gingival assessment Flashcards
free gingiva division
- free gingival groove
- oral epithelium
- gingival margin
gingival sulcus
- location
- boundaries
- sulcular epithelium
- depth of sulcus
- gingival sulcus fluid
junctional epithelium
- description: non keratinized, encircles the tooth
- size: 15 to 20 cells thick, 1-2 cells at the apical end
- position: in health is longer than in disease. can migrate along the root surface
- relation: of crest of alveolar bone to the attached gingival tissue - base of attachment to the crest of alveolar bone is 1-1.5 mm
- attachment: of the epithelium to the tooth surface - provides a seal at the base of the sulcus
interdental gingiva/papilla
- location: interproximal area between adjacent teeth
- shape: varies with spacing (anterior: single papilla pointed, pyramidal. posterior: flatter papilla, two papilla: 1 facial and 1 lingual)
what is a col
- a depression between the lingual or the facial papilla that conforms to the proximal contact
- not keratinized and most perio disease starts in this area
clinically normal gingiva should be:
- coral pink (greyish pink)
- pyramid shaped papilla
- knife like margins
- adapts closely to the tooth
- minimal sulcus depth
- no bleeding on probing
- normal can vary anatomically and physiologically. general characteristics form a baseline of normal
causes of tissue changes
- disease causes: change in colour, size, position, shape, consistency, texture, bleeding and exudate production
descriptive terminology for tissue changes
- severity: mild, moderate, severe
- distribution: localized, generalized, marginal, interproximal and/or diffuse
early recognition of tissue changes
- significant changes such as moderate to severe generalized redness, enlargement, sponginess, deep pockets, and mobility are easy to detect with good light and accessibility
- subtle changes are more difficult to assess
- early recognition and treatment is the key to the success of gingival and periodontal infections, as clinicians we must be on the ball with our assessment skills
signs of health in colour of gingiva
- signs of health:
1. pale pink - darker in darker complexions
2. factors influencing colour: - vascular supply
- thickness of epithelium
- degree of keratinization
- physiologic pigmentation
changes in disease in colour of gingiva
- changes in disease:
1. in chronic inflammation: dark red to bluish tone
2. in acute inflammation: bright red
3. extent: deep involvement expected when diffuse colour changes extend: - into attached gingiva
- from marginal gingiva to mucogingival junction
- through into alveolar mucosa
signs of health in size of gingiva
- signs of health:
1. free gingiva: skinny, fits snuggly around tooth
2. attached gingiva: varies amongst teeth and individuals - approx. 1-9 mm
changes in disease in size of gingiva
- changes in disease
1. free gingiva: becomes enlarged, col deepens as papillary size increases
2. attached gingiva: decreases in amount as pocket deepens
enlargement of gingiva from drug therapy (what drugs)
- dilantin, adalat
signs of health in contour of gingiva
- signs of health:
1. free gingiva: - curved line, knife edged
- papilla contact teeth
- diastema areas are flatter
changes in disease in contour of gingiva
- changes in disease:
1. free gingiva: - rounded or rolled
- papilla blunted/flattened, bulbous or cratered
two types of stillman’s clefts
- v-shaped stillman’s
2. slitlike stillman’s
signs of health in the consistency of gingiva
- signs of health:
- firm when palpated with side of a blunt instrument, ie probe
changes in disease in contour of gingiva
- changes in disease:
- soft, spongy, red
- smooth and shiny with loss of stippling
- marginal enlargement
- bleeds easily upon probing
- firm fibrotic purplish if inflammation is severe
- bleeds in deeper part of pocket when probed. delayed BOP
- free gingiva is easily retracted from tooth with air or probe
signs of health in the surface texture of gingiva
- signs of health:
1. free gingiva: smooth
2. attached gingiva: stippled
3. interdental gingiva: is smooth with stippling in the middle
changes in disease in the surface texture of gingiva
- changes in disease:
1. inflammatory: loss of stippling, smooth, shiny surface
2. hyperkeratosis: leathery, hard, nodular
what are the 3 C’s in gingival health
- colour
- contour (shape and size)
- consistency (texture)
what is festooned rolling
- exaggerated rolling
where should the gingival margin be in healthy gingiva
- at or slightly below the prominence of the cervical third of the tooth
what can occur with gingival enlargement
- the gingival margin is higher on the tooth than normal
effects of gingival recession
- definition: exposure of root surface as a result of apical migration of the JEA
- actual recession: the distance from the CEJ to the JEA
- visible recession: exposed root surface visible on clinical examination. CEJ to the gingival margin
- localized recession: deep or shallow, narrow or wide
- measurement: can be measured with a probe
what is CAL
- clinical attachment loss
- the ‘actual’ recession
bleeding in gingiva
- healthy tissues do not bleed
- changes with disease indicated by bleeding on probing (BOP)
- sulcular epithelium becomes disease pocket epithelium
signs of health in the gingiva of the primary dentition:
- pink or slightly red, rolled or rounded, less fibrous and not tightly adapted to teeth, may not be stippled, width of attached gingiva about 1-6 mm
- interdental papillae: anterior diastemata often present and papillae are flat or saddle shaped
signs of health in the mixed dentition
- constant state of change
- free gingiva can be rolled or rounded, slightly red, shiny, and lack firmness
- clinical crown depends upon stage of eruption
changes in disease in the gingiva of young children
- periodontal tissues are examined the same in children as in adults
- probe the adult teeth only
- do not probe erupting teeth
- gingivitis occurs frequently periodontitis can occur but is rare
- mucogingival tissues are of relevance to children and need to be examined closely especially if considering orthodontics
mobility
- charted/noted in ‘grade’
1 = slight mobility detected beyond normal, up to 1 mm horizontal displacement
2 = moderate mobility, greater than 1 mm but less than 2 mm displacement
3 = severe mobility, greater than 2 mm may move in all directions including vertical as well as horizontal - chart notation is made on tooth diagram
furcation involvement (classes) and symbols (descriptions)
- class I: able to detect with probe (not necessary to see it, but can feel the furcation of roots with probe), symbol is upside down triangle with open top
- class II: able to get probe into furcation (symbol is upside down triangle with closed top
- class III: probe can go through entire furcation, symbol is filled in upside down triangle
- class IV: visible through and through, symbol same as III