Gingivitis
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The document discusses the classification and stages of gingivitis. It describes gingivitis as being classified based on duration into acute or chronic, and based on distribution into localized, generalized, marginal, or papillary. It then outlines the four stages of gingivitis: initial lesion, early lesion, established lesion, and advanced lesion. It provides details on the clinical and microscopic features of each stage. The document also discusses changes in the position of the gingiva that can occur during disease, such as coronal migration (pseudopockets) or apical migration (recession).
Gingivitis
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- 2. Dr Jaffar Raza Syed Page 2 Classification I. According to duration: 1. Acute gingivitis 2. Chronic gingivitis II. According to distribution: 1. Localized gingivitis 2. Generalized gingivitis 3. Marginal gingivitis 4. Papillary gingivitis 5. Diffuse gingivitis
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- 8. Dr Jaffar Raza Syed Gingival Diseases Various Stages Of Gingivitis 4 stages of gingivitis: • Stage I Initial lesion • Stage II Early lesion • Stage III Established lesion • Stage IV Advanced lesion Initial lesion 2-4 days Early lesion 4-7 days Established lesion 14-21 days dvanced lesion Page 8
- 9. Dr Jaffar Raza Syed Stage I Gingivitis: The Initial Lesion --no visible changes --presence of exudation of fluid from the gingival sulcus subclinical gingivitis --The following features are observed in stage I 1. Classic vasculitis of vessels subjacent to the junctional epithelium. 2. Exudation of fluid from gingival sulcus. 3. Changes in the coronal most portion Junctional epithelium 4. Increased migration of the leukocytes into the Junctional epithelium and gingival sulcus. 5. Presence of serum proteins. 6. Loss of perivascular collagen. tage I Gingivitis: The Initial Lesion exudation of fluid from subclinical gingivitis. The following features are observed in stage I of vessels subjacent to of fluid from gingival sulcus. coronal most portion of the of the leukocytes into the d gingival sulcus. Page 9
- 10. Dr Jaffar Raza Syed Stage II Gingivitis: The Early Lesion Clinically, erythematous gingiva and on probing may be evident. Microscopic features of the early lesion 1. All the changes seen in the initial lesion continue to intensify. 2. The junctional epithelium may begin to show the development of rete pegs or ridges 3. Accumulation of lymphocytes beneath the junctional epithelium. 4. Further loss of collagen fiber network supporting the marginal gingiva. 5. Fibroblasts show cytotoxic alteration with a decreased capacity for collagen production. Stage II Gingivitis: The Early Lesion Clinically, erythematous gingiva and bleeding ic features of the early lesion include: 1. All the changes seen in the initial lesion 2. The junctional epithelium may begin to show development of rete pegs or ridges. lymphocytes beneath the junctional epithelium. fiber network marginal gingiva. show cytotoxic alteration with a decreased capacity for collagen production. Page 10
- 11. Dr Jaffar Raza Syed Page 11 Stage III Gingivitis: The Established Lesion --Same as early lesion, with blood stasis --Changes are seen in color consistency and surface texture. --Bluish hue around the reddened gingiva --Proliferation, apical migration and lateral extension of junctional epithelium --Atropic areas --Plasma cells are predominant --Further loss of collagen. --Increased enzyme levels like acid and alkaline phosphatase, β glucuronidase and others.
- 12. Dr Jaffar Raza Syed Page 12 Stage IV Gingivitis: The Advanced Lesion The advanced lesion is also known as phase of advanced periodontal breakdown. The following clinical and microscopic features are seen: 1. Persistence of features described in the established lesion. 2. Extension of the lesion into the alveolar bone and PDL leading to significant amount of bone loss. 3. Continued loss of collagen. 4. Formation of periodontal pockets. 5. Conversion of bone marrow into fibrous tissue. 6. Presence of almost all the types of inflammatory cells.
- 13. Dr Jaffar Raza Syed Page 13 Clinical Findings Changes in color, contour, consistency, size, position, severity of bleeding, surface textur
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- 21. Dr Jaffar Raza Syed Changes in the Position of Gingiva Normal attachment CEJ In disease Coronally pseudopocket Apically gingival recession Types 1..Visible 2..hidden Changes in the Position of Gingiva Page 21
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- 24. Dr Jaffar Raza Syed Page 24 PD Miller’s Classification of Gingival Recession
- 25. Dr Jaffar Raza Syed Page 25 Etiology of Gingival Recession Plaque-induced gingival inflammation Faulty tooth brushing Tooth malpositions Presence of dehiscence and fenestrations Smoking Primary trauma from occlusion Iatrogenic factors
- 26. Dr Jaffar Raza Syed Page 26 Clinical Significance of Gingival Recession 1. The exposed root surface may be extremely sensitive. 2. Hyperemia of the pulp may result due to gingival recession. 3. Interproximal recession creates oral hygiene problems thereby resulting in plaque accumulation. 4. Finally, it is aesthetically unacceptable.
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