1 / 40

Stages and clinical features of Gingivitis

Stages and clinical features of Gingivitis. CONTENT. INTRODUCTION STAGES OF GINGIVITIS TYPES OF GINGIVITIS CLINICAL FINDINGS. INTRODUCTION. DEFNITION: Inflamation Of The Gingiva Is Termed As Gingivitis.

waynemitchell
Download Presentation

Stages and clinical features of Gingivitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Stages and clinical features of Gingivitis

  2. CONTENT • INTRODUCTION • STAGES OF GINGIVITIS • TYPES OF GINGIVITIS • CLINICAL FINDINGS

  3. INTRODUCTION DEFNITION: Inflamation Of The Gingiva Is Termed As Gingivitis. The micro organism in plaque can exert its effect on periodontium by releasing certain products which can cause damage to the epithelium and connective tissue constituents. The sequence of events during the development of gingivitis can occur in four different stages

  4. STAGEIGINGIVITIS: THE INITIAL LESION • Clinically no visible changes are seen except presence of exudation of fluid from the gingival sulcus , hence this condition is called subclinical gingivitis Features. 1. Classic vasculitis of vessels subadjacent to the junctional epithelium 2. Exudation of fluid from gingival sulcus 3. Increased migration of the leukocytes into the junctional epithelium and gingival sulcus. 4. Presence of serum proteins 5. Loss of perivascular collagen

  5. STAGE II GINGIVITIS: THE EARLY LESION • Clinically erythematous gingiva and bleeding on probing may be evident. • Features • All the changes seen in the initial lesions continue to intensify • The junctional epithelium may begin to show the development of rete pegs or ridges. • Accumulation of lymphocytes (t cells) beneath the junctional epithelium. • Further loss of collagen fibre network supporting the marginal gingiva

  6. STAGE III GINGIVITIS: THE ESTABLISHED LESION Clinical features 1. A bluish hue on the reddended gingiva due to impaired venous return Microscopically 1. Predominant inflamatory cells type are plasma cells, which invades epithelium and also deep into the connective tissue. 2. Proliferation, apical migration and lateral extension of the junctional epithelium is seen. Early pocket formation may or may not be present. 3. Further collagen destruction and continuing loss of connective tissue substance seen in the early lesion. 4. The following enzyme levels are said to be elevated in chronically inflammed gingiva:acid and alkaline phosphates,b-glucoronidase etc

  7. STAGE IV GINGIVITIS: THE ADVANCED LESION • The advanced lesion is also known as phase of advanced periodaontal breakdown • FEATURES 1. Persistence of features described in the established lesion 2. Extension of the lesion into the alveolar bone and periodontal ligament 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

  8. STAGES OF GINGIVITIS

  9. TYPES OF GINGIVITIS • DEPENDING UPON THE COURSE AND DURATION • DEPENDING ON DISTRIBUTION

  10. DEPENDING ON COURSE AND DURATION 1.ACUTE GINGIVITIS IT IS A PAINFUL CONDITION THAT COMES ON SUDDENLY AND IS OF SHORT DURATION 2. SUB ACUTE GINGIVITIS IT IS A LESS SEVERE PHASE OF AN ACUTE CONDITION 3. RECUURENT GINGIVITIS APPEARS AFTER HAVING BEEN ELIMINATED BY TREATMENT OR DISAPPEARS SPONTANEOUSLY AND THEN REAPPEARS 4. CHRONIC GINGIVITIS COMES ON SLOWLY, IS OF LONG DURATION AND IS PAINLESS UNLESS COMPLICATED BY ACUTE/SUB ACUTE EXACERBATION

  11. DEPENDING ON DISTRIBUTION 1.LOCALISED GINGIVITIS IS CONFINED TO GINGIVA IN RELATION TO A SINGLE TOOTH OR GROUP OF TEETH 2.GENERALISED GINGIVITIS INVOLVES THE ENTIRE MOUTH 3.MARGINAL GINGIVITITIS INVOLVES THE GINGIVAL MARGIN BUT MAY INCLUDE A PORTION OF THE CONTIGEOUS ATTACHED GINGIVA 4.PAPILLARY GINGIVITIS INVOLVES THE INTER DENTAL PAPILLAE AND OFTEN EXTENDS INTO THE ADJACENT PORTION OF THE GINGIVAL MARGIN 5.DIFFUSE GINGIVITIS AFFECTS THE MARGIN, ATTACHED GINGIVA AND THE INTER DENTAL PAPILLAE PAPILLARY, MARGINAL AND DIFFUSE GINGIVITIS CAN OCCUR AS LOCALISED OR GENERALISED CONDITIONS

