GINGIVA-2

DEPT. OF PERIODONTOLOGY

1
 CONTENT

• Microscopic and macroscopic

features of gingiva
 GINGIVAL EPITHELIUM

Three areas of gingival epithelium

Outer epithelium
Sulcular epithelium
Junctional epithelium
GENERAL ASPECTS OF ALL GINGIVAL
EPITHELIUM

Principle cell type is keratinocyte

Other cells:
Langerhans cells
Merkel cells
Melanocytes

Main function of gingival epithelium is protection

Layers of Gingival Epithelium
Stratum Corneum - keratinized
Stratum granulosum - parakeratinized
Stratum spinosum - nonkeratinized
Stratum basale - nonkeratinized

Junctional and Sulcular epithelium have only

spinosum and basal layers
Epithelial Cells held together by
desmosomes
 NONKERATINOCYTE CELLS IN GINGIVAL
EPITHELIUM
Melanocytes - basal and spinous layers -
produce melanin pigment

Langerhans cells - all suprabasal layers -

these are modified monocytes and have an
important role in the immune reaction as antigen-
presenting cells for lymphocytes
Merkel Cells - deeper layers - contain nerve
endings and have been identified as tactile
perceptors.
Epithelium joined to connective tissue by
basal cell layer
Basal Layer contains:

Lamina Densa - attaches to tooth

or connective
tissue

Lamina Lucida - attaches to

epithelium
Basal layer attached to tissue and tooth by
hemidesmesomes
 ORAL OR OUTER EPITHELIUM

Covers outer surface of marginal and attached

gingiva
Keratinized or parakeratinized
 SULCULAR EPITHELIUM
Lines the gingival sulcus
Nonkeratinized stratified squamous cells
Contains no rete pegs
Extends from the coronal edge of junctional
epithelium to the gingival margin
No granulosum or corneum layer
Does not usually contain Merkel Cells
Potential to Keratinize if:
➢ exposed to the oral cavity
➢ bacterial flora of sulcus is totally
eliminated
Outer epithelium loses its keratinization if
placed in contact with tooth.
Local irritants prevent keratinization
 JUNCTIONAL EPITHELIUM
❖Epithelial attachment
❖Clinical attachment level
❖Collar like band of nonkeratinized stratified
squamous epithelium
❖3 to 4 layers thick in early life - may increase to as
many as 10 to 20 layers
❖Length - .25 to 1.35 mm
Internal basal lamina
contains

lamina densa - tooth

or ct

lamina lucida -
epithelium
Attachment to tooth and CT is by hemidesmesomes
DEVELOPMENT OF GINGIVAL SULCUS

Enamel is covered with reduced enamel epithelium.

When tooth erupts the ree transforms into the
junctional epithelium.
 GINGIVAL FLUID
Enters sulcus from connective tissue through
sulcular membrane
✓ Cleanses material from sulcus
✓ Contains plasma proteins that may
improve adhesion of epithelium to the tooth
✓ Possess antimicrobial properties
✓ Exerts antibody activity in defense of gingiva
 CONNECTIVE TISSUE
LAMINA PROPRIA
Papillary Layer - adjacent to epithelium
Reticular layer - adjacent to bone

Elastic fiber system composed of:

oxytalan, elaunin, and elastin fibers
 GINGIVAL FIBERS

Collagen fiber bundles have three functions:

1. Keep marginal gingival firmly against tooth
2. Withstand forces of mastication
3. Unite free marginal gingiva with the
cementum of the root and the
adjacent attached gingiva
 GINGIVODENTAL GROUP

Attached in cementum just below the epithelial

attachment.
On facial and lingual they project to the crest and
outer surface of the marginal gingiva and terminate
short of the epithelium
They also extend to the periosteum of bone
 CIRCULAR FIBERS

Run through the marginal and interdental gingiva

to encircle the tooth
•TRANSSEPTAL GROUP

Cementum to cementum of adjacent teethng

•Semicircular

•Transgingival
 CONNECTIVE TISSUE CELLS
Predominant cell is Fibroblast

Mast Cells numerous in CT

Macrophages and histiocytes are part of
phagocyte system

Normal gingiva: small numbers of plasma cells

and lymphocytes. Neutrophils can be in
high numbers if inflammation is present
 GINGIVAL BLOOD SUPPLY

Three sources:
supraperiosteal arteries
vessels of periodontal ligament
arterioles that emerge from the crest of the
interdental septa
 LYMPHATIC DRAINAGE

Begins with lymphatics of connective tissue papillae

Progresses to periosteum of alveolar process
Then to regional lymph nodes
In addition, lymphatics just below JE extend into
periodontal ligament and follow the blood vessels
 GINGIVAL INNERVATION

Fibers arising from nerves in periodontal ligament,

and from labial, buccal and palatal nerves.
 COLOR
Coral pink color of attached gingiva is determined
by:
✓ degree of keratinization
✓ presence of pigment - pigmentation
Alveolar mucosa is red, smooth and shiny
✓ thinner, nonkeratinized, no rete pegs, and
more blood vessels
 Color

Coral Pink Reddish Pink

 SIZE
❖Determined by cellular and intercellular elements.
❖Alteration is size is common in gingival diseases.
 Size

Normal (Not enlarged) Enlarged

 CONTOUR

Depends on shape of teeth and alignment in the

arch.
 Contour

Interdental Gingiva – Pyramidal Interdental Gingiva – Straight

Marginal Gingiva – Knife edged Marginal Gingiva – Blunt, Rolled

 CONSISTENCY

➢Firm and Resilient

➢Tightly bound to underlying bone
➢Fibers contribute to firmness of gingival margin
Consistency

Soft and Edematous

 SUFACE TEXTURE

✓Stippled - best viewed by drying tissue

✓The attached gingiva is stippled
✓The marginal gingiva is not stippled
✓Produced by rete pegs
✓Stippling is a feature of healthy gingiva
Stippling Present – Orange Peel Stippling Absent
 POSITION
Level of the gingival margin – 1 mm. coronal to CEJ
Recession – Apical to CEJ
 CONTINUOUS TOOTH ERUPTION

Tooth eruption continues throughout life.

Active eruption - movement in vertical plane.
Passive eruption - exposure of teeth by apical
migration of gingiva
Apposition of bone accompanies active eruption.
Distance between apical portion of junctional
epithelium and alveolar bone remains constant in
the absence of disease
Passive eruption - caused by gingival recession or
atrophy
Recession is not a normal physiologic process of
aging.
 CONCLUSION
It is very important to know the gingiva in health in order to treat it
in case of disease.
TAKE HOME MESSAGE
It is very important to know the gingiva in health in order to treat it
in case of disease.
PROBABLE SAQS AND LAQS

Discuss the gingiva with reference to

1. Microscopic and macroscopic features.
2. Junctional epithelium
3. Blood supply.
4. Gingival fiber groups with illustrations.