“Normal Periodontium”

Dr. Saima Mazhar

Senior Lecturer
Periodontology Department
What is Periodontium?

Periodontium is the investing and supporting

tissues of the tooth.

It consists of:
Gingiva
Periodontal ligaments
Cementum
Alveolar bone
 Periodontium can be classified as:

Gingiva - The main Attachment apparatus

function of which is to -which is composed of
protect the underlying Periodontal ligament
tissues. Cementum
Alveolar bone
GINGIVA
 Types of Gingiva

Gingiva has been anatomically divided into 3 major

categories:
1. Marginal gingiva
2. Attached gingiva
3. Interdental gingiva
Marginal Gingiva
It is also called “unattached or free
gingiva”
Location: On the terminal edges of
gingiva, surrounding the teeth in a
collar-like fashion
It is approximately 1mm wide
Is separated from attached gingiva by a
shallow deprssion called “free gingival
groove”.
Attached Gingiva

Is continous with marginal gingiva

It is firm, resilient and tightyly attached to the
periosteum below.
On the facial aspect it extends onto the alveolar
mucosa. And is demarcated by mucogingival
junction.
Width of this type of gingiva is the distance
between the mucogingival junction and the base
of gingival sulcus. It is greatest in the anteriors.
Interdental Gingiva
Occupies the interproximal spaces between the teeth
Can be pyramidal or have the “col” shape. The shape
of gingiva depends on the the contact point between
the adjacent teeth.
Microscopic Features

1. Overlying Stratified
Squamous Epithelium

2. Underlying
Connective Tissue
Gingival Epithelium
Functions of epithelium:
1. Serves as a physical barrier to infections
2. It provides underlying gingival attachment.
3. Plays a role in host defense system. By:
• Increasing poliferation
• Changes in differentation and cell death
Cell Types of Gingiva
Keratinocytes

Non-keratinocytes:
Langerhan Cells
Merkels Cells
Melanocytes
Gingival Epithelium Types

They have been divided according to

Morphological and Functional point of view:

Oral Epithelium
Sulcular Epithelium
Junctional Epithelium
A.Gingival epithelium
B.Sulcular epithelium
C.Junctional epithelium
D.Gingival lamina
propria
E.Alveolar crest bone
F.Periodontal ligament
Oral Epithelium
It covers the crest and outer surface of
marginal gingiva AND the surface of
attached gingiva
It is 0.2-0.3mm thick
Is keratinised or parakeratinised. And
the degree of keratinisation decreases
with age.
Sulcular Epithelium

Lines the gingival sulcus. It extends from

the coronal limit of junctional epithelium to
crest of gingival margin.
Is thin and non-keratinised
Importance: Is a semi-permeable membrane
through which injurous bacterial products
pass into gingival and tissue fluid, from
gingiva into sulcus.
Junctional Epithelium

Is a collar-like band of stratified squamous

non-keratinised epithelium
Is attached to tooth by: Internal basal lamina.
And is attached to the connective tissue by:
External basal lamina
Junctional Epithelium
Exhibits a few unique features:
Firmly attaches to tooth surface,
forming a barrier against microbes
Allows the access of gingival fluid,
inflammatory cells into the gingival
margin
Has a rapid turnover, after an injury.
 Dento Gingival Junction
❖ The dentogingival junction is an
anatomical and functional interface
between the gingiva and the tooth
structure.
❖ Dento gingival junction is the region
where the tooth is attached to
gingival and is form as soon as the
tooth erupts in the oral cavity.
❖ It provides attachment of the gingiva
to the enamel surface via
hemidesmosomes
❖ With time the position of the gingiva
of the surface change
 Shift of the dento gingival junction

❖ Components
1. Epithelial component is derived from
reduced dental (enamel) epithelium
and oral epithelium.
2. The connective tissue component is
derived from the lamina propria of
the oral mucosa.
❖ The attachment of the functional
epithelium to the tooth is reinforced with
the gingival fibers, which brace the
gingival against the tooth surface.
Dento gingival junction
 Shift of the dento gingival
junction
When the tip of the enamel first emerge through the mucous
membrane of the oral cavity . one third to one fourth of
enamel is still covered by the gingiva

The actual movement of teeth towards occlusal plane called

acitve eruption

The separation of primary attached epithelium from the

enamel surface called passive eruption
 TH THE SHIFT OF DENTINO GINGIVAL
HEAL
Y JUNCTION INVOLVE
❖ First stage

Occur in the primary teeth till one year

before shedding in the permanent teeth.
the bottom of the sulcus present on the
enamel and the apical end of the AE on
the cement enamel junction.