  12. CLINICAL FINDINGS WHILE EXAMINING THE GINGIVA CLINICALLY ONE MUST ADOPT A SYSTEMATIC APPROACH WHILE CLOSE ATTENTION SHOULD BE GIVEN TO ANY TISSUE ALTERATION BECAUSE THEY CONTRIBUTE TO DIAGNOSIS. THE GINGIVA IS EXAMINED FOR: COLOUR, CONTOUR, CONSISTENCY, SIZE, POSITION, SEVERITY OF BLEEDING, SURFACE TEXTURE.

  13. GINGIVAL BLEEDING The two earliest symptoms 1.Increased gingival fluid prodution rate 2.Bleeding from the gingival sulcus on gentle probing Gingival bleeding varies in severity, duration and the ease with which it is provoked.Bleeding on probing is easily detectable clinically and hence it is of great value for early diagnosis and prevention . it is one of the two earliest visual signs of inflammation. It can appear earlier than colour changes.

  14. GINGIVAL BLEEDING CAUSED BY LOCAL FACTORS • Chronic and recurrent bleeding The most common cause of abnormal gingival bleeding is chronic inflammation. The bleeding is chronic or reccurent and is provoked by mechanical trauma, or by biting into solid foods. Severity of bleeding and the ease with which it is provoked depends on intensity of the inflammation

  15. Acute bleeding: Acute episodes of gingival bleeding are caused by injury or occur spontaneously in acute gingival disease. Gingival burns from hot foods or chemicals increase the ease of gingival bleeding. Spontaneous bleeding or bleeding on slight provocation occurs in acute necrotizing ulcerative gingivitis.

  16. COLOUR CHANGES IN GINGIVA Colour of the gingiva is an important cliniacal sign of gingival disease. Normally gingiva appears to be coral pink.Endogeneous oral pigmentations can be due to melanin,bilirubin or iron.Melanin is commonly found in darker races. Disease that increases melanin pigmentation include addison’s disease (adrenal dysfunction) which produces isolated patches of discolouration varying from bluish black to brown.

  17. Peutz jeghers syndrome (produces intestinal polyposis) and melanin pigmentation in oral mucosa and lips; and albright’s syndrome and von reckling hausen’s disease both of which produce areas of oral melanin pigmentation. Jaundice is best detected by examination of sclera, but the oral mucousa also acquires a yellowish colour. The deposition of iron in haemochromatosis may produce a blue grey pigmentation of the oral mucosa

  18. Several endocrine and metabolic disturbances, including diabetes and pregnancy, may result in colour changes. Blood dyscrasis such as anemia, polycythemia and leukemia may also induce colour changes. Exogeneous factor producing colour changes include atmospheric irritants such as coal and metal dust and colouring agents in food or lozenges. Tobacco cause a grey hyper keratosis of the gingiva. Localised bluish black areas of pigment are normally due to amalgam implanted in the mucosa.

  19. CHANGES IN THE CONSISTENCY OF THE GINGIVA Normal gingiva exhibits firm and resilient consistency. Factors that are responsible are cellular and fluid content and collagenous nature of lamina propria. In disease condition it can be soggy and edematous or firm and leathery in consistency.

  20. CHANGES IN SURFACE TEXTURE Under normal condition gingiva appears to be stippled (orange peel appearance) . Loss of stippling is an early sign of gingivitis. In chronic inflamation the surface is either smooth and shiny or firm or nodular. Smooth surface texture is also produed by epithelial atrophy in senile atrophic gingivitis peeling of the surface occures in chronic desquamative gingivitis. Hyper keratosis results in leathery texture and non inflamatory gingival hyperplasia produces a minutely nodular surface.

