GINGIVA

The periodontium (peri-around, dontium-tooth, greek) consists of investing and supporting tissues. The investing tissue of the periodontium is known as the GINGIVA. It is the most periphera periodontium at arge. According to the !or and "edica !ictionar#, the word gingiva means the $gum of the mouth%. It is that part of the ora mucosa over #ing the crown of unerupted teeth and encirc ing the necks of these that have erupted, serving as the supporting structure for the su&ad'acent tissues. DEFINITIONS 1. CARANZA Is the part of ora mucosa that covers the a veo ar processes of 'aw and surrounds the neck of teeth. 2. SCHROEDER It is a com&ination of epithe ium and connective tissue and is defined as that portion of ora mucous mem&rane, which in comp ete posteruptive dentition of a hea th# #oung individua , surrounds and is attached to the teeth and the a veo ar processes. 3. GRANT Is the part of ora mucous mem&rane attached to the teeth and the a veo ar processes. ( portion of

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LINDHE Is that part of masticator# mucosa covering the a veo ar processes

and the cervica portions of teeth. FUNCTIONS As the gingiva represents &oth the masticator# mucosa as we as the most periphera part of the periodontium, its functions are two fo d. I] As part of the oral !"osa

It protects the supporting tissues from the ora environment. a) As part of ora mucosa, it is su&'ected to friction and pressure in the masticator# process. Its dense # co agenous periphera amina propria,

sensor# innervation and keratini)ation he p in the

adaptation to these ph#sica re*uirements. &) It is a mucosta& e tissues &ecause of its firmness, sca oped contour, c ose adaptation and attachment to the under #ing structures. c) Gingiva tissues fu fi the functions of sensitivit# and resistance. II] As part of the per#o$o%t#! The gingiva e+hi&its functiona properties, a) It ensures denta arch inkage and contro s the positioning of teeth in the hori)onta p ane &# means of its supra-a veo ar fi&re apparatus. These fi&res a ong with those of -!. secure teeth against rotationa forces and generate forces resu ting in mesia drift. /

&) It maintains gingiva and periodonta hea th &# means of various defense mechanism operating within the gingiva tissues. This periphera defense action of gingiva has two arms, (. The humora arm which represents the generation of gingiva f uid. /. The ce u ar arm which represents the continuous irrigation of neutriphi ic granu oc#tes via the 'unctiona epithe ium. 0oth these arms keep a /1 hour watch on the periodonta hea th. Development 2n ike, the other tissues of the periodontium which are derived from the ectomesench#ma denta fo ic e, the gingiva is a derivative of mesoderm. According to 3chroeder, the shape, topographica distri&ution and width of the gingiva are functions of the presence and position of erupted teeth. 4e a so sa#s that, there are reasons to assume that the gingiva tissues e+ist and deve op as a site specific portion of the ora mucous mem&rane prior to the eruption of deciduous teeth. Thereafter, the gingiva a though increasing si)e serves &oth deciduous and permanent teeth.

Normal Clinical Features Gingiva is divided into, 6ra part Anatomica #, it has &een divided into, "A7GINA. gingiva ATTA849! ginigiva -#ramida INT97!9NTA. gingiva 8o A] Marginal gingiva / Free gingiva / Margio Gingivalis De inition It is the termina edge or &order of the gingiva surrounding the teeth ike a co ar. Vesti&u ar part

:igure 1

It is demarcated from the ad'acent attached gingiva &# a sha ow inear depression ; the free gingiva groove. This is a&out (mm wide and forms the soft tissue wa of the gingiva su cus. According to 3chroeder, the term $free gingiva% is a c inica designation and re ates to the c inica propert# of the gingiva rim. !] Attac"e# Gingiva It is continuous with the margina gingiva. It is firm, resi ient, and tight # &ound to the under #ing tissues of the a veo ar &one. 6n the facia aspect, the attached gingiva e+tends to the re ative # oose and mova& e a veo ar mucosa from which it is demarcated &# the mucogingiva 'unction (5 " G .ines) :acia ma+i ar# :acia mandi&u ar .ingua mandi&u ar

< .ingua ma+i ar# is not seen as there is not a veo ar mucosa on the pa ate and the pa ata tissue is firm # attached to the &one. $i#t" o t"e attac"e# gingiva Is defined as the distance &etween the mucogingiva 'unction and the pro'ection on the e+terna surface of the &ottom of the gingiva su cus = periodonta pocket. It is genera # greatest in the incisor region (5.> ; 1.>mm in ma+i a and 5.5 ; 5.?mm in mandi& e) and ess in the posterior region with east in the (st premo ar area ((.?mm in ma+i a and (.@mm in mandi& e).

