“Gingiva”

Dr.Muhammad Wasif Haq

What is Oral Mucosa?• Mucous membrane epithelium of oral

cavity.• Divided into three types on basis of

“Function”:• -Masticatory mucosa: Gingiva & Hard

palate.• -Specialized mucosa: Dorsum of tongue.• -Lining mucosa: Remainder of oral cavity

e.g. inner surface of cheeks, soft palate

Lining Mucosa

Specialized Mucosa

Masticatory Mucosa

Gingiva & Types

• Gingiva: Soft tissue adjacent to the cervical portion of the teeth.

• Commonly called ‘gums’.• Divided into three types on basis of “Location”.

(A) Marginal Gingiva• Most coronally positioned portion of

gums, surrounding the tooth in a ‘collar like’ fashion.

• Not attached to the tooth, hence called as ‘free’ or ‘unattached gingiva’.

• Forms the soft tissue wall of the gingival sulcus.

• 1 mm wide.Marginal Gingiva: Surrounds the tooth in a ‘collar’ like fashion.

(B) Attached Gingiva• Apical to marginal gingiva.• Firmly bound to the tooth and underlying

periosteum.• Width dependant upon : (i) Type of tooth

involved, (ii) Buccolingual position in arch, (iii) Location of frena and muscle attachment.

• “Greatest width in incisor region: Can anyone tell why?”

• Maxillary anterior: 3.5-4.5 mm, Maxillary pre-molars: 1.99 mm.

• Mandibular anterior: 3.3-3.9 mm, Mandibular pre-molars: 1.88 mm

(C) Interdental Gingiva• In the interproximal area; usually

‘Triangular” in shape.• Shape dependant upon: (i) Contours of

teeth, (ii) Degree of recession.• Flat contours- Narrow and short.• Convex contours- Broad and high.• Gingival col: Where facial and lingual

I.D.G. peaks unite, a depression.• If teeth overlap, what happens to

interdental gingiva???• What happens in diastemia?

Doing nothing is very hard; you never know when you are going to finish up.

>>Differences Between Gingivae>>

Free Gingiva Attached Gingiva Interdental Gingiva

Location: Coronally positioned around tooth.Unattached.

Apical to free gingiva.Firmly attached to the tooth & underlying bone.

Between the contact surfaces of teeth.

Color: Coral pink Coral pink, physiogical pigmentaion.

No difference

Contour: Knife edge Tapered If proximal contacts flat- Narrow and short.If convex- Wide & high.

Consistency: Firm No difference No difference

Texture: Smooth “Orange peel” Central portion-StippledMarginal border- Smooth

Keratinization: Keratinized. Keratinized. Keratinized.

Function: Surrounds teeth, forms wall of sulcus

Withstands mechanical forces of brushing & prevents movement of free gingiva.

Prevents food stagnation.

Gingival Sulcus, Mucogingival junctional and junctional

epitheilum• Gingival sulcus: Space between the marginal

gingiva and teeth. Normal depth: 1.88 mm (+ 0-6 mm) Non-Keratinized.

• Contains gingival/crevicular fluid : Importance?• Mucogingival junction: Where “a”levolar

mucosa and “a”ttached gingiva unite.• Junctional epithelium: Circular arrangement of

epithelial cells at the bottom of the sulcus which attaches the tooth and sub-epithelial connective tissue. Non-keratinized.Length 0.71-1.35 mm

Gingival Sulcus, Mucogingival junctional and junctional

epitheilum

Histology of Gingiva

• (a) Epithelium (b) Connective tissue.• Keratinized areas: Attached and marginal gingiva.• Non-Keratinized areas: Sulcular and junctional

epithelium.• Connective tissue: Connective tissue of gums

“Lamina Propria” (Latin word meaning layer, plate)

• Two layers: (i) Papillary (adjacent to epithelium), (ii) Reticular (adjacent to periosteum)

Do you know what are ‘rete pegs?’

• Rete Pegs: Projections of epithelium into connective tissue.

What Does Connective Tissue Contain?

• Collagen Fibers (Bind & hold together tissues).• Intercellular ground substance

(Mucopolysaccharides & glycoproteins> Regulate distribution of water, electrolytes & metabolites).

• Cells (Plasma cells, Fibroblasts, Mast Cells, Lymphocytes).

• Blood supply, nerve supply & lymphatic vessles.

Blood supply Nerve Supply Lymphatic Drainage

1. Supra-periosteal arteries: Along facial, lingual/ palatal surfaces of alveolar bone

Maxillary teeth: Facially:Incisors & Cuspids: Labial branch of infra-orbital nerve.Palatally: Nasopalatine nerve.

Drainage of lymphatics from connective tissue papillae into “SUBMAXILLARY LYMPH NODES”.

2. Interdental arteries: Inside the interproximal bone.

Maxillary posterior teeth:Bucally: Superior alveolar nerve.Palatally: Anterior palatal nerve.

3. Periodontal ligament arterioles: Extend in gingiva and anastomose with capillaries in sulcus

Mandibular teeth:Facially: Anterior teeth: Mental nerve.Bucally: Posterior teeth: Long buccal nerve.Lingually: Lingual nerve.