Gingiva

Gingiva

Overview
The gingiva or gums, consists of the mucosal tissue that lies over the mandible
Mandible
The mandible pronunciation or inferior maxillary bone forms the lower jaw and holds the lower teeth in place...

 and maxilla
Maxilla
The maxilla is a fusion of two bones along the palatal fissure that form the upper jaw. This is similar to the mandible , which is also a fusion of two halves at the mental symphysis. Sometimes The maxilla (plural: maxillae) is a fusion of two bones along the palatal fissure that form the upper...

 inside the mouth
Mouth
The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth....

.

Gingiva are part of the soft tissue
Soft tissue
In anatomy, the term soft tissue refers to tissues that connect, support, or surround other structures and organs of the body, not being bone. Soft tissue includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes , and muscles, nerves and blood vessels .It is sometimes...

 lining of the mouth. They surround the teeth and provide a seal around them. Compared with the soft tissue linings of the lips and cheeks, most of the gingiva are tightly bound to the underlying bone which helps resist the friction of food passing over them.
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Encyclopedia
The gingiva or gums, consists of the mucosal tissue that lies over the mandible
Mandible
The mandible pronunciation or inferior maxillary bone forms the lower jaw and holds the lower teeth in place...

 and maxilla
Maxilla
The maxilla is a fusion of two bones along the palatal fissure that form the upper jaw. This is similar to the mandible , which is also a fusion of two halves at the mental symphysis. Sometimes The maxilla (plural: maxillae) is a fusion of two bones along the palatal fissure that form the upper...

 inside the mouth
Mouth
The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth....

.

General description


Gingiva are part of the soft tissue
Soft tissue
In anatomy, the term soft tissue refers to tissues that connect, support, or surround other structures and organs of the body, not being bone. Soft tissue includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes , and muscles, nerves and blood vessels .It is sometimes...

 lining of the mouth. They surround the teeth and provide a seal around them. Compared with the soft tissue linings of the lips and cheeks, most of the gingiva are tightly bound to the underlying bone which helps resist the friction of food passing over them. Healthy gingiva are usually coral pink, but may contain physiologic pigmentation. Changes in color, particularly increased redness, together with edema
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...

 and an increased tendency to bleed, suggest an inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...

 that is possibly due to the accumulation of bacterial plaque
Dental plaque
Dental plaque is a biofilm, usually a pale yellow, that develops naturally on the teeth. Like any biofilm, dental plaque is formed by colonizing bacteria trying to attach themselves to a smooth surface...

.


Macroscopic features of gingiva


The gingiva is divided anatomically into marginal, attached and interdental areas.

Marginal gingiva


The marginal gingiva is the terminal edge of gingiva surrounding the teeth in collar like fashion. In about half of individuals, it is demarcated from the adjacent, attached gingiva by a shallow linear depression, the free gingival groove. Usually about 1 mm wide, it forms the soft tissue wall of the gingival sulcus
Gingival sulcus
The gingival sulcus is an area of potential space between a tooth and the surrounding gingival tissue and is lined by sulcular epithelium. The depth of the sulcus is bounded by two entities: apically by the gingival fibers of the connective tissue attachment and coronally by the free gingival...

. The marginal gingiva is supported and stabilized by the gingival fibers
Gingival fibers
The gingival fibers are the connective tissue fibers that inhabit the gingival tissue adjacent to teeth and help hold the tissue firmly against the teeth...

.

Attached gingiva


The attached gingiva is continuous with the marginal gingiva. It is firm, resilient, and tightly bound to the underlying periosteum of alveolar bone. The facial aspect of the attached gingiva extends to the relatively loose and movable alveolar mucosa, from which it is demarcated by the mucogingival junction
Mucogingival junction
A mucogingival junction is an anatomical feature found on the intraoral mucosa. The mucosa of the cheeks and floor of the mouth are freely moveable and fragile, whereas the mucosa around the teeth and on the palate are firm and keratinized...

. Attached gingiva may present with surface stippling
Stippling (dentistry)
The gingiva often possess a textured surface that is referred to as being stippled . Stippling only presents on the attached gingiva bound to underlying alveolar bone, not the freely moveable alveolar mucosa...

.

Interdental gingiva


The interdental gingiva occupies the gingival embrasure, which is the interproximal space beneath the area of tooth contact. The interdental gingiva can be pyramidal or have a "col
Mountain pass
A mountain pass is a route through a mountain range or over a ridge. If following the lowest possible route, a pass is locally the highest point on that route...

" shape.Attached gingiva is resistant to masticatory forces and always keratinised.

