PERIODONTAL

DISEASES
1.
2.

DISEASES OF THE GUM

DISEASES OF THE ATTACHMENT APPARATUS

GINGIVAL DISEASES
1. DENTAL PLAQUE INDUCED GINGIVAL DISEASES
1.

2.
3.

4.

GINGIVITIS ASSOCIATED WITH DENTAL PLAQUE ONLY

GINGIVAL DISEASES MODIFIED BY SYSTEMIC FACTORS
GINGIVAL DISEASES MODIFIED BY MEDICATIONS
GINGIVAL DISEASES MODIFIED BY MALNUTRITION

2. NON-PLAQUE-INDUCED GINGIVAL LESIONS

1.

2.
3.

4.
5.

6.
7.

8.

GINGIVAL DISEASES OF SPECIFIC BACTERIAL ORIGIN

GINGIVAL DISEASES OF VIRAL ORIGIN
GINGIVAL DISEASES OF FUNGAL ORIGIN
GINGIVAL LESIONS OF GENETIC ORIGIN
GINGIVAL MANIFESTATIONS OF SYSTEMIC CONDITIONS
TRAUMATIC LESIONS
FOREIGN BODY REACTIONS
NOT OTHERWISE SPECIFIC

CHARACTERISTICS COMMON TO
ALL
GINGIVAL DISEASES

1. SIGNS AND SYMPTOMS THAT ARE CONFIRMED TO THE

GINGIVA

2. THE PRESENCE OF DENTAL PLAQUE TO INITIATE OR

EXACERBATE THE SEVERITY OF THE LESION
3. CLINICAL SIGNS OF INFLAMMATION ( ENLARGED
GINGIVAL CONTOURS DUE TO EDEMA OR FIBROSIS,
COLOR TRANSITION TO A RED AND/OR BLUISH RED HUE,
ELEVATED SULCULAR TEMPERATURE, BLEEDING UPON
STIMULATION, INCREASED GINGIVAL EXUDATE)
4. CLINICAL SIGNS AND SYMPTOMS ASSOCIATED WITH
STABLE ATTACHMENT LEVELS ON A PERIODONTIUM WITH
NO LOSS OF ATTACHMENT OR ON A STABLE BUT
REDUCED PERIODONTIUM
5. REVERSIBILITY OF THE DISEASE BY REMOVING THE
ETIOLOGY
6. POSSIBLE ROLE AS A PRECURSOR TO ATTACHMENT
LOSS AROUND TEETH

1. DENTAL PLAQUE INDUCED

GINGIVAL DISEASES
GINGIVITIS ASSOCIATED WITH DENTAL PLAQUE ONLY

a. without other local contributing factors

b. with local contributing factors

associated with endocrine system

associated with blood dyscrasias

GINGIVAL DISEASES MODIFIED BY MEDICATIONS

drug-influenced gingival enlargements

drug-induced gingivitis

GINGIVAL DISEASES MODIFIED BY MALNUTRITION

GINGIVAL DISEASES MODIFIED BY SYSTEMIC

FACTORS

ascorbic acid-deficiency gingivitis

others

CHARACTERISTICS OF PLAQUE-INDUCED
GINGIVITIS
1. PLAQUE PRESENT AT GINGIVAL MARGIN
2. DISEASE BEGINS AT THE GINGIVAL MARGIN
3. CHANGE IN GINGIVAL COLOR
4. CHANGE IN GINGIVAL CONTOUR
5. SULCULAR TEMPERATURE CHANGE
6. INCREASED GINGIVAL EXUDATE
7. BLEEDING UPON PROVOCATION
8. ABSENCE OF ATTACHMENT LOSS
9. ABSENCE OF BONE LOSS
10. HISTOLOGICAL CHANGES
11. REVERSIBLE WITH PLAQUE REMOVAL

Distribution:
Marginal gingivitis:
involves the gingival margin and may include a portion of the
contiguous attached gingiva.

Diffuse gingivitis:
affects the gingival margin, the attached gingiva and the
interdental papillae

Localized gingivitis:

is confined to the gingiva of single tooth or group of teeth.

Generalized gingivitis:
involves the entire mouth
Described as follows:

Localized marginal gingivitis.

Localized diffused gingivitis.

Generalized marginal gingivitis
Generalized diffuse gingivitis.

Etiology:
-

Microbial plaque is the DIRECT cause of gingivitis.

Prevalance
-

63% in age 13-17 yrs.

Males>females.