Clinical crown is less than anatomical

crown.
 THE SHIFT OF DENTINO GINGIVAL
EAL TH JUNCTION INVOLVE
H
Y
❖ Second stage

Occur till age of the 40 or even later.

The bottom of the sulcus still present on

the enamel and the apical end of the AE on
cementum.
the clinical crown is less than anatomical
crown.
 H
THE SHIFT OF DENTINO GINGIVAL
EALT
UNH JUNCTION INVOLVE
Y

❖ Third stage

It is unhealthy condition.

The bottom of the sulcus present at

the CEJ and the apical end at
cementum.
The clinical crown equal to the
anatomical crown.
 THE SHIFT OF DENTINO GINGIVAL
H
UN H EALT JUNCTION INVOLVE
Y

❖ Fourth stage

It is unhealthy condition.

From 60 years later .

The bottom of the sulcucs and apical
end on the cementum.
The clinical crown is longer than
anatomical crown
 CONNECTIVE TISSUE OF GINGIVA

Connective tissue of Gingiva is called Lamina Propria.

❖ Lamina Propria is divided into 2 layers:

1.Papillary layer —associated with epithelial

ridges.

2. Reticular layer---lies b/w the papillary

layer and the underlying structures.

The MAJOR components of gingival C.T are:

• Collagen fibres—60%
• Cells(fibroblasts)--- 5%
• Vessels, nerves and matrix—35%
 COLLAGEN FIBERS

• Strong rope like cords that bind and hold tissues together in
functioning units
• Fibers consists of 3 polypeptide chains that bind together to form
basic collagen molecule.
• Molecules arrange themselves side by side to form filaments which
are then accumulated to form collagen fibril.
• Collagen type I forms bulk of lamina propria and provides tensile
strength.
• Collagen type iv branches b/w type I & continuous with fibers of
basement membrane.
1. Cellular component---which includes:

• Fibroblasts
❖ Development, Maintainance and Repair of C.T
❖ Synthesize Collagen &
ElasticFibres,Glycoproteins,Glycosaminoglycans
❖ Regulate Collagen degradation through phagocytosis & collagenases.
❖ Generate tractional forces that keeps the teeth tightly bound to each
other.
Mast cells
• Lymphocytes
• Plasma cells
• Histiocytes
• Adipose cells
• Eosinophils
• Neutrophils

2. Extracellular component---which includes:

• Fibres—mainly collagen type i (and type iv)
• Elastic Fibres(oxytalan,eluanin and elastin)
• Reticular Fibres
• Ground substance
 GINGIVAL FIBRES

Fibres are classified mainly into 3 groups:

1. Gingivodental
2. Circular
3. Transseptal

▪ Semicircular fibres
▪ Transgingival fibres
are also present
1. GINGIVODENTAL:

▪ They are present on facial,lingual and interproximal

surfaces.
▪ On facial & lingual surfaces,fibres run from cementum
in fan like conformation towards
the crest and outer surface of
marginal gingiva.

▪ Interproximally,fibres extend
toward crest of interdental
gingiva.
2. CIRCULAR:
▪ These fibers encircle each tooth within the C.T of
marginal and interdental gingiva in a ring like fashion.

3.TRANSSEPTAL:
▪ Located interproximally, these fibers form horizontal
bundles from the root of one tooth, above the alveolar
crest, to be inserted into the root of the adjacent tooth.
▪ They lie b/w the base of gingival sulcus and crest of
interdental bone.
Functions of the Gingival Fibers
Hold the marginal gingiva tightly against the tooth
Binding of the attached gingiva to alveolar bone
Linkage of teeth one to another
Provide rigidity to withstand the forces of mastication
Unite marginal gingiva with cementum of root and attached
gingiva.
 GROUND SUBSTANCE

• Fills the space b/w fibers

and cells
• Has high water content

• Mainly composed of:

✔ Proteoglycan (hyaluronic acid, chondroitin sulphate)
✔ Glycoproteins (laminin)
✔ fibronectin
 FUNCTION OF GROUND SUBSTANCE:

1. Helps to regulate the distribution of water, electrolytes,and

metabolites in tissues.

