GINGIVA

DR. NANCY GOEL

DEPARTMENT OF PERIODONTOLOGY
 CONTENTS
Introduction Junctional epithelium
 Definition Dentogingival unit

Marginal gingiva Gingival fibers

Gingival fluid
Gingival sulcus
Gingival connective tissue
Attached gingiva
Blood supply
Mucogingival junction
Lymphatic drainage
Interdental gingiva
Nerve supply
Microscopic features
Color
Cells of Gingival epithelium Size
Orthokeratinization Contour
Parakeratinization Shape
Non keratinization Consistency
Ultrastructure of epithelium Surface texture
Basal lamina Position

Function of gingival epithelium Repair and healing of gingiva

Outer epithelium Age changes

Sulcular epithelium
 INTRODUCTION
PERIODONTIUM
Peri=around

Odontos=tooth
i.e structures around the tooth

Comprises
 Gingiva
 Periodontal ligament
 Cementum
 Alveolar bone
Oral mucosa has three zones:

The gingiva and the covering of the hard

palate: masticatory mucosa

The dorsum of the tongue, covered by

specialized mucosa

The oral mucous membrane lining the

remainder of the oral cavity
 DEFINITION
The GINGIVA is the part of oral mucosa that covers the
alveolar processes of jaws and surrounds the neck of the
teeth.
- CARRANZA(11th )edition

•Anatomically,it has been divided into:

 MARGINAL gingiva
 ATTACHED gingiva
 INTERDENTAL gingiva
 MARGINAL GINGIVA
The marginal or
unattached or free gingiva
is the terminal edge or
border of the gingiva
surrounding the teeth in
collar like fashion.

It is demarcated from the

adjacent attached gingiva
by a shallow linear
depression,the free gingival
groove, in about 50% cases.
Usually 1 mm wide

It forms the soft tissue wall

of gingival sulcus

Most apical part of

marginal gingiva scallop is
gingival zenith

Its apicoronal and

mesiodistal dimensions
varied between 0.06
&0.96mm
 GINGIVAL SULCUS
It is a shallow crevice or space around
the tooth

Bounded by the surface of the tooth on

one side and the epithelial linning the
free margin of the gingiva on the other
side

It is v-shaped and barely permits the

entrance of periodontal probe

The probing depth of a clinically normal

gingival sulcus in humans is 2-3 mm

Ideally 0 mm
 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.

Facially it extends to the relatively loose and movable alveolar mucosa,

from which it is demarcated by the mucogingival junction.

Lingually , the attached gingiva terminates at the junction with the

lingual alveolar mucosa, which is continuous with the mucous membrane
lining the floor of the mouth.

Palatally it blends imperceptibly with the equally firm, resilient palatal

mucosa
MUCOGINGIVAL JUNCTION
Width of attached gingiva:
It is the distance between the mucogingival junction and the
projection on the external surface of the bottom of the
gingival sulcus or the periodontal pocket

 In the incisor region :

3.5-4.5mm in maxilla
3.3-3.9mm in mandible

 In the posterior region:

1.9mm in maxilla
1.8mm in mandible

 Lingual:
Wider in molar region
Narrow in incisor region
 FUNCTIONS OF ATTACHED GINGIVA
Esthetic
Bears trauma from occlusion
Reduce plaque b/c of proper margin closure
Reduce inflammation around tooth
Bears masticatory forces
Prevent attachment loss & soft tissue recession b/c of more tissue resistance
Maintain vestibular depth
Prevent root caries, chemical erosion
Ease in tooth brushing
Provides tight collar around implants.
Dissipating physiological forces exerted by the muscular fibers of the alveolar
mucosa on the gingival tissue
Increase resistance to external injury
 INTERDENTAL GINGIVA
 Occupies gingival embrassure,which is the
interproximal space beneath the area of
tooth contact.

 It can be pyramidal or have a “col” shape.

 In the pyramid shape ,the tip papilla is

located immediately beneath the contact
point

 The col shape presents a valley like

depression that connects a facial and
lingual papilla

 • Formed by:
 Lateral borders & tip – marginal gingiva
 Central intervening portion – attached
gingiva
The shape of the gingiva in a given interdental space
depends on the :
 Contact point between the two adjoining teeth
 The presence or absence of some degree of recession.
If a diastema is present, the gingiva is firmly bound
over the interdental bone and forms a smooth,
rounded surface without interdental papillae
 MICROSCOPIC FEATURES

Stratified squamous epithelium

●
predominantly cellular in nature

Central core of connective tissue

●
less cellular and composed primarily of
collagen fibers and ground substance
Layers of stratified squamous epithelium
as seen by electron microscopy
 Cells of Gingival Epithelium
Keratinocytes
Non – keratinocytes or clear cells
 Langerhans cells
 Merkel cells
 Melanocytes
Proliferation through mitosis occurs in the basal layer ,
less frequently in the suprabasal layer and migration
occurs.