GINGIVITIS ASSOCIATED WITH DENTAL PLAQUE ONLY

a. without other local contributing factors

b. with local contributing factors
tooth anatomic factors
dental restorations
root fractures
cervical root resorption

GINGIVAL DISEASES MODIFIED BY

SYSTEMIC FACTORS
a. associated with endocrine system
A. puberty associated gingivitis

1. PLAQUE PRESENT AT GINGIVAL MARGIN

2. PRONOUNCED INFLAMMATORY RESPONSE O
3. MUST BE CIRCUMPUBERTAL

4. CHANGE IN GINGIVAL COLOR

4. CHANGE IN GINGIVAL CONTOUR WITH POSS
OF GINGIVAL SIZE
5. SULCULAR TEMPERATURE CHANGE
6. INCREASED GINGIVAL EXUDATE
7. BLEEDING UPON PROVOCATION
8. ABSENCE OF ATTACHMENT LOSS
9. ABSENCE OF BONE LOSS
10. REVERSIBLE WITH PLAQUE REMOVAL

MODIFICATION

B. menstrual-cycle-associated gingivitis

1. PLAQUE PRESENT AT GINGIVAL MARGIN

2. MODEST INFLAMMATORY RESPONSE OF
GINGIVA PRIOR TO OVULATION
3. MUST BE AT OVULATORY SURGE WHEN
LUTENIZING HORMONE LEVELS ARE >
25MLU/ml OR OSTRADIOL LEVELS ARE >
200 pg/ml
4. INCREASE IN GINGIVAL EXUDATE BY AT
LEAST 20% DURING OVULATION
5. ABSENCE OF ATTACHMENT LOSS
6. ABSENCE OF BONE LOSS
7. REVERSIBLE WITH PLAQUE REMOVAL
C. pregnancy associated gingivitis

1. PLAQUE PRESENT AT GINGIVAL MARGIN

2. PRONOUNCED INFLAMMATORY RESPONSE OF
GINGIVA
3. ONSET IS IN PREGNANT WOMEN (2nd OR 3rd
TRIMESTER)

4. CHANGE IN GINGIVAL COLOR

5. CHANGE IN GINGIVAL CONTOUR
6. INCREASED GINGIVAL EXUDATE
7. BLEEDING UPON PROVOCATION
8. ABSENCE OF ATTACHMENT LOSS
9. ABSENCE OF BONE LOSS
10. REVERSIBLE WITH PLAQUE REMOVAL
D. pregnancy associated gingival enlargements

1. PLAQUE PRESENT AT GINGIVAL MARGIN

2. PRONOUNCED INFLAMMATORY RESPONSE OF
GINGIVA
3. CAN OCCUR ANYTIME DURING PREGNANCY
4. MORE COMMONE IN MAXILLA
5. MORE COMMONE IMTERPROXIMALLY
6. SESSILE OR PEDUNCULATED PROTUBERANT MASS
7. NOT A NEOPLASM; HAS HISTOLOGIC APPEARANCE
OF A PYOGENIC GRANULOMA
8. REGRESSES FOLLOWING PARTURITION
E. diabetes-mellitus-associated gingivitis

1.
2.
3.
4.
5.
6.
7.

PLAQUE PRESENT AT GINGIVAL MARGIN

PRONOUNCED INFLAMMATORY RESPONSE OF GINGIVA
CHANGE IN GINGIVA COLOR
CHANGE IN GINGIVAL CONTOUR
INCREASED GINGIVAL EXUDATE
BLEEDING UPON PROVOCATION
MOST COMMONLY ASSOCIATED IN CHILDREN WITH POORLY
CONTROLLED TYPE I DIABETES MELLITUS
8. NO BONE LOSS
9. NO ATTACHMENT LOSS
10. REVERSIBLE WITH CONTROL OF DIABETIC STATE

11. REDUCTION OF DENTAL PLAQUE CAN LIMIT SEVERITY OF

LESION

b. associated with blood dyscrasias

A. leukemia-associted gingivitis
1. PRONOUNCED INFLAMMATORY RESPONSE OF
GINGIVA IN RELATION TO THE PLAQUE PRESENT BUT
PLAQUE IS NOT A PREREQUISITE FOR ORAL LESIONS.
ORAL LESIONS
2. GINGIVAL LESIONS ARE PRIMARILY FOUND IN ACUTE
LEUKEMIA
3. CHANGE IN GINGIVA COLOR
4. CHANGE IN GINGIVAL CONTOUR WITH POSSIBLE
GINGIVAL ENLARGEMENTS
5. ENLARGEMENT FIRST OBSERVED AT THE
INTERDENTAL PAPILLA
6. BLEEDING UPON PROVOCATION -MAY BE ONE OF
THE EARLIEST SIGN
7. REDUCTION IN DENTAL PLAQUE CAN LIMIT THE
SEVERITY OF LESION

B.