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The width of the attached gingiva increases with age and supraerupted teeth. 7educed = A&sent Attached gingiva ma# &e due to, &ase of the pocket is c ose to the mucogingiva ine. frena = musc e attachments that encroach on pockets and pu them awa# from the tooth surface. denudation of root surfaces. Ade*uac# of the attached gingiva can &e determined &# the T9N3I6N T93T which consists of retracting the cheeks and ips atera # with fingers and checking if such tension po s the margina gingiva from the teeth. 7educed width of attached gingiva can &e corrected with mucogingiva surgeries. C] Inter#ental Gingiva

It occupies the gingiva em&rasure, which is the interpro+ima space &eneath the area of tooth contact T%pes& '%rami#al Col

Bhere there is one papi a with Bhich represents as a depression its tip immediate # &eneath the that connects a fascia and a ingua contact point. papi a and conforms to the shape of interpro+ima contact. () Various anatomic variations of the interdenta co in the norma gingiva and after gingiva recession GINGI(A) SU)CUS Is the sha ow space = crevice around the tooth &ounded &# the surface of the tooth on one side and epithe ium ining the free margin of the gingiva on the other. It is V-shaped and rare # permits the entrance of a periodonta pro&e. 2nder norma circumstances, the depth is C In histo ogic sections ; (.@mm. The pro&ing depth is /-5mm GINGI(A) F)UID / SU)CU)A* F)UID +GCF, The gingiva su cus contains a f uid that seeps into it from the gingiva connective tissue through the thin su cu ar epithe ium.

&!%"t#o% of GC&' c eanses materia from the su cus. 8ontains p asma proteins that ma# improve adhesion of the epithe ium to the tooth. It a so possesses antimicro&ia properties. It e+erts anti&od# activit# in defense of the gingiva.

NO*MA) MIC*OSCO'IC FEATU*ES The gingiva consists of a centra core of c.t. ( amina propria) covered &# stratified s*uamous epithe ium. G#%(#)al Ep#thel#! :rom the morpho ogic and function points of view 5 different t#pes are seen. 6ra = 6uter 3u cu ar Eunctiona &!%"t#o%s To protect the deep structures whi e a owing a se ective interchange with the ora environment (achieved &# pro iferation and differentiation of keratinoc#tes). .ater The princip e ce is the keratinoc#te. -ro iferation takes p ace &# mitosis. !ifferentiation invo ves the process of keratini)ation. @

The main morpho ogic change is the progressive f attening of the ce . 5 t#pes of keratini)ation can &e seen, 4isto ogica #, a keratini)ed epithe ium shows a num&er of distinct a#er. I] St Corneum It is the surface of ver# f at eosinophi ic ce s. II] St Granulosum
.arger f attened ce s that contain kerato-h#a ine granu es. The upper most a#er of stratified spi contains numerous granu es ca ed keratinosomes = od and &odies. III] St Spinosum / 'ric-le cell )a%er

.arger e iptica = spheroida ce s. Bhen prepared for histo ogic sections, these ce s shrink awa# from one another remaining in contact on # at patients known as interce u ar &ridges = desmosomes. I(] St !asale *rol#ferat#)e la+er. 5 t#pes Ort"o .eratinoc%te 8omp ete keratinoc#te No nuc ei in st corneum 'ara .eratinoc%te -artia incomp ete keratinoc#te -#knotic ? Non/-eratinoc%te = nuc ei No keratinoc#te No corneum = granu osum

Be defined 3t. granu osum e.g. a#ers of outer gingiva epithe ium

in st corneum Feratinoh#a ine granu es No st granu osum e.g. most areas of gingiva epithe ium

