Evaluation of the Gingiva: The Periodontal Examination Flashcards
an intraoral exam includes
an evaluation of the gingiva and its relation to the adjacent structures of the periodontium, the teeth and the oral mucosa
12 features of gingival evaluation
color, contour, consistency, surface texture, keratinization, position, size, sulcus and pocket depth, bleeding, suppuration, pain, mucogingival involvement
the colour of the gingiva is determined by
vascularity within connective tissue
melanin pigmentation
degree of epithelial keratinization
thickness of the epithelium
subgingival deposit
healthy gingiva colour
uniformly pink or light to dark brown
inflamed gingiva colour
shiny red, bruise bluish, chronic fibrotic pink
contour of the gingiva is determined by
shape of the teeth
alignment of the teeth in the arch
location and size of the contact areas of the teeth
size of the embrasure spaces between the teeth
contours of the proximal surfaces of the teeth
presence of inflammation
healthy gingiva contour
gingival margin is 1 mm above CEJ
knife-edge, flat; follows a curved line around the tooth; fits snug around tooth
papilla is pointed and fills interproximal spaces
inflamed gingiva contour
margins are irregular from edema, fibrosis, and recession
may be rounded, rolled, or bulbous, more coronal to the CEJ
papilla may be cratered, flattened or blunted
cratered or missing papilla
lots of recession visible
loss of papilla around the tooth
consistency
refers to resiliency and may be tested by pressing the gingiva with the back of an instrument
the firmness of the attached gingiva is a result of
being tightly bound to the underlying bone by dense fibrous connective tissue
healthy consistency
firm and resilient
inflamed consistency
tissue is soft and spongey which dents when tested with probe
chronically inflamed gingiva may have increased _______ ______ to restore some of the ______ or ________
granulation tissue
firmness or resiliency
surface texture
surface of the attached gingiva may have a dimpled appearance like the skin of an orange
stippling
caused by the connective tissue fibers that attach the gingival tissue to the cementum and bone
is not a direct indication of health
_____ will cause changes to healthy stippled gingiva by causing pressure under the epithelium
edema
keratinization
the development of cells containing keratin on the outer surface
epithelium may become thin with decreased keratinization
keratinized
squamous cells without nuclei
parakeratinized
some squamous cells with nuclei
position sign of health
the gingival margin is normally at the level of, or slightly below, the enamel contour or prominence of the cervical third of a tooth
position sign of disease
gingival enlargement: gingival margin may be high on the enamel, partly or nearly covering the anatomic crown
gingival recession: exposure of root surface that results from the apical migration of the JE
actual position of the gingiva
the level of the attached periodontal tissue, not directly visible but can be determined by probing
apparent position of the gingiva
the level of the gingival margin or crest of the free gingiva that is seen by direct observation
size of gingiva
tissue elements
cellular elements + intercellular elements + vascular supply = size of the gingiva
size of healthy gingiva
free marginal gingiva is near the CEJ and closely adheres to the tooth
size of inflamed gingiva
enlarge from excess fluid in tissues or fibrotic from the formation of scar tissue within the connective tissue
free marginal gingiva may be highly retractable with air
reduced periodontium
when periodontisis has been resolved, but periodontal damage has previously occurred
chronic inflammation
will sometimes present smaller or reduced
fibrotic gingiva may appear outwardly healthy, thus masking underlying disease
once a sulcus is inflamed it is termed a
pseudo-pocket
a pocket formed by gingival enlargement without apical migration of the junctional epithelium
periodontal pocket
a pocket formed as result of disease, causing apical migration of the junctional epithelium along the cementum
bleeding
can occur up to 10% of sites in a healthy periodontium
can occur if clinician uses too much force
2 types of bleeding
bleeding on provocation: scaling, probing, flossing
spontaneous bleeding: severe inflammation, hemorrhagic disease
suppuration
when purulent exudate is present, pus escapes the pocket during probing
does not indicate the severity of inflammation or pocket depth
presence of pus is an indicator of active periodontal destruction 2%-30%
pain occurs in
advanced stages of periodontitis
symptoms of pain
localized pain or pressure after eating
deep, radiating pain in the bone
gnawing or itchy feeling in the gums
urge to put pressure on the gingiva
sensitivity
toothache in absence of caries
mucogingival involvement (stress)
occurs where frenal, muscle or alveolar mucosa attachments pull upon gingival margins or periodontal pockets, retracting the tissue away from the tooth surface
method of evaluating the adequacy of the attached gingiva
retract cheeks and lips laterally or away from the teeth with fingers
if tension pulls the marginal gingiva from the teeth, the zone of attached gingiva is too narrow… or the frenal or muscle attachment is too close to the gingival margin
