gingival assessment Flashcards
1
Q
free gingiva division
A
- free gingival groove
- oral epithelium
- gingival margin
2
Q
gingival sulcus
A
- location
- boundaries
- sulcular epithelium
- depth of sulcus
- gingival sulcus fluid
3
Q
junctional epithelium
A
- 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
4
Q
interdental gingiva/papilla
A
- 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)
5
Q
what is a col
A
- 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
6
Q
clinically normal gingiva should be:
A
- 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
7
Q
causes of tissue changes
A
- disease causes: change in colour, size, position, shape, consistency, texture, bleeding and exudate production
8
Q
descriptive terminology for tissue changes
A
- severity: mild, moderate, severe
- distribution: localized, generalized, marginal, interproximal and/or diffuse
9
Q
early recognition of tissue changes
A
- 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
10
Q
signs of health in colour of gingiva
A
- signs of health:
1. pale pink - darker in darker complexions
2. factors influencing colour: - vascular supply
- thickness of epithelium
- degree of keratinization
- physiologic pigmentation
11
Q
changes in disease in colour of gingiva
A
- 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
12
Q
signs of health in size of gingiva
A
- signs of health:
1. free gingiva: skinny, fits snuggly around tooth
2. attached gingiva: varies amongst teeth and individuals - approx. 1-9 mm
13
Q
changes in disease in size of gingiva
A
- changes in disease
1. free gingiva: becomes enlarged, col deepens as papillary size increases
2. attached gingiva: decreases in amount as pocket deepens
14
Q
enlargement of gingiva from drug therapy (what drugs)
A
- dilantin, adalat
15
Q
signs of health in contour of gingiva
A
- signs of health:
1. free gingiva: - curved line, knife edged
- papilla contact teeth
- diastema areas are flatter
16
Q
changes in disease in contour of gingiva
A
- changes in disease:
1. free gingiva: - rounded or rolled
- papilla blunted/flattened, bulbous or cratered
17
Q
two types of stillman’s clefts
A
- v-shaped stillman’s
2. slitlike stillman’s
18
Q
signs of health in the consistency of gingiva
A
- signs of health:
- firm when palpated with side of a blunt instrument, ie probe
19
Q
changes in disease in contour of gingiva
A
- 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
20
Q
signs of health in the surface texture of gingiva
A
- signs of health:
1. free gingiva: smooth
2. attached gingiva: stippled
3. interdental gingiva: is smooth with stippling in the middle
21
Q
changes in disease in the surface texture of gingiva
A
- changes in disease:
1. inflammatory: loss of stippling, smooth, shiny surface
2. hyperkeratosis: leathery, hard, nodular
22
Q
what are the 3 C’s in gingival health
A
- colour
- contour (shape and size)
- consistency (texture)
23
Q
what is festooned rolling
A
- exaggerated rolling
24
Q
where should the gingival margin be in healthy gingiva
A
- at or slightly below the prominence of the cervical third of the tooth
25
Q
what can occur with gingival enlargement
A
- the gingival margin is higher on the tooth than normal
26
Q
effects of gingival recession
A
- 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
27
Q
what is CAL
A
- clinical attachment loss
- the ‘actual’ recession
28
Q
bleeding in gingiva
A
- healthy tissues do not bleed
- changes with disease indicated by bleeding on probing (BOP)
- sulcular epithelium becomes disease pocket epithelium
29
Q
signs of health in the gingiva of the primary dentition:
A
- 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
30
Q
signs of health in the mixed dentition
A
- constant state of change
- free gingiva can be rolled or rounded, slightly red, shiny, and lack firmness
- clinical crown depends upon stage of eruption
31
Q
changes in disease in the gingiva of young children
A
- 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
32
Q
mobility
A
- 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
33
Q
furcation involvement (classes) and symbols (descriptions)
A
- 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