C.

anemia
bleeding disorders

CHARACTERISTICS OF PLAQUEINDUCED GINGIVITIS ON A

REDUCED PERIODONTIUM
1. RESOLUTION OF A PERIODONTITIS, THEREFORE,
PRE-EXISTING ATTACHMENT LOSS OR BONE LOSS MAY
BE PRESENT

2. PLAQUE PRESENT AT GINGIVAL MARGIN

3. DISEASE BEGINS AT THE GINGIVAL MARGIN
4. CHANGE IN GINGIVAL COLOR
5. CHANGE IN GINGIVAL CONTOUR
6. SULCULAR TEMPERATURE CHANGE
7. INCREASED GINGIVAL EXUDATE
8. BLEEDING UPON PROVOCATION
9. HISTOLOGICAL CHANGES
10. REVERSIBLE WITH PLAQUE REMOVAL

GINGIVAL DISEASES MODIFIED BY

MEDICATIONS
a. drug-influenced gingival
enlargements
b. drug-induced gingivitis
CHARACTERISTICS OF DRUG-INDUCED
GINGIVAL ENLARGEMENT
1.
2.
3.
4.
5.

VARIATION IN INTERPATIENT AND INTRAPATIENT PATTERN

PREDILECTION FOR ANTERIOR TEETH
HIGHER PREVALENCE IN CHILDREN
ONSET WITHIN 3 MONTH
CHANGE IN GINGIVAL CONTOUR LEADING TO MODIFICATION OF
GINGIVAL SIZE
6. ENLARGEMENT FIRST OBSERVED AT THE INTERDENTAL PAPILLA
7. CHANGE IN GINGIVAL COLOR
8. INCREASED GINGIVAL EXUDATE
9. BLEEDING UPON PROVOCATION
10. FOUND IN GINGIVA WITH OR WITHOUT BONE LOSS BUT IS NOT
ASSOCIATED WITH ATTACHMENT LOSS
11. PRONOUNCED INFLAMMATORY RESPONSE OF GINGIVA IN RELATION
TO THE PLAQUE PRESENT
12. REDUCTION IN DENTAL PLAQUE CAN LIMIT THE SEVERITY OF
LESION
13. MUST BE USING PHENITOIN, CYCLOSPORINE A OR SECRETION

CALCIUM CHANNEL BLOCKERS; THE PLASMA CONCENTRATIONS TO

INDUCE THE LESION HAVE NOT BEEN CLEARLY DEFINED IN
HUMANS

GINGIVAL DISEASES MODIFIED BY

MEDICATIONS

a. drug-influenced gingival
enlargements

dilantine
Ca channel blockers
cyclosporin-A

b. drug-induced gingivitis
oral contraceptive-associated
gingivitis
others

CHARACTERISTICS OF ORAL
CONTRACEPTIVE-ASSOCIATED
GINGIVITIS
-

1. PLAQUE PRESENT AT GINGIVAL MARGIN

2. PRONOUNCED INFLAMMATORY RESPONSE OF GINGIVA
3. CHANGE IN GINGIVA COLOR
4. CHANGE IN GINGIVAL CONTOUR
5. INCREASED GINGIVAL EXUDATE
6. BLEEDING UPON PROVOCATION
7. REVERSIBLE FOLLOWING DISCONTINUATION OF ORAL
CONTRACEPTIVE

GINGIVAL DISEASES MODIFIED BY

MALNUTRITION
a. ascorbic acid-deficiency gingivitis
b. others
NOMA
2. NON-PLAQUE-INDUCED GINGIVAL
LESIONS
GINGIVAL DISEASES OF SPECIFIC
BACTERIAL ORIGIN
GINGIVAL DISEASES OF VIRAL ORIGIN
GINGIVAL DISEASES OF FUNGAL
ORIGIN
GINGIVAL LESIONS OF GENETIC
ORIGIN
GINGIVAL MANIFESTATIONS OF
SYSTEMIC CONDITIONS
TRAUMATIC LESIONS
FOREIGN BODY REACTIONS
NOT OTHERWISE SPECIFIC
GINGIVAL DISEASES OF SPECIFIC
BACTERIAL ORIGIN

*
*
*
*

Neiserria gonorrhea-associated lesions

Treponema pallidum-associted lesions
streptococcal species-associated lesions
others

