gingival must be documented in chart
 Location and extent should be noted
 Localized, generalized, papillary, marginal, slight,
moderate, advanced
 Color, shape, size and consistency also
 Experimental Gingivits
- Loe and Theilade » 1965
- Clinical signs in 10-21 days
- Reversible with reinstitution of OH
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This handout is provided by the CLR.
Plaque Induced Gingivitis Modified by Local Factors
- Malposed or crowed teeth
- Overhanging restorations
- Overcontoured restorations
- Orthodontic bands
 All plaque traps
 Dot not cause disease of aid or intensify the gingival
response
 Gingival Disease Modified by Systemic Factors
- Circulating corticosteroids
 Associated with stress or steroid type hormones
 Produced by hormonal or endocrine system changes
o During menstruation or pregnancy
- Increase in subgingival bacteria such as Bacteroides and
increase in serum concentrations of estrogen during
pregnancy
 Gingiva reacts more sensitively to plaque and poor
plaque control aggravates
 May turn bright red and bleed much easier
 May become hypoplastic
 Pregnancy tumor (pyogenic granuloma) may occur
- Patients taking oral contraceptive or older patient taking a
hormone replacement
 Gingival Diseases Modified by Medication
- Seizure medications can cause hyperplasia
- Phenytoin or dilantin
- Immunosuppressive drugs or cardiac meds can cause
excessive accumulation of connective tissue in many other
tissues of the body
 Cyclosporine or verapamil (calcium channel blocker)
 Nifedipine (procardia) (calcium channel blocker)
 Gingival Disease Modified by Malnutrition
- Vitamin A, B1, B2, B6 or C
- C deficiency can cause scurvy
 Results in defective collagen formation and
maintenance
 Gingiva may hemorrhage and become swollen
 Condition can progress to advanced periodontitis and
cause extensive bone and tooth loss
Non Plaque Induced Gingivitis
 Gingival Diseases of Specific Bacterial Origin
- Streptococcal infections of the throat and oral tissues in
young children
- Syphilis
- Gnonorrhea
- Necrotizing Ulcerative Gingivitis
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This handout is provided by the CLR.
Can occur with no bone loss and a bacterial
component
 Common in WWI » poor oral hygien in trenches
“trench mouth”
 Begins in IDP and tips become blunted/punched out
 IDP covered in a white necrotic pseudomembrane
o Collection of PMN’s trapped in a fibrin clot
 Distinctive breath odor » fector oris
 Caused by fusiform bacillus bacteria and a spirochete
o Vincents organisms
 Routine treatment » debridement (gentle to prevent
further damage and OHI
 Systemic antibiotics such a penicillin and
metronidazole are useful
o Recommended only for patients with fever and
severe malaise
Gingival Diseases of Viral Origin
- Primary herpetic gingivostomatitis or primary herpes
infection
- fever blisters or cold sores
- similar symptoms to ANUG however a higher temp and
patient appears more ill with greater malaise
- vesicles form which may coalesce into ulcerative lesions
- no punched out IDP
- odor but not as distinctive as fector oris
Gingival Diseases of Fungal Origin
- Candidiasis is caused by a yeast organism
 Candida albicans
 Gingival reddens » linear gingival erythema
 White patches of organisms and debris that can easily
be rubbed off to expose ulcerative tissue
 Common in young kids on palate
Gingival Lesions of Genetic Origin
- Cause gingival enlargements
- Idiopathic gingival enlargement of an unknown origin
Gingival Manifestation of Systemic Conditions
- Blood dyscrasias
- Acute leukemia
 Hemorrhagic and swollen gingival
 Far more pronounced than amount of plaque and
calculus present
 Very life threatening disease
Gingival Manifestations of Dermatologic Conditions
- Lichen Planus
 Chronis disease thought to be immune related
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This handout is provided by the CLR.
Affects skin and mucous membranes
Men and women are equally effects
Reticular form » lacy white lines on gingival called
Wickham’s striae
 Rare erosive form » bulbous, portions of the lesions
become ulcerative and painful
o Can transform into squamous cell carcinoma
 Topical steroids can treat but there is no cure
- Benign Mucous Membrane Pemphigoid
 Cicatricial pemphigoid
 Chronic vesiculobullous disease
 Blistering and sloughing of surface epithelium
o Raw, painful bleeding areas
o Skin strips away when rubbed » Nikolsky’s
strips
 Unknown origin
o Considered to be autoimmune
 Common in older individuals and females
 On buccal mucosa and inner lip surfaces
 Pallative treatment with topical corticosteroids
 Systemic steroids also ease symptoms
- Desquamative Gingivitis or Gingivosis
 Cicatricial pemphgoid limited to gingival tissues
 Autoimmune
 Meticulous plaque control may help of this is often
difficult due to painful lesions
 Topical steroids and systemic steroids may help
- Traumatic Lesions
 Damage to gingival tissue
 Burns » aspirin placed on gingival relieves pain
 Cuts
 Some lesions can be severe enough to lead to
advanced recession
Foreign Body Reactions
 Lesions or damage can be acute
 Often localized painful lesions with sudden onset
 Removal of source will bring immediate relief