.eratini0ation The prot s#n during maturation process ; kerato inin and invo ved in form an enve ope &e ow the ce mem&rane (chemica # resistant

structure). As the ce s reach the corneum keratin or disappear and give rise to a protein ; fi agirin which forms the matri+ of the most differentiated epithe ia ce s ; 867N96.GT9. Cell t%pe (. "e anoc#te /. .angerhans ce s 5. "erke s ce s )evel in epit"elium 0asa -redominant # supra&asa 0asa Functions 3#nthesis pigment of me anin

7egu ator# ce "acrophage (contain granu es) 0ir&eck%s

Tacti e perception 0oth epithe ia pro iferation and maturation are needed for

continuous ce renewa to maintain structura integrit#. The contro over these two processes is mediated &# su&stance produced &# maturing epithe ia ce s ; 84A.6N93 which acts &# ;ve feed&ack mechanism.

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ST*UCTU*E E'IT1E)IUM

AND

C1A*ACTE*ISTICS

OF

GINGI(A)

I] Oral , o!ter ep#thel#! It covers the crest = outer surface of the margina gingiva and the surface of the attached gingiva. It is keratini)ed = parakeratini)ed or present various com&inations of these conditions. The preva ent surface is however parakeratini)ed. In orthokeratini)ed areas Feratins F(, F/ and F-(C, F-(/ which are specific for epiderma differentiation are e+pressed with high intensit#. FA and F(A characteristic of high # pro iferative epithe ium F(, F/, F-(C, F-(/ ; e+pressed with ow intensit# in parakeratini)ed area. These a so e+press F-(? which are a&sent from 6rtho keratini)ed area. II] S!l"!lar ep#thel#! .ines the gingiva su cus. It is a thin, non-keratini)ed s*uamous epithe ium without retepegs, which e+tends from the corona imit of 'unctiona epithe ium to the crest of the gingiva margin. It shows ce s and with h#dropic degeneration.

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It contains keratins F1 and F(5, a so e+presses F-(?. It acks stratum granu osum and corneum, c#tokeratins F( and F/ and F(CF(/ and a so acks "erke s ce s.

It has the potentia to keratini)e, if, a) It is ref ected and e+posed to the ora cavit#. &) The &acteria f ora of the su cus is tota # e iminated. These findings suggest that the oca irritation of the su cus (due to its contact with tooth) prevents su cu ar keratini)ation.

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&!%"t#o%s of s!l"!lar ep#thel#! It acts as a semi-permea& e mem&rane three which in'urious &acteria pass into the gingiva and three which tissue f uid from the gingiva seeps into the su cus. III] -!%"t#o%al ep#thel#! 8onsists of a co ar- ike &and of stratified s*uamous nonkeratini)ing epithe ium. a) It is 5-1 a#ers thick in ear # ife, &ut it increases with age to (C-/C. &) The ength ranges from C-/> ; (.5> mm. c) It is widest in its corona portion ((>-/C ce thinner towards the 89E. d) It e+presses F-(? and the stratification specific c#tokeratins F> and F(1. 1istolog% o 2unctional epit"elium Is a continuous se f-renewa structure and is continuous # renewed through ce division occurring in the &asa a#er. The ce s migrate to the &ase of the gingiva su cus, from where the# are shed. 8e s are arranged in / strata 0asa 3upra&asa a#ers) &ut &ecomes

0oth are f attened with their ong a+is (( to the tooth surfaces

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Functions 2n ike the epithe ia connective tissue interface, the amina densa of the interna &asa a#er (facing the ename ) has no anchoring fi&ri s attached to it, which means that the 'unctiona epithe ium is ph#sica # attached to the tooth via the hemidesmosomes (3chroerder). The attachment of the 'unctiona epithe ium to the tooth is further reinforced &# the gingiva fi&res which &race the margina gingiva against the tooth surface for this reason. Eunctiona epithe ium and gingiva fi&res are a function unit FI!*ES The connective tissue fi&res are, 8o agen 7eticu um 6+#ta an 9 astic 8o agen ; A>H of 8.T. vo ume Tropoco agen (sma est unit of a co agen are aggregated ongitudina # to form mo ecu e) after s#nthesis, it is secreted out from the fi&ro& asts into e+trace u ar space. -rotofi&ri atera # aggregates to in II form co agen fi&ri s with an over apping of tropoco agen mo e &# a&out />H of their engths. These are &und es of co agen fi&ri s, a igned in such a wa# that fi&res e+i&it a cross-&inding. 8o agen T#pe I (1

:orms the &u k of amina propria and provides tensi e strength. Gingiva co agen fi&res ; consists of T#pe I co agen.