Differentiation includes keratinisation in which main

morphologic changes seen are:
 Progressive flattening of the cell.
 Increased prevalence of tonofilaments.
 Intercellular junctions coupled to the production of
keratohyaline granules.
 Disappearance of the nucleus
Three types of surface keratinization can occur in the
gingival epithelium:

1. Orthokeratinization

2. Parakeratinization

3. Nonkeratinization
 ORTHOKERATINIZATION
Complete keratinization

No nuclei in stratum corneal

layer.

Well-defined stratum
granulosum.

Present in few areas of outer

gingival epithelium
 PARAKERATINIZATION
Intermediate stage of keratinization.

Most prevalent surface area of the

gingival epithelium.

Can progress to maturity or

dedifferentiate under different
physiologic or pathologic conditions

Stratum cornea retains PYKNOTIC

NUCLEI.

Keratohyalin granules are dispersed

rather than giving rise to a stratum
granulosum.
 NONKERATINIZATION
Viable nuclei in superficial
layer.

Has neither granulosum nor

corneum strata.

Layers of nonkeratinized
epithelium:
1. Stratum superficiale
2. Stratum intermedia
3. Stratum basale
ULTRASTRUCTURE OF EPITHELIUM
Each epithelial type have characteristic pattern of cytokeratins.

Basal cells begin synthesis of low mol. Wt. keratins. Ex.: K19
(40kD)

High mol. Wt. keratins are expressed when they reach superficial
layers. Ex.: K1 (68kD).

Other proteins synthesized during maturation proess:

 Keratolinin
 Involucrin
 Filaggrin
Corneocyte:
 Most differentiated epithelial cell
 Composed of bundles of keratin tonofilaments in
amorphous matrix of filaggrin, surrounded by a resistant
envelope made of keratolinin and involucrin.

Desmosomes:
 Keratinocytes are interconnected by desmosomes
 Located between the cytoplasmic processes of adjacent
cells

Tight Junctions (Zonae Occludens):

 Rarely observed forms of epithelial cell connections where
the membranes of the adjoining cells are believed to be
fused
 BASAL LAMINA
The epithelium is joined to the underlying connective
tissue by a basal lamina 300 to 400 A thick

The basal lamina consists of:

 lamina lucida
 lamina densa.

The lamina densa is composed of type IV collagen.

The basal lamina is permeable to fluids but acts as a barrier

to particulate matter.
 FUNCTIONS OF GINGIVAL
EPITHELIUM
Physical barrier to Infection
Host reactions in integrating innate and acquired
immune responses.
To protect deep structures
Allow a selective interchange with the oral
environment.
 GINGIVAL EPITHELIUM
Gingival epithelium is
differentiated as follows:
 ORAL EPITHELIUM:
which faces the oral cavity
 SULCULAR EPITHELIUM:
which faces the tooth without
being in contact with the
tooth surface.
 JUNCTIONAL EPITHELIUM:
which provides the contact
between the gingiva and the
tooth
ORAL OR OUTER EPITHELIUM
Covers the crest and outer surface
of the marginal gingiva and the
surface of the attached gingiva.

0.2 to 0.3 mm in thickness.

Keratinized or parakeratinized, or
it may present combination.

The oral epithelium is composed

of four layers.
 SULCULAR EPITHELIUM
Lines the gingival sulcus.

Thin, nonkeratinized stratified squamous epithelium

No rete pegs.

Extends from the coronal limit of the junctional

epithelium to the crest of the gingival margin.

Don’t have merkel cells.

Sulcular epithelium has the potential to keratinize:
 If it is reflected and exposed to the oral cavity.
 If the bacterial flora of the sulcus is totally eliminated.

Outer epithelium loses its keratinization: • When it is placed

in contact with the tooth.

These findings suggest that the local irritation of the sulcus

prevents sulcular keratinization.

Sulcular epithelium act as a semi permeable membrane

through which injurious bacterial products pass into gingival
fluid.

Less permeable than JE

 JUNCTIONAL EPITHELIUM
Collarlike band of stratified squamous
non-keratinizing epithelium.

3 to 4 layers thick in early life, but the

number increases with age to 10 or even
20 layers.

Tapers from its coronal end to apical

termination

Located at the cementoenamel

junction in healthy tissue.

