this is chapter five the clinical features of the gingiva we're going to talk about how the gingiva should look in health healthy tissue should be free of inflammation it has not been altered by disease or trauma and it does not bleed when probing color the tissue color in health should be pink and or pigmented there are variations in light pink and dark pink but overall it should be pink or it could be pigmented healthy attached gingiva should be fully firmly bond to the underlying cementum and bone and it should be what we call resilient meaning it should spring back if it's gently pressed on so if you took your probe and you laid it sideways and you pressed on the gingiva it should spring back right away so there shouldn't be any residual indentation of the probe and if you blow air on it it shouldn't it should stay nice and tight and firm texture for healthy gingiva should be stippled and firm it may or may not be stippled but it should be firm and it should be have that pink color and this is a picture of what stippling looks like it looks kind of orange peely sometimes you have to take your air and dry it to see that stippling and other times you can just see it healthy tissue margin should be coronal to the cej so the free gingival margin should be coronal meaning higher on the tooth to the cej or closer to the edge of the tooth this is a picture of what healthy gingiva should look like in the posterior sextant there's variations usually tissue can be a little bit lighter in the anterior than in the posterior but should still be pink could still have stippling should be firm you can press it with your probe and have it bounce right back the tissue contour meaning size and shape of the tissue it should lie snugly around the tooth or firm against the bone um it should have that nice even scalloped look like the mcdonald's arches um it should be knife like or pointed on the inner dental papilla so in other words it should come to an exact point but keeping in mind that if teeth don't contact each other like in that lower picture it's going to be blunted or flat when you're describing healthy gingiva or doing your gingival description in your clinical notes you should describe it as by color contour consistency and texture and then use the term generalized or localized to describe it so an example would be generalized pink firm stippled fit snugly around the tooth with knife-like papilla or you could say flat papilla now we're going to talk about gingivitis gingivitis um is a form of periodontal disease it's brought on usually by plaque biofilm or the presence of plaque pile film and the response or the host's immune response so there there's plaque or irritation and then your tissue responds to it it's an inflammatory response to the bacteria and it results in clinical changes it and the changes involve the free and or attached gingiva and or interdental papilla but it does not include any of the other structures of the periodontium acute gingivitis is a short duration chronic may exist for years you can have local factors that play a role in gingivitis such as orthodontic bands other examples would be crown margins you could have rotated teeth you could have calculus present anything that's going to help retain plaque against the tooth or make oral hygiene procedures difficult could would be a local factor is an inflammation of the gingiva causing tissue changes color the color will change from pink to red and there's a nice chart on page 90 that will kind of outline this for you and this is a picture of early gingivitis you can see some slight marginal redness then we've got changes in the tissue contour or the size and the shape edema which is swelling is increased tissue fluid and it makes the gingival margin or the interdental papilla bigger in other words it's what creates those false pockets or those pseudo pockets it takes the gum tissue from being flat like this against the tooth to being bulbous around a tooth tissue contour so you can have marginal and papillary redness you can have you can lose the scalloped nice scalloped appearance if you have a lot of redness such as on the picture on the right this is a picture of slight marginal and papillary redness this is a picture of some fiery red marginal gingiva and papilla and is aggravated and horrible as that tissue might look to you it is still just gingivitis it's still localized to the areas the gingival tissue and not any of the surrounding periodontal structures these are some pictures of changes in shape of the papilla so you can describe the papilla as being bulbous or enlarged or like appear to bulge out you can have blunted papilla where they're flat and they don't fill the inner dental spaces so if you use the term blunted papilla we would know that that means the papilla are not filling the interdental spaces or you can have cratered cratered is more of a description for an active more active disease state such as like nug and we're going to talk about nug later on consistency changes inflammation causes an increased fluid in the tissue the tissue becomes what we say is spongy so if you were to have your tooth and you lay your probe against the tooth instead of that probe mark disappearing of the tissue bouncing right back the inflammation would leave the indentation of the probe on the tissue if it feels squishy it's like pressing on a sponge um it deflects when air is blown into the sulcus so if you took your airwater syringe and you blew at the sulcus it would kind of flap loosely um texture increased fluid in the area of inflammation gives tissue a smooth shiny appearance or in other words a loss of stippling if you blow air on the tissue when it's healthy you'll see it the stippling or you'll at least see like a flat matte finish when you blow air on inflammation it appears shiny and smooth um the position of the margin changes so the margin moves more coronally or above the cej to due to the swelling so in other words the tissue appears higher up on the tooth and the inside lining of the sulcus that gum tissue that where you stick your probe that tissue on the inside of the sulcus becomes ulcerated and when it becomes ulcerated the blood vessels are swollen and they become much more easily disrupted when you stick your probe in there in other words you get bleeding on probing and this slide shows you a picture of inflammation in the pocket or and bleeding on probing bleeding is an important indicator of inflammation because that sulcus becomes irritated and ulcerated and when you poke your probe in there it bleeds easily so the extent of inflammation can be localized or confined to a single tooth or a few teeth it can be generalized covering most of the mouth the general rule of thumb is that if it affects less than 30 percent of the mouth it's localized if it affects more than 30 percent of the mouth it's generalized it can just be papillary so just the interdental papilla are inflamed it could be marginal where it affects the papilla and the gingival margin or it can be what we call diffuse so it goes from the papilla to the margin and then all the way up to the muco gingival junction affecting all of the attached gingiva as well this is a picture of diffuse inflammation so diffuse inflammation you can see affects the papilla the gingival margin and the attached gingiva is also red but if you look more toward the back areas it's more pink and healthy looking that's why it's localized in this picture it's generalized and as angry and inflamed as that tissue might be it is still just localized to the gingival tissues it does not affect the periodontal structures you can have localized marginal inflammation or diffuse inflammation and that looks painful so those are the terms you're going to use to you do your gingival description you