&!%"t#o%s' To &race the margina gingiva firm # against the tooth. To provide rigidit# necessar# to without and the forces of mastication without &eing def ected from the tooth surfaces. To un ike the free margina gingiva with the cementum of the root and the ad'acent attached gingiva. Ret#"!l! Are present at the epithe ia connective tissue and the endothe ium c.t. interface. O.+tala% are present in a c.t. structure of the periodontium and are composed of ong thin fi&ri s. The# regu ate vascu ar f ow. In the -!., these fi&res run (( to the root surfaces in a vertica direction and &end to attach to cervica 5rd of cementum. Are present in a 8.T. of gingiva and periodonta on # in

association with the & ood vesse s. GINGI(A) FI!*ES Carra%/a 011123 Gingiovodenta .

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8ircu ar. Transepta . 3emicircu ar Transgingiva

MAT*I3 8onstitutes the environment for the ce . It is produced &# fi&ro& asts and is composed of protein po #saccharides and macromo ecu es. -roteog #cans !)OOD SU'')4 5 sources of & ood supp # to gingiva (8arran)a (??A). a) 3upra-periostea arterio es A ong the fascia and ingua surface of the a veo ar &one, from which capi aries e+tend a ong the su cu ar epithe ia and &etween the retepegs of the e+terna gingiva surface. &) / vesse s of the -!. ; which e+tend into the gingiva anastomose with capi aries in the su cus area. c) Arterio es which emerge from crest of the interdenta septa. Nerve suppl% region - 2pper gingiva Innervation Anterior, post and midd e supraa veo ar &ranches of ma+i ar# (A G #coproteins

nerve, pa ata nerves. .ower gingiva &ucca and ingua Infection a veo ar &ranch of mandi&u ar nerve, &ucca &ranch of mandi&u ar nerve, su& ingua &ranch of ingua nerve.

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L+ phat#" $ra#%a(e 0rings in the #mphatics of the 8.T. papi ae. It progresses to the regiona #mph nodes.
86-79.ATI6N 6: N67"A. 8.INI8A. :9AT2793 AN! "I876386-I8 :9AT2793 Appearance in "ealt" (. 8o our C"anges in #isease / clinical appearance ; = Causes or c"anges Vesse s engorged 0 ood f ow s uggish and Venous return impaired 9dematous inf ammator# f uid, ce u ar e+udates hemorrhage

2niform # pa e a) 8hronic pink = cora pink & uish pink Variations in & uish red pigmentation re ated to race

/. 3i)e

Not en arged fits 9n arged snug # around the tooth

5. 3hape

a) "argina 7o ed = rounded gingiva , Fnife edge, fo ows a curved ine around the tooth :irm 3oft, spong#, red co our, dents readi # when pressed with a pro&e, smooth and shin# surface

Inf ammation changes, edema or fi&rosis

1. 8onsistenc#

9dematous f uid &etween ce s in the connective tissue

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>. 3urface te+ture

7epresents that of an orange pe and is known as stipp ing. The attached gingiva is stipp ed ; not the margina . It varies with age, is a&sent in infanc# increase ti adu thood and disappears in o d age. It is produced &# a ternate protru&erances I depressions in the gingiva surfaces.

9+posure of the tooth &# the apica migration of gingiva is ca ed gingiva recession = atroph# -h#sio ogic =-atho ogic occurs.

*e erences& (. 8 inica -eriodonto og# &# 8arran)a, Newman and Takei. /. -eriodontics &# Grant, 3tern and .istgarten.

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Gingiva

SEMINAR BY Dr. N.Upendra Natha Reddy Postgraduate Student

/CC1-/CCD
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8ontents
(. !efinition /. :unction 5. !eve opment 1. Norma 8 inica :eatures >. Gingiva : uid = 3u cu ar : uid (Gcf) A. Norma "icroscopic :eatures D. 3tructure 9pithe ium @. Gingiva :i&ers
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and

8haracteristics

6f

Gingiva

0 ood supp #J Nerve supp # J .#mphatic drainage Norma c inica features and microscopic 7eferences

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features

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