Diseases of the gingiva


The gingival cavity microecosystem
Microecosystem
Microecosystems can exist in locations which are precisely defined by critical environmental factors within small or tiny spaces.Such factors may include temperature, pH, chemical milieu, nutrient supply, presence of symbionts or solid substrates, gaseous atmosphere etc.-Pond microecosystems:These...

, fueled by food residues and saliva, can support the growth of many microorganisms, of which some can be injurious to health. Improper or insufficient oral hygiene
Oral hygiene
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...

 can thus lead to many gingival and periodontal disorders, including gingivitis
Gingivitis
Gingivitis is a term used to describe non-destructive periodontal disease. The most common form of gingivitis is in response to bacterial biofilms adherent to tooth surfaces, termed plaque-induced gingivitis, and is the most common form of periodontal disease...

 or pyorrhea
Periodontal disease
Periodontitis is a set of inflammatory diseases affecting the periodontium, i.e., the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth...

, which are major causes for tooth failure. Recent studies have also shown that Anabolic steroid
Anabolic steroid
Anabolic steroids, technically known as anabolic-androgen steroids or colloquially simply as "steroids", are drugs that mimic the effects of testosterone and dihydrotestosterone in the body. They increase protein synthesis within cells, which results in the buildup of cellular tissue ,...

s are also closely associated with gingival enlargement requiring a gingivectomy for many cases. Gingival recession is when there is an apical movement of the gingival margin away from the biting (occlusal) surface. It may indicate an underlying inflammation such as periodontitis or pyorrhea, a pocket formation, dry mouth or displacement of the marginal gingivae away from the tooth by mechanical (such as brushing), chemical, or surgical means. Gingival retraction, in turn, may expose the dental neck and leave it vulnerable to the action of external stimuli, and may cause root sensitivity.

Color


Healthy gingiva usually has a color that has been described as "coral pink." Other colors like red, white, and blue can signify inflammation (gingivitis
Gingivitis
Gingivitis is a term used to describe non-destructive periodontal disease. The most common form of gingivitis is in response to bacterial biofilms adherent to tooth surfaces, termed plaque-induced gingivitis, and is the most common form of periodontal disease...

) or pathology. Although the text book color of gingiva is "coral pink", normal racial pigmentation makes the gingiva appear darker. Because the color of gingiva varies due to racial pigmentation, uniformity of color is more important than the underlying color itself.

Contour


Healthy gingiva has a smooth arcuate
Arcuate
Arcuate can refer to:* Arcuate delta, a type of river delta* Arcuate fasciculus* Arcuate line * Arcuate artery* Arcuate nucleus* Arcuate nucleus * Internal arcuate fibers of the brain...

 or scalloped appearance around each tooth. Healthy gingiva fills and fits each interdental space, unlike the swollen gingiva papilla seen in gingivitis or the empty interdental embrasure seen in periodontal disease. Healthy gums hold tight to each tooth in that the gingival surface narrows to "knife-edge" thin at the free gingival margin
Free gingival margin
The free gingival margin is the interface between the sulcular epithelium and the epithelium of the oral cavity. This interface exists at the most coronal point of the gingiva, otherwise known as the crest of the marginal gingiva....

. On the other hand, inflamed gums have a "puffy" or "rolled" margin.

Texture


Healthy gingiva has a firm texture that is resistant to movement, and the surface texture often exhibits surface stippling
Stippling (dentistry)
The gingiva often possess a textured surface that is referred to as being stippled . Stippling only presents on the attached gingiva bound to underlying alveolar bone, not the freely moveable alveolar mucosa...

. Unhealthy gingiva, on the other hand, is often swollen and mushy. Healthy gingiva has an orange-peel like texture to it.

Reaction to disturbance


Healthy gums usually have no reaction to normal disturbance such as brushing or periodontal probing. Unhealthy gums on the other hand will show bleeding on probing
Bleeding on probing
250px|right|thumb|Straight [[periodontal probe]] at left, and Nabers probe on the right.Bleeding on probing which is also known as bleeding gums or gingival bleeding is a term used by dentists and dental hygienists when referring to bleeding that is induced by gentle manipulation of the tissue at...

 (BOP) and/or purulent exudate (pus
Pus
Pus is a viscous exudate, typically whitish-yellow, yellow, or yellow-brown, formed at the site of inflammatory during infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection of pus within or beneath the epidermis is known as a pustule or...

).

Further reading

  • Willmann, Donald. PERI 5081 - Freshman Periodontics. UTHSCSA, 2006. 2.3.1