  21. CHANGES IN THE POSITION OF GINGIVA Actual and apparent Position. Recession is exposure of the Root surface by an apical shift In the position of the gingiva. Actual position is the level Of epithelial attachment on The tooth. Apparent position is the Level of crest of the gingival Margin. The severity of recession is Determined by the actual Position of the gingiva and Not its apparent position

  22. TWO TYPES OF RECESSION • VISIBLE-WHICH IS CLINICALLY OBSERVABLE • HIDDEN- IT IS COVERED BY GINGIVA AND CAN BE MEASURED ONLY BY INSERTING A PROBE TO THE LEVEL OF EPITHELIAL ATTACHMENT. RECESSION MAY BE LOCALISED ONE TOOTH OR A GROUP OF TEETH OR MAY BE GENERALISED THROUGH OUT THE MOUTH.

  23. CLASSIFICATION OF GINGIVAL RECESSION • TWO CLASSIFICATION SYSTEMS ARE AVAILABLE 1.ACCORDING TO THE SULLIVAN AND ATKINS SHALLOW NARROW SHALLOW WIDE DEEP NARROW DEEP WIDE

  24. 2. ACCORDING TO P.D MILLER’S CLASS I : Marginal Tissue Recession That Does Not Extend To The Muco Gingival Junction. There Is No Loss Of Bone Or Soft Tissue In The Intermediate Area. This Can Be Narrow Or Wide. CLASS II : Marginal Tissue Recession That Extends To Or Beyond The Mucogingival Junction. There Is No Loss Of Bone Or Soft Tissue In The Interdental Areas. This Can Be Narrow Or Wide. Class III : Marginal Tissue Recession That Extends To Or Beyond The Muco Gingival Junction. In Addition There Is Loss Of Bone/ Soft Tissue In The Inter Dental Areas Or There Is Malpositioning Of The Tooth. CLASS IV : Marginal tissue recession that extends to or beyond the mucogingival junction wth severe loss of bone and soft tissue interdentally.Severemalpositioning of the tooth is seen.

  25. PROGNOSIS CLASS I AND II IS GOOD TO EXCELLENT CLASS III ONLY PARTIAL COVERAGE CAN BE EXPECTED CLASS IV POOR PROGNOSIS

  26. ETIOLOGY OF GINGIVAL RECESSION Plaque induced gingival inflammation is the primary etiological factor responsible for gingival recession; Next most common cause is faulty tooth brushing. Other secondary or contributing factors of gingival recession are broadly categorised as: • Anatomic factors • Habits • Iatrogenic factors • Physiological factors

  27. ANATOMIC FACTORS INCLUDE • Tooth malposition or position of the tooth in the arch.. • Presence of dehiscence and fenestrations. • Gingival ablation from soft tissue like lips etc. • mesiodistal curvature of the tooth surface.

  28. HABITS FAULTY TOOTH BRUSHING OR BRUSHING WITH HARD BRISTLES MAY LEAD TO GINGIVAL RECESSION.

  29. IATROGENIC FACTOR ORTHODONTIC MOVEMENT IN THE LABIAL DIRECTION AND IMPROPER RESTORATION CAN LEAD TO GINGIVAL RECESSION.

  30. PHYSIOLOGICAL FACTORS GINGIVAL RECESSION WAS THOUGHT TO BE A PHYSIOLOGIC PROCESS RELATED TO AGING. HOWEVER THIS IDEA WAS DISCARDED BECAUSE THERE WAS NO CONVINCING EVIDENCE FOR A PHYSIOLOGIC SHIFT OF THE GINGIVAL ATTACHMENT.

  31. CLINICAL SIGNIFICANCE OF GINGIVAL RECESSION • THE EXPOSED ROOT SURFACE MAY BE EXTREMELY SENSITIVE. • HYPEREMIA OF THE PULP MAY RESULT DUE TO GINGIVAL RECESSION • INTERPROXIMAL RECESSION CREATES ORAL HYGEINE PROBLEMS THEREBY RESULTING IN PLAQUE ACCUMULATION • FINALLY IT IS AESTHETICALLY UNACCEPTABLE

  32. CHANGES IN GINGIVAL CONTOUR Normally, marginal gingiva is scalloped and knife edged whereas interdental papilla in the anterior region is pyramidal and posteriorly tent shaped. The factors that maintain normal contour are shape of the teeth and its alignment in the arch, location and size of the proximal contact and dimensions of facial and lingual embrasures. In diseased conditions, the marginal gingiva may become rounded or rolled where as interdental papilla can become blunt and flat

  33. Indentations of the gingival margin referred to as Stillman's clefts and the so-called McCall festoons (life preserver-shaped enlargement of the margin) can be seen.

  34. THANK YOU

More Related