Evaluation of the Gingiva: The Periodontal Examination

Question 1

an intraoral exam includes

Answer 1

an evaluation of the gingiva and its relation to the adjacent structures of the periodontium, the teeth and the oral mucosa

Question 2

12 features of gingival evaluation

Answer 2

color, contour, consistency, surface texture, keratinization, position, size, sulcus and pocket depth, bleeding, suppuration, pain, mucogingival involvement

Question 3

the colour of the gingiva is determined by

Answer 3

vascularity within connective tissue
melanin pigmentation
degree of epithelial keratinization
thickness of the epithelium
subgingival deposit

Question 4

healthy gingiva colour

Answer 4

uniformly pink or light to dark brown

Question 5

inflamed gingiva colour

Answer 5

shiny red, bruise bluish, chronic fibrotic pink

Question 6

contour of the gingiva is determined by

Answer 6

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

Question 7

healthy gingiva contour

Answer 7

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

Question 8

inflamed gingiva contour

Answer 8

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

Question 9

cratered or missing papilla

Answer 9

lots of recession visible
loss of papilla around the tooth

Question 10

consistency

Answer 10

refers to resiliency and may be tested by pressing the gingiva with the back of an instrument

Question 11

the firmness of the attached gingiva is a result of

Answer 11

being tightly bound to the underlying bone by dense fibrous connective tissue

Question 12

healthy consistency

Answer 12

firm and resilient

Question 13

inflamed consistency

Answer 13

tissue is soft and spongey which dents when tested with probe

Question 14

chronically inflamed gingiva may have increased _______ ______ to restore some of the ______ or ________

Answer 14

granulation tissue

firmness or resiliency

Question 15

surface texture

Answer 15

surface of the attached gingiva may have a dimpled appearance like the skin of an orange

Question 16

stippling

Answer 16

caused by the connective tissue fibers that attach the gingival tissue to the cementum and bone
is not a direct indication of health

Question 17

_____ will cause changes to healthy stippled gingiva by causing pressure under the epithelium

Answer 17

edema

Question 18

keratinization

Answer 18

the development of cells containing keratin on the outer surface
epithelium may become thin with decreased keratinization

Question 19

keratinized

Answer 19

squamous cells without nuclei

Question 20

parakeratinized

Answer 20

some squamous cells with nuclei

Question 21

position sign of health

Answer 21

the gingival margin is normally at the level of, or slightly below, the enamel contour or prominence of the cervical third of a tooth

Question 22

position sign of disease

Answer 22

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

Question 23

actual position of the gingiva

Answer 23

the level of the attached periodontal tissue, not directly visible but can be determined by probing

Question 24

apparent position of the gingiva

Answer 24

the level of the gingival margin or crest of the free gingiva that is seen by direct observation

Question 25

size of gingiva

Answer 25

tissue elements
cellular elements + intercellular elements + vascular supply = size of the gingiva

Question 26

size of healthy gingiva

Answer 26

free marginal gingiva is near the CEJ and closely adheres to the tooth

Question 27

size of inflamed gingiva

Answer 27

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

Question 28

reduced periodontium

Answer 28

when periodontisis has been resolved, but periodontal damage has previously occurred

Question 29

chronic inflammation

Answer 29

will sometimes present smaller or reduced
fibrotic gingiva may appear outwardly healthy, thus masking underlying disease

Question 30

once a sulcus is inflamed it is termed a

Answer 30

pocket

Question 31

pseudo-pocket

Answer 31

a pocket formed by gingival enlargement without apical migration of the junctional epithelium

Question 32

periodontal pocket

Answer 32

a pocket formed as result of disease, causing apical migration of the junctional epithelium along the cementum

Question 33

bleeding

Answer 33

can occur up to 10% of sites in a healthy periodontium
can occur if clinician uses too much force

Question 34

2 types of bleeding

Answer 34

bleeding on provocation: scaling, probing, flossing

spontaneous bleeding: severe inflammation, hemorrhagic disease

Question 35

suppuration

Answer 35

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%

Question 36

pain occurs in

Answer 36

advanced stages of periodontitis

Question 37

symptoms of pain

Answer 37

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

Question 38

mucogingival involvement (stress)

Answer 38

occurs where frenal, muscle or alveolar mucosa attachments pull upon gingival margins or periodontal pockets, retracting the tissue away from the tooth surface

Question 39

method of evaluating the adequacy of the attached gingiva

Answer 39

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