gingival assessment

Question 1

free gingiva division

Answer 1

• free gingival groove
• oral epithelium
• gingival margin

Question 2

gingival sulcus

Answer 2

• location
• boundaries
• sulcular epithelium
• depth of sulcus
• gingival sulcus fluid

Question 3

junctional epithelium

Answer 3

• 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

Question 4

interdental gingiva/papilla

Answer 4

• 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)

Question 5

what is a col

Answer 5

• 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

Question 6

clinically normal gingiva should be:

Answer 6

• 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

Question 7

causes of tissue changes

Answer 7

• disease causes: change in colour, size, position, shape, consistency, texture, bleeding and exudate production

Question 8

descriptive terminology for tissue changes

Answer 8

• severity: mild, moderate, severe

- distribution: localized, generalized, marginal, interproximal and/or diffuse

Question 9

early recognition of tissue changes

Answer 9

• 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

Question 10

signs of health in colour of gingiva

Answer 10

• signs of health:
  1. pale pink - darker in darker complexions
  2. factors influencing colour:
• vascular supply
• thickness of epithelium
• degree of keratinization
• physiologic pigmentation

Question 11

changes in disease in colour of gingiva

Answer 11

• 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

Question 12

signs of health in size of gingiva

Answer 12

• signs of health:
  1. free gingiva: skinny, fits snuggly around tooth
  2. attached gingiva: varies amongst teeth and individuals - approx. 1-9 mm

Question 13

changes in disease in size of gingiva

Answer 13

• changes in disease
  1. free gingiva: becomes enlarged, col deepens as papillary size increases
  2. attached gingiva: decreases in amount as pocket deepens

Question 14

enlargement of gingiva from drug therapy (what drugs)

Answer 14

• dilantin, adalat

Question 15

signs of health in contour of gingiva

Answer 15

• signs of health:
  1. free gingiva:
• curved line, knife edged
• papilla contact teeth
• diastema areas are flatter

Question 16

changes in disease in contour of gingiva

Answer 16

• changes in disease:
  1. free gingiva:
• rounded or rolled
• papilla blunted/flattened, bulbous or cratered

Question 17

two types of stillman’s clefts

Answer 17

1. v-shaped stillman’s

2. slitlike stillman’s

Question 18

signs of health in the consistency of gingiva

Answer 18

• signs of health:

- firm when palpated with side of a blunt instrument, ie probe

Question 19

changes in disease in contour of gingiva

Answer 19

• 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

Question 20

signs of health in the surface texture of gingiva

Answer 20

• signs of health:
  1. free gingiva: smooth
  2. attached gingiva: stippled
  3. interdental gingiva: is smooth with stippling in the middle

Question 21

changes in disease in the surface texture of gingiva

Answer 21

• changes in disease:
  1. inflammatory: loss of stippling, smooth, shiny surface
  2. hyperkeratosis: leathery, hard, nodular

Question 22

what are the 3 C’s in gingival health

Answer 22

• colour
• contour (shape and size)
• consistency (texture)

Question 23

what is festooned rolling

Answer 23

• exaggerated rolling

Question 24

where should the gingival margin be in healthy gingiva

Answer 24

• at or slightly below the prominence of the cervical third of the tooth

Question 25

what can occur with gingival enlargement

Answer 25

• the gingival margin is higher on the tooth than normal

Question 26

effects of gingival recession

Answer 26

1. definition: exposure of root surface as a result of apical migration of the JEA
2. actual recession: the distance from the CEJ to the JEA
3. visible recession: exposed root surface visible on clinical examination. CEJ to the gingival margin
4. localized recession: deep or shallow, narrow or wide
5. measurement: can be measured with a probe

Question 27

what is CAL

Answer 27

• clinical attachment loss

- the ‘actual’ recession

Question 28

bleeding in gingiva

Answer 28

• healthy tissues do not bleed
• changes with disease indicated by bleeding on probing (BOP)
• sulcular epithelium becomes disease pocket epithelium

Question 29

signs of health in the gingiva of the primary dentition:

Answer 29

• 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

Question 30

signs of health in the mixed dentition

Answer 30

• constant state of change
• free gingiva can be rolled or rounded, slightly red, shiny, and lack firmness
• clinical crown depends upon stage of eruption

Question 31

changes in disease in the gingiva of young children

Answer 31

• 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

Question 32

mobility

Answer 32

• 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

Question 33

furcation involvement (classes) and symbols (descriptions)

Answer 33

• 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