Ch. 15 Clinical Examination: Gingival Assessment DHG 220 Ms. McHuen by…
Ch. 15 Clinical Examination: Gingival Assessment
DHG 220 Ms. McHuen
by Sandy R.
Why do we do gingival Assessments?
Gingingival assessments are to evaluate the condition of the gingival tissue and determine inflammatory and noninflammatory changes.
:star: I wish I could get faster at gingival assessments, I find myself over thinking things.
Risk Factors for Gingival Disease
Inflammation is the host's response to irritation, which in return stimulated tissue repair.
If inflammation does not resolve after treatment other risk factors must be considered.
Poor Oral home care
Changes in hormone levels
Eruption of permanent teeth
Certain drugs: phenytoin ( seizure meds), Valproate ( Anitconvulsant), cyclosporine ( transplant meds), Calcium channel Blockers ( blood pressure meds)
Clinical Assessment Procedures:
Initial signs of inflammation:
Redness, swelling, heat, pain , and loss of function.
Alveolar mucosa is composed of loose connective tissue that is why the disease travels faster than attached gingiva that is composed of dense conenective tissue.
Interdental Papillae and gingival margin are the first areas to be affected clinically by inflammation.
healthy gingiva is salmon pink due to keratin in the epethelium
healthy gingiva can still be diseased from deep within the tissue and not seen until disease progresses.
inflamed Gingiva is shades of red (erythemic) or light to whitish pink. Initially: bright red and then deep red to bluish red (cyanotic) or pale white in severe perio disease.
can absorb into the gingiva and cause it to look bluish gray..this is called Amalgam Tattoo.
Pt. with thin oral epithelium may have a healthy gingiva but red in color.
Dark skinned pts ( asians, African Descendants, mediterranean) have light brown to black pigmentation due to presence of melanin.
Marginal and interdental gingiva
HEalthy Gingival MArgin:
is knife edge in contour.
Diseased gingival margin:
gingival margin becomes rolled and round due to destruction of circular fibers.
Healthy interdental papillae:
tightly tucked into embrasures.
shape as a pyramid because it follows contour of CEJ and contact area is narrow.
flat because CEJ is flat and contact area is wider.
Blunting of gingiva:
can also be due to noninflammatory causes such as overuse or misuse of interdental aids.
Diseased Interdental papillae:
bulbous or enlarged due to edema, cratered where there is depression, blunted where tip of papillae is absent.
shape and position of teeth, alignment of teeth, location and size of contact area, embrasure size, soft tissue inflammation.
Changes in the contour of the gingiva can reflect present and past tissue destruction.
:star: this section made me understand the contour a lot better but its still hard for me to determine a slight change rather than something obvious.
V-Shape slit that extends apically from the gingival margin.
incorrect tooth brushing, incorrect flossing, pocket formation.
they can resolve spontaneously or may need periodontal surgery
not a true cleft due to no marginal tissue distruction
Common is patients with severe enlarged gingiva who are on phenytoin (seizure meds), cyclosporin ( transplant meds). nifedipine ( HighBlood pressure meds)
occurs when adjacent papillae become enlarged and join together at the center of the tooth.
caused my gingival overgrowth which can form pseudopocket or gingival pocket.
firmness of underlying connective tissue.
firm and resilient when pressed.
examined by lightly pressing the side of perio probe against marginal and interdental gingiva.
firm and resilient gingiva may also be a sign of fibrotic gingiva. Fibrotic gingiva will be hard and not show a "pit"
Not healthy Gingiva:
inflammation and edema may be present and tissue will "pit" and not rebound quickly.
causes gingival enlargement which can form pseudo pockets or gingival pocket.
gingiva is fibrotic with rolled gingival margins. Tissue becomes hyperkeratinized with abnormal whitish thickening of keratin layer of epithelium.
Stippling is not always a sign of health. Stippling is present in health and chronic inflammation.
Chronic inflammation :Stippling is present in fibrotic tissue which is a sign of tissue scarring.
Assessed by drying the attached gingiva with gauze and looking for stippling.
Edematous gingival can have some stippling.
No stippling :
gingiva is described as smooth or shiny
: :star: funny up until today I thought stippling was ALWAYS a sign of healthy gingiva
:star: How to can I easily combine all these assessments into one gingival statement?
Hormonal and Drug influenced Gingivitis
Hormonal Changes (pregnancy)
generalized or localized inflammation to givival papillae, sharp demarcation from attached gingiva.
can spread to margin. Appears bright red and edematous, shiny, smooth surface. The molars show most inflammation then premolars and finally incisors.
Pregnancy Tumors AKA Pyogenicgranuloma
: Severe cases ( not true neoplasm) but a inflammatory reaction to dental plaque.
Appears mainly on anterior facials and looks like a deep red and edematous mass of tissue that protrudes out
gingival condition usually goes back to normal on the second month of pregnancy and can be prevented by proper Oral health care.
present even without plaque. After puberty, the enlargement goes down but won't disappear until all irritants are removed.
Drug influenced gingival enlargement
generalized overgrowth of the gingiva specially ( interdental papillae on facial of max and man ant. sextants.
does not occur in areas were there aren't any teeth
Enlargement interferes with malposition of teeth, chewing, speech, and oral hygiene.
Calcium channel blockers:
nifedipine, amlodipine, diltiazem.
Cyclosporine (transplant meds):
overgrowth is more soft, red or bluish red, fragile, and bleeds easy.
:star: my son will be going through puperty soon and I already started seeing some gingival inflammation
cellular, intercellular, vascular supply.
plaque, hormones, medications, mouth breathing, poor dentistry.
Free gingiva margin is located coronal to normal position or slightly coronal to CEJ.
constant drying and wetting of the gingiva causes inflammation response causing the gingival to become enlarged on the maxillary canine to canine. The look of the gingiva specially on the palate is shiny and red.
Enlarged Maxillary Tuberocity is not considered a disease state.
Hereditary gingival Fibromatosis
rare severe gingival enlargement in children
etiology is unknown but may be hereditary
generalized in the mouth both margin and papillae gingiva
teeth may be completely covered by tissue and prevent eruption
:star:my daughter is a mouth breather, specially at night.
Bleeding on Probing:
indicated deeper inflammation from a pocket.
bleeding index is used to standardize measurements
any bleeding seen within 30 seconds is labeled as bleeding site. Bleeding on gingival crevice indicates inflammation.
bleeding may not appear if the gingiva is fibrotic like in heavy smokers.
Assessed by stroking the lining of the sulcus with perio probe or inserting a wooden or plastic wedge to assess the bleeding.
intake of 325 mg /day for 7 days increases bleeding on probing.
when there is a disruption of the sulcular and junctional epithelium allowing blood to pass. When the epithelium becomes inflamed it reacts and form microulcers.
Some visually inflamed site do not bleed.
BOP may not indicate perio disease.
Healthy tissue may bleed if the patient is a smoker or taking certain medication such as warfarin( bloodthinner), aspirin, or clopidogrel ( blood thinner)
:star: My father takes aspirin every day due to his heart problems, no wonder his gingiva bleeds no matter what he does.