2. Fibronectin binds fibroblasts to the fibers and other

components of intercellular matrix and therefore mediate
cell adhesion and migration.
 REPAIR OF GINGIVAL CONNECTIVE
TISSUE

▪ Because of high turnover rate, the C.T of the gingiva has

good healing & regenerative capacity

GINGIVAL FLUID
▪ Can be a transudate or an exhudate
▪ Continually secreted from gingival C.T into the sulcus.
▪ This fluid contains components of C.T, epithelium,
inflammatory cells, serum & microbial flora.
▪ In healthy sulcus, amount of gingival fluid is small
▪ But during inflammation & pregnancy, gingival fluid flow
increases.
 FUNCTIONS OF GINGIVAL FLUID:
✔ Cleanse material from the sulcus
✔ Contain plasma proteins which improve adhesion of
epithelium to the tooth
✔ Have antimicrobial property
✔ Possess antibody activity to defend the gingiva
 CLINICAL DESCRIPTION CRITERIA

1. GINGIVAL COLOR
▪ The color of attached and free gingiva is
CORAL PINK and is produced by vascular
supply, thickness, degree of keratinization,
presence of pigment containing cells(melanin).

2. GINGIVAL CONTOUR & SHAPE

▪ The contour of the gingiva varies and depends on the shape of the
teeth and their alignment in the arch
▪ Location & size of the area of proximal contact
▪ The marginal gingiva envelops the teeth in collar like fashion.
▪ The interdental gingiva is generally pointed.
▪ Contours of the gingiva varies depending upon the shape of the
teeth, buccolingual position of the teeth, size of interproximal
embrasure space.

3. GINGIVAL CONSISTANCY:
▪ Gingiva is firm and resilient due to collagenous nature of gingival
C.T and its attachment to the mucoperiosteum (in attached
gingiva)
▪ Gingival fibres contribute to the firmness of gingival margin.
4. SURFACE TEXTURE

▪ The texture of gingiva is described as being STIPPLED

similar to an orange peel.
▪ Stippling is produced by alternate rounded
protuberances and depressions in the gingival surface
▪ It is a feature of healthy gingiva
▪ The attached gingiva is stippled &
marginal gingiva is not.
▪ The central portion of interdental
gingiva is usually stippled but
marginal borders are smooth.
▪ Stippling is less prominent on lingual than facial surfaces
5. GINGIVAL POSITION
▪ The level on the tooth at which the gingiva
is attached is known as gingival position
▪ When teeth first erupts in the oral cavity,
the gingival attachments are close to the
tips of the crowns, however, they generally
shift to the areas of CEJ during eruption and
aging.
How to keep gingiva healthy?

Always drink your beverages with a straw. This is a very simple

solution to keep most of the sugar and acid from soda and coffee off
of your teeth and gums. Brush and rinse afterwards.
Avoid lollipops and hard candies that just sit in your mouth.
It is important that you brush your teeth after every meal. This is the
ideal way to take care of your teeth and gums.
See a qualified dentist on a regular basis. Get regular check ups from
your dentist to keep your teeth and gums healthy.
It is a good habit to massage the gums
after brushing, for it improves
the blood circulation to the area
and helps it to maintain health.
 Age Changes in Gingiva

Decreased keratinisation
Decreased stippling
Reduced connective tissue cellularity
Increased intracellular substance
PERIODONTAL
LIGAMENTS
Periodontal ligament
Composed of a complex vascular and highly cellular
connective tissue that surrounds the tooth root and
connects it to the inner wall of alveolar bone.

Its continous with the CT of the Gingiva and

communicates with the marrow spaces through
vascular channels. Average width is 0.2
mm but variation can be seen.
PERIODONTAL FIBERS
They are the principal fibers that
are collagenous and follow a wavy
course,
The terminal portion of the fibers
that are inserted into the cementum
and the bone are termed as sharpy
fibers.
Types of the principal fibers
Transseptal group:
extends from the tooth
interproximally over the
alveolar bone crest and
embedded in the
cementum of the
adacent teeth.
Alveolar crest fibers attach to the cementum just apical to
the cementoenamel junction, run downward, and insert into
the alveolar bone.
Horizontal fibers
Horizontal fibers attach to the cementum apical to the
alveolar crest fibers and run perpendicularly from the root of
the tooth to the alveolar bone.
Oblique fibers
Oblique fibers are the most numerous fibers in the
periodontal ligament, running from cementum in an oblique
direction to insert into bone coronally.
Radiating from cementum around the apex of the root to the
bone, forming base of the socket
Interradicular fibers
Interradicular fibers are only found between the roots of
multi-rooted teeth, such as molars. They also attach from the
cementum and insert to the nearby alveolar bone.
 Organization of the PDL
Cells of the PDL
Ground substance
PDL vascularity
Cells of the PDL:
The cellular constituents of the PDL include:
Osteoblasts
Osteoclasts
Fibroblasts,Epithelial rests of Malassez, Undifferentiated
mesenchymal cells, Cementoblasts, Cementoclasts, as well as
neurovascular elements.
The extracellular constituents of the PDL consist of:
Collagen fibers
Oxytalan fibers
Ground substance
Nerves and Vessels.
 Ground substance

