Gingiva

Question 1

where is gingiva located

Answer 1

• part of the oral mucosa surrounding crevices of teeth
• firmly attached to alveolar process and teeth
• buccal, labial, lingual, palatal,… gingiva

Question 2

what is free gingiva

Answer 2

• above junctional epithelium and not attached to tooth or alveolar bone

Question 3

what is interdental papilla

Answer 3

• between 2 adjacent teeth (triangle)

Question 4

wha is attached gingiva

Answer 4

• firmly attached alveolar bone

Question 5

what is stippling

Answer 5

• firm gingiva
• pitted (when dried)
• more on attached
• scalloped margin around teeth

Question 6

what is the colour of healthy gingiva

Answer 6

• coral pink
• greyish - pink (fair skinned people
• pigmented in dark skin people - melanin
  extends to mucogingival junction
• blends without a distinct line on palate

Question 7

what is the position of the gingiva on teeth related to age

Answer 7

• young: interdental papilla fills IPS, clinical crown < anatomical crown
• age 30-40: IDP does not always fill IPS, clinical crown = or larger than anatomical crown
• age 50-60 IDP does not fill IPS, clinical crown > anatomical crown, cementum/dentin visible

Question 8

what are the 2 layer of gingiva

Answer 8

1. connective tissue called lamina propria: finger like projections of connective tissue, which produces pitted appearance (stippling)
2. epithelial layer: keratinized SSE, keratinization gives colour of gingiva (obscures vascularity making tissue pinkish). non keratinized in sulcus

Question 9

what are the fibers of the PDL that penetrate the connective tissue of the gingiva

Answer 9

• transseptal
• alveolar crest fibers
• free gingival

Question 10

what is the sulcus

Answer 10

• space around the tooth
• inner border is non-keratinized gingiva, is not attached to tooth/bone -> free gingiva
• 1 to 3 mm in health
• borders: tooth (inner), Stratified Squamous Epithelium (outer), JE (bottom), GM (top)

Question 11

what is the junctional epithelium

Answer 11

• SSE (non keratinized) attached to tooth
• continuous with SS Epith of sulcus up to gingival margin
• normal and disease JE - apical migration
• normal, may be related to slow occlusal movement, however, root ward migration of the JE is a natural aging process

Question 12

what is the junctional epithelium like in age

Answer 12

• young: less apical migration

- older: natural progression, sulcus remains shallow in health, some cementum exposed recession but no probing

Question 13

what is the origin for the JE

Answer 13

• 4 layer enamel organ reduced to one
• during eruption, reduced enamel epithelium attaches to oral epithelium -> junctional epithelium
• JE high on tooth during eruption
• eventually will firmly attach to cementum below the CEJ after eruption (in adults)

Question 14

what is the clinical significance of the JE

Answer 14

• keeping the sulcus epithelium and JE intact will be good perio health
• sulcus epithelium and JE not protected (non keratinized)

Question 15

what does damage/disease to epithelium of gingival sulcus cause

Answer 15

• penetrate underlying connective tissue easily
• inflammation/swelling of connective tissue
• damage to PDL/JE
• bone resorption
• loosening tooth

Question 16

what is seen in a healthy periodontium

Answer 16

• no inflammation
• JE intact
• sulcular epithelium
  firmly against tooth

Question 17

what is the significance of recession/exposed cementum and dentin

Answer 17

• migration of JE and GM
• cervical abrasion often present
• due to aggressive horizontal brushing, abrasive toothpaste and hard bristle
• increase risk to caries
• increase sensitivity
• patient education