GINGIVAL DISEASES OF VIRAL ORIGIN

a. herpesvirus infections
primary herpetic
gingivostomatitis
recurrent oral herpes
varicella-zoster infections
b. others
HPV cancer
GINGIVAL DISEASES OF FUNGAL ORIGIN
a. Candida-infections
generalized gingival candidosis
b. linear gingival erythema
c. histoplasmosis
d. others
GINGIVAL LESIONS OF GENETIC ORIGIN
a. Hereditary gingival fibromatosis
b. others

GINGIVAL MANIFESTATIONS OF SYSTEMIC

CONDITIONS
a. mucocutaneous disorders
lichen oris
pemphigoid
pemphigus vulgaris
erythema multiforme
lupus erythematosus
drug-induced
others
b. allergic reactions
* dental restorative materials
mercury
nickel
acrylic
* ractions attributed to
toothpaste
chewing gum
mouthrinses
foods
TRAUMATIC LESIONS
chemical injuries
physical injuries

thermal Injuries
FOREIGN BODY REACTIONS
NOT OTHERWISE SPECIFIC

PERIODONTAL
DISEASES
1. CHRONIC PERIODONTITIS
A. LOCALIZED PERIODONTITIS
B. GENERALIZED PERIODONTITIS

2. AGGRESSIVE PERIODONTITIS
A. LOCALIZED
B. GENERALIZED

3. PERIODONTITIS AS A MANIFESTATION
OF SYSTEMIC DISEASES
A. ASSOCIATED WITH HEMATOLOGICAL DISORDERS
1. ACQUIRED NEUTROPENIA
2. LEUKEMIAS
3. OTHER

B. ASSOCIATED WITH GENETIC DISORDERS

1.
2.
3.
4.
5.
6.

Familial and cyclic neutropenia

Down syndrome
Leukocyte adhesion deficiency s
Papillion-Lefvre syndrome
Chediak-Higashi syndrome
Hystiocytosis syndrome

7. Glycogen storage diseases

8. Infantile genetic agranulocytosis
9. Cohen syndrome
10. Ehlers-Danlos syndrome
11. Hypophosphatasia
C. NOT OTHERWISE SPECIFIC

4. NECROTIZING PERIODONTAL DISEASES

A. NECROTIZING ULCERATIVE GINGIVITIS (NUG)

1.
2.
3.
4.
5.
6.
7.
8.
9.

PLAQUE PRESENT AT GINGIVAL MARGIN

DISEASE BEGINS AT THE INTERDENTAL GINGIVA
ULCERATION ON THE INTERDENTAL PAPILLAE
SPONTANEOUS BLEEDING
PAIN
REGIONAL LYMPHADENOPATHY
GENERAL MALAISE
FEVER
FOETOR EX ORE

PREDISPOSING FACTORS OF (NUG)

1.
2.
3.
4.
5.

ABUNDANT PLAQUE
PRE-EXISTING GINGIVITIS
PSYCHOLOGICAL STRESS
SMOKING
IMMUNOSUPPRESSION

B. NECROTIZING ULCERATIVE PERIODONTITIS (NUP)

5. ABSCESSES OF THE PERIODONTIUM

A. GINGIVAL ABSCESS
B. PERIODONTAL ABSCESS
C. PERICORONAL ABSCESS

6. PERIODONTITIS ASSOCIATED WITH

ENDODONTIC LESIONS
7. DEVELOPMENTAL OR ACQUIRED
DEFORMITIES AND CONDITIONS
A. LOCALIZED TOOTH-RELATED FACTORS
THAT MODIFY OR PREDISPOSE TO
PLAQUE-INDUCED
GINGIVAL/PERIODONTAL DISEASE
1.
2.
3.
4.

Tooth anatomic factors

dental restorations/apliances
Root fractures
Cervical root resorption and cemental tears

B. MUCOGINGIVAL DEFORMITIES AND

CONDITIONS AROUND TEETH
1.
2.
3.
4.
5.
6.

gingival recession (buccal and lingual)

gingival recession - interproximal
Lack of keratinized gingiva
Decreased vestibular depth
Aberrant frenum/muscle position
Gingival excess
pseudopocket
inconsistent gingival margin
gingival enlargement
7. Abnormal gingival color

C. MUCOGINGIVAL DEFORMITIES AND

CONDITIONS ON EDENTULOUS RIDGES
1. Vertical and horizontal ridge deficiency
2. Lack of keratinized tissue
3. Gingival enlargement

4. Aberrant frenum/muscle position

5. Decreased vestibular depth
6. Abnormal color

D. OCCLUSAL TRAUMA
1. Primary occlusal trauma
2. Secondary occlusal trauma