The ground substance is a major constituent of the

periodontal ligament. Its primary components are:
Hyaluronic acid
Glycoproteins
Proteoglycans (Polysaccharide portion of
proteoglycans are Glycosaminoglycans (GAGs).
 Functions of the PDL

❖ Supportive: Attaches the tooth to the surrouding

alveolar bone.
❖ Sensory: Richly supplied by nerve endings that have
primary receptors for pain and pressure.
❖ Nutritive: Maintains the vitality of various cells.
❖ Shock Absorber: Provides resistance to light and heavy
forces.
❖ Remodeling: By provinding cells that makeup attachment
apparatus i.e bone,cementum.
 Age changes in Periodontal Ligaments

Reduced vascularity
Decreased collagen fibers
CEMENTUM
INTRODUCTION
Is mineralized dental tissue covering the anatomic
roots of human teeth.

Begins at cervical portion of the tooth at the

cementoenamel junction & continues to the apex.

Furnishes a medium for the attachment of collagen

fibers that bind the tooth to surrounding structures.

Makes functional adaptation of the teeth possible.

Unlike bone, human cementum is avascular.

60
PHYSICAL CHARACTERSTICS
⚫ Hardness is less than that of dentin.

⚫ Light yellow in color.

⚫ Can be distinguished from enamel by its lack of luster

& its darker hue.

⚫ Semi-permeable to a variety of materials.

61
COMPOSITION
Cementum is approximately
45%-50% hydroxyapatite
(inorganic)
50% collagen and noncollagenous
matrix protein (organic)
CHEMICAL COMPOSITION
⚫ Contains 45% to 50% inorganic substances & 50% to
55% organic material & water.

⚫ Cementum has the highest fluoride content of all the

mineralized tissues.

⚫ Organic portion consists primarily of type I collagen &

protein polysaccharides (proteoglycans).

63
NONCOLLAGENOUS COMPONENT
ALKALINE PHOSPHATASE
PROTEOGLYCANS
OSTEOPONTIN
OSTEONECTIN
OSTEOCALCIN
FIBRONECTIN
DENTINE SILOPROTEIN
DENTINE MATRIX PROTEIN
 FORMATION

As the epithelial root

sheath breaks down,
cells from the dental
sac migrate to the
surface of the root
dentin and differentiate
into cementoblasts.
These cells lay down
cememtum on the
surface of the root.
CLASSIFICATION OF CEMENTUM

Primary Cementum

Secondary Cementum
Acellular exrinsic fiber or Primary Cementum

Located in cervical half of tooth.

Collagen fibers derived from sharpey’s
fibers.
Mineralization rate is very fast.
No cells are present.
Functions in anchoring of tooth.
CELLULAR INTRINSIC OR SECONDARY
CEMENTUM
Starts forming after the root is in
occlusion.
Located in middle to apical third and
interradicular areas of root.
Mineralization rate is slow so cells are
incorporated with majority of fibers in
matrix arranged parallel to root surface.
Function in adaptation and repair
CEMENTOENAMEL JUNCTION
⚫ In 60% of the teeth, cementum overlaps the cervical end
of enamel for a short distance.

⚫ In 30% of all teeth, cementum meets the cervical end of

enamel in a relatively sharp line.

⚫ In 10% of the teeth, enamel & cementum do not meet.

