Gingival Diseases

Dr. Kristina Corazon L. Robles

Periodontal Medicine
Graduate School

Healthy
Periodontium

Pink* and firm with a knife-edge

appearance
The gingival margin is a few millimetres
coronal to the CEJ
The gingival sulcus (or crevice) is a
shallow groove which may be between
0.5 and 3 mm in depth around a fully
erupted tooth.
The gingival tissues are keratinised and
appear paler pink than sites of nonkeratinised oral epithelium.

Gingivitis
Inflammation of the papillary and
marginal gingivae
Gingivitis may be more or less
pronounced depending upon the
plaque (quantity/quality) and the
host response
Clinical symptoms:
Bleeding on probing
Erythema
Eventual swelling

Acute Necrotizing Ulcerative Gingivitis

(ANUG)
NAMES: Necrotizing gingivitis (NG)
Necrotizing stomatitis (NS)
Most severe inflammatory periodontal
disorder caused by plaque
They are rapidly destructive &
debilitating, & they appear to
represent various stages of the same
disease process
(Horning & Cohen 1995)

Acute Necrotizing Ulcerative Gingivitis

(ANUG)
History
Characterized by sudden onset, sometimes after an episode of
debilitating disease or acute respiratory tract infection.
A change in living habits, protracted work without adequate rest,
poor nutrition, tobacco use, and psychologic stress are frequent
features of the patient's history.

Acute Necrotizing Ulcerative Gingivitis

(ANUG)
CLINICAL CHARACTERISTICS:
Ulcerated and necrotic papillae and gingival
margins, giving a punchedout appearance.
The ulcers are covered by a yellowishwhite or
grayish slough, which has been termed a
pseudomembrane
It consists primarily of fibrin and necrotic tissue
with leukocytes, erythrocytes, and masses of
bacteria.

Acute Necrotizing Ulcerative Gingivitis

(ANUG)
SYMPTOMS
The lesions are extremely sensitive to
touch, and the patient often complains of
a constant radiating, gnawing pain that is
intensified by eating spicy or hot foods
and chewing.
There is a metallic foul taste, and the
patient is conscious of an excessive
amount of pasty saliva.
**Bacterial smear / Biopsy- not necessary

Gingival
Enlargement

Gingivitis from Puberty and

Menstruation
The incidence and severity
of gingivitis in adolescents
are influenced by a variety
of factors:
plaque levels
dental caries
mouth breathing
Crowding of the teeth
tooth eruption

Gingivitis from Puberty and

Menstruation
The dramatic rise in steroid hormone
levels during puberty in both sexes
has a transient effect on the
inflammatory status of the gingiva
(Mariotti 1994; Mariotti & Mawhinney
2013)

Pregnancy
Gingivitis
During human gestation, pregnancy
associated gingivitis is characterized
by an increase in the prevalence
and severity of gingivitis during the
second and third trimesters of
pregnancy

Pregnancy Gingivitis
Increased levels of progesterone

Increased permeability and dilatation of gingival capillary

vessels
increased vascular flow and exudation

These effects are partly mediated by

an
increased
synthesis
of
prostaglandin

Menopausal
Gingivitis

Menopause is defined as
having 12 consecutive months
without menstruation, marking the
end of perimenopause and
fertility.

Occurs at the 4th or 5th decade

(average age 51 years)

life expectancy of 80+ years

Menopausal Gingivitis
CLINICAL FEATURES
Erythema, edema
thinning of the oral mucosa
altered taste (salty, sour, peppery, metallic)
pain or burning sensations (burning
tongue)
xerostomia, halitosis, and accelerated
attachment loss.
varies in color (pale to deep red)
Gingiva- dry, shiny, and bleeds easily.

Microbiology of
Gingival
Disease

Teeth and Biofilm

-Biofilm is a well organized community of bacteria that adheres
to tooth surfaces and is embedded in an extracellular SLIME
LAYER
-Fluid channels penetrate the Slime Layer and facilitate
movement of nutrients and bacterial products
Allows communication between bacterial MICROCOLONIES

Treponema denticola

Fusobacterium nucleatum

Agregatibacter actinomycetemcomutans

Bacteria are the prime etiological agents in

periodontal disease, and it is estimated that more than
500 different bacterial species are capable of
colonizing the adult mouth.

Prevotella Intermedia

Porphyromonas gingivalis

Tannerella forsythia

Saini R, et al., 2009

BIOFILM IS HIGHLY
RESISTANT TO
ANTIBIOTICS AND
ANTISEPTICS!

REFERENCES

Carranza, F. A., & Newman, M. G. (2012).Carranza's clinical

periodontology. St. Louis, MO: Elsevier Saunders.

Hall, W. B., & Harpenau, L. (2013).Hall's critical decisions in

periodontology and dental implantology. Shelton, CT: People's
Medical Pub. House.

Lindhe, J., Lang, N. P., & Karring, T. (2015).Clinical

periodontology and implant dentistry. Oxford: Blackwell
Munksgaard.