71
 Cementoenamel junction
O
M
G
R
U
L OVERLAP MEETS
GAP B/W
ENAMEL AND

E ENAMEL 60% ENAMEL 30% CEMENTUM 10%

 Age changes
Smooth surface become irregular due to
calcification of fibers.
Hypercementosis: continue deposition of
cementum with age in apical area (good:
maintain length, bad: obstruct foramen).
Reversal lines: cementum doposition continue
and then stop for a period of time.
Cementicles: calcified round nodules found in
PDL and surface of cementum.
 Reversal lines FREE
CEMENTICAL

TOS ATTACHED
EN CEMENTICLE
C EM
PER
HY
IS
INCREMENTAL LINES
Are highly mineralized areas with less collagen and
more ground substance than other portions of the
cementum.

The thickness of cementum does not enhance functional

efficiency by increasing the strength of attachment of the
individual fibers.
CEMENTODENTINAL JUNCTION
⚫ Smooth in permanent teeth.

⚫ Scalloped in deciduous teeth.

⚫ Dentin is separated from cementum by a zone known as the

intermediate cementum layer.

⚫ This layer is predominantly seen in apical two-thirds of roots of

molars & premolars.
 HYPERCEMENTOSIS
⚫ Is an abnormal thickening of cementum.

⚫ May be diffuse or circumscribed.

⚫ May affect all teeth of the dentition, be confined to a single tooth, or

even affect only parts of one tooth.

⚫ If the overgrowth improves the functional qualities of the

cementum, it is termed cementum hypertrophy.

⚫ If the overgrowth occurs in non-functional teeth or if it is not

correlated with increased function, its termed hyperplasia.
Extensive hyperplasia of cementum is occasionally
associated with chronic periapical inflammation.

Hyperplasia of cementum in non-functioning teeth is

characterized by a reduction in the number of
Sharpey’s fibers embedded in the root.

Spur or prong like extension of cementum is found in

teeth that are exposed to great stress.

Knob like projections are designated as excementoses.

 Clinical correlation
Cementum is similar to bone but its non
painful, therefore insensitive to scaling
produce. But if the cementum is removed,
dentine is exposed causes sensitivity.
Cementum is resistant to resorption specialy
in young patients.Thus orthodontic movement
causes alveolar bone resorption and root is
safe.
Cementum have the capacity to regenerate
and restore attachment.
ALVEOLAR
BONE
Alveolar Bone

The part of the maxilla

and mandible that
supports and protect the
Teeth is known as
alveolar bone
EMBRYOLOGICAL ORIGIN

Alveolar bone has its

embryological origin from the
initial condensation of
ectomesenchyme around the
early tooth germ .
It comprises of:
Alveolar bone proper
Compact bone
Cancellous bone
In alveolar bone proper sharpey’s
fibers are embedded
The compact bone comprises of the
lingual and buccal cortical plates .
Cancellous bone is located in b/w
them
Function
Supporting the teeth
Gives attachment to muscles
Provides frame work for the bone
marrow
Act as a reservior for ions
particularly calcium
Composition
It is mineralized connective
tissue and consists of
60%inorganic material
25% organic material
15 % water
Alveolar bone proper
Alveolar bone proper consists of thin
lamellae of bone that surronds the
root of tooth
The collagen fibres of PDL when
inserted in bone is called bundle
bone
Also called as cribriform plate
Supporting bone
It surrounds the alveolar bone
proper and gives support to
socket
This bone has facial and lingual
plate of compact bone B/W which
is cancellous trabeculations
(spongy bone)
Cells in Alveolar bone
Osteoblast (bone forming cells)
Osteoclast (bone resorbing cells)
Osteoprogenitor cells(stem cells
population to generate
osteoblast)
Like all bones alveolar bone
undergoes constant
remodelling as a response to
mechanical stress and
metabolic need for calcium and
phosphorus ions
Alveolar Bone (Alveolar Process)
Location.:
Alveolar bone is found in the mandible, or lower part
of the jaw, along with the maxilla, the upper part of
the jaw.
It is attached to the cementum of a root of a tooth
with the periodontal ligament.
Alveolar bone is especially thick and dense when
compared to other types of bone so that it can
provide adequate support for the teeth, along with
attachment points for muscles involved in the jaw and
for the gums which provide protection for teeth
and bone.
 Anatomy.:
It includes sockets which are designed to
accommodate the roots and lower part of the
teeth, with each socket separated from the
next by an interdental septum.
The gums attach to the alveolar process, and
the bone has accommodations to allow blood
vessels to enter for the purpose of supplying
blood to the teeth.
Unique aspects of alveolar ridge, defects and
resorption.:
Throughout life, alveolar bone is modified like all other
bone. Osteoblasts are cells that create new bone, and
osteoclasts are cells that destroy it when force is applied
on a tooth.
Alveolar ridge defects and deformities can be the result of
congenital maldevelopment, trauma, periodontal disease or
surgical ablation, as in the case of tumor surgery.
Resorption after tooth-loss has been shown to follow a
predictable pattern:
The labial aspect of the alveolar crest is the principal site
of resorption, which reduces first in width and later in
height.
Bone loss.:

The magnitude of bone loss is

estimated to be 40–60 %
during the first 3 years
following tooth-loss and then
decreases to 0.25–0.5 %
annual loss thereafter.
The cause for resorption of
alveolar bone after tooth-loss
has been assumed to be due
to disuse atrophy, decreased
blood supply, localized
inflammation or unfavorable
prosthesis pressure.
Fenestration And Dehiscence:
Dehiscence and Fenestration:

Dehiscence is loss of alveolar bone on the facial (rarely

lingual) aspect of a tooth that leaves a characteristic oval,
root-exposed defect from the cementoenamel junction
apically. The defect may be one or two millimeters long or
extend the full length of the root. The three features of
dehiscence include:
Gingival recession
Alveolar bone loss
Root exposure.
Fenestration is a "window" of bone loss on
the facial or lingual aspect of a tooth that
places the exposed root surface directly in
contact with gingiva or alveolar mucosa. It can
be distinguished from the dehiscence in that
the fenestration is bordered by alveolar bone
along its coronal aspect.
Pathology of alveolar bone
Alveolar bone can undergo these possible pathologies:
Alveolar osteitis: Or a dry socket, is a
complication of wound healing following extraction of a
tooth.
The term alveolar refers to the alveolus, which is the part
of the jawbone that surrounds the teeth, and
osteitis means simply "bone inflammation.”
Osteoporotic bone marrow defect:
Is a condition which may be found in the body of
the mandible.
It is usually painless and found during
routine radiographs. It appears as a poorly defined
radio lucency (dark area) where there was a
previous history of an extraction of a tooth.
It may resemble a metastatic disease.
Random causes of alveolar bone pathological
dystrophy
Dental plaque
Tartar
Chewing of hard and corrosive edibles such as
pan, gutkha, chalia (betel nut) etc..
BLOOD AND
NERVE SUPPLY OF
PERIODONTIUM
 BLOOD AND NERVE SUPPLY OF
PERIODONTIUM
Blood supply of peridontium is derived from following branches of
SUPERIOR and INFERIOR alveolar arteries:

1. SUPRAPERIOSTEAL ARTERIES on facial,lingual and palatal surfaces of

the alveolar bone.
2. VESSELS OF PDL which extend into the gingiva and anastomose with
capillaries in the sulcus area.
3. INTERDENTAL ARTERIES emerge from

crest of interdental septa and anastomose

with vessels of PDL.
The blood supply to the gingiva is profuse with
multiple capillary loops extending throughout
lamina propria and into each C.T papilla.
NERVE SUPPLY:
✔ The innervation of the gingiva
is derived from the maxillary and
mandibular branches of Trigeminal
nerves.
✔ Buccal gingiva of maxillary posterior teeth---superior alveolar
nerve
✔ Facial gingiva of maxillary incisors---labial branch of
infraorbital nerve
✔ Palatal gingiva of of maxillary anterior---nasopalatine nerve
✔ Buccal gingiva of mandibular molar & premolar---buccal nerve
✔ Facial gingiva of mandibular anterior teeth---mental nerve
✔ Lingual gingiva of all mandibular teeth---lingual nerve
Lymphatic Drainage

Lymph: A colourless fluid containing

white blood cells, which bathes the tissue
and drain through the lymphatic system
into the blood stream.
LYMPHATIC DRAINAGE:
Usually follows the blood supply, with the major portion of
the lymph drainage from the gingiva going to the
submandibular lymph nodes.
From mandibular gingival lymph nodes cervical
submandibular submental
From maxillary gingival lymph nodes deep cervical lymph
nodes
Drainage of lymph from tissues of periodontium.
Lymph from tissues of periodontium goes to lymph nodes
of the head and neck (Fig. 1-26).
Submandibular lymph nodes drain cervical
submandibular submental

Deep cervical lymph nodes drain palatal gums upper jaw

Submental lymph nodes drain the gum in the incisors of
the lower jaw
Jugulodigastric lymph nodes drain the gum in the third
molar region
THANKYOU