Length: 0.25 to 1.35 mm.

These cells can be grouped in two strata:

The basal layer: that faces the connective tissue (External

Basal Lamina)

The suprabasal layer: that extends to the tooth surface

Junctional epithelium is attached to the tooth surface by

means of internal basal lamina

Internal basal lamina –

 lamina densa (adjacent to enamel)
 lamina lucida
Junctional epithelium is firmly attached to the tooth
surface, forming an epithelial barrier against plaque
bacteria.

It allows access of gingival fluid, inflammatory cells, and

components of the immunologic host defense to the
gingival margin.

Junctional epithelial cells exhibit rapid turnover, which

contributes to the host-parasite equilibrium and rapid
repair of damaged tissue.

Cells of the junctional epithelium have an endocytic

capacity equal to that of macrophages and neutrophils,
 THE DENTOGINGIVAL UNIT
The attachment of the junctional epithelium to the
tooth is reinforced by the gingival fibers, which brace
the marginal gingiva against the tooth surface.

The junctional epithelium and the gingival fibers are

considered together as a functional unit
 GINGIVAL FIBERS
The gingival fibers are arranged in
three groups:

1. Gingivodental - Originates from cementum

and spreads laterally into lamina propria (fan
like)

2. Circular - Originates from within the free

marginal and attached gingiva coronal to
alveolar crest and encircles each tooth

3. Transseptal - Originates from interproximal

cementum coronal to crest and courses mesially
and distally in the interdental area into
cementum of adjacent teeth
Dentoperiosteal - Originates from cementum near CEJ into Dentoperiosteal
periosteum of alveolar crest

Transgingival - Originates within the attached gingiva interwing along dental

arch Transgingival between and around teeth

Semicircular - Originates from cementum of the mesial surface of tooth and

courses distally and inserts on the cementum of distal surface of same tooth
 FUNCTIONS OF GINGIVAL FIBERS

To brace marginal gingiva firmly against the tooth

To provide the rigidity necessary to withstand the forces of mastication without

being deflected away from tooth surface

To unite the free marginal gingiva with the cementum of the root & the adjacent
attached gingiva
 GINGIVAL FLUID
Can be a transudate or exudate
Diagnostic or prognostic biomarker of the biological state of periodontium in
health and disease

Contains components of connective tissue, epithelium, inflammatory cells, serum,

and microbial flora

Very small in health

Seeps through the thin sulcular epithelium

Cleanse material from the sulcus

Improve adhesion of the epithelium to the tooth

Antimicrobial properties

Antibody activity
 GINGIVAL CONNECTIVE TISSUE
Components –
 Collagen fibers 60%
 Fibroblast 5%
 Vessels, nerves & matrix 35%

CT- lamina propria

1. Papillary layer
2. Reticular layer

Cellular and Extracellular

compartment composed of
Fibers and Ground substance
CONNECTIVE TISSUE CELLS
 Fibroblasts - development, maintenance, repair
Synthesize collagen and elastic fibers
 Mast cells
 Fixed Macrophages & Histiocytes
 Inflammatory cells (Plasma cells, Lymphocytes,
Neutrophils)
 Adipose cells
 Eosinophils

CONNECTIVE TISSUE FIBERS

 Collagen – collagen type I(provide tensile strength), type
IV
 Reticulin
 Elastic – oxytalan, elaunin, elastin
 BLOOD SUPPLY
Supraperiosteal
arterioles

Vessels of the
periodontal ligament

Arterioles, which
emerge from the crest
of the interdental
septa 4
 LYMPHATIC DRAINAGE
It plays role in removing excess fluids, cellular and protein debris,
microorganisms, and other elements

Important in controlling diffusion and the resolution of inflammatory

processes.
The It progresses Then to the
lymphatic into the regional
drainage of collecting lymph
the gingiva network
nodes,
brings in the external to
lymphatics of the particularly
the periosteum of the
connective the alveolar submaxillar
tissue papillae process y group.

In addition, lymphatics just beneath the junctional epithelium extend

into the periodontal ligament and accompany the blood vessels
 NERVE SUPPLY
Most nerve fibers are myelinated and are closely associated
with the blood vessels

Gingival innervation is derived from fibers arising from nerves

in the periodontal ligament and from the labial, buccal, and
palatal nerves

Nerve structures
 a meshwork of terminal argyrophilic fibers
 Meissner-type tactile corpuscles
 Krause-type end bulbs
 encapsulated spindles
 CORRELATION OF
CLINICAL AND
MICROSCOPIC FEATURES
 COLOR
Generally coral pink (pale
pink to red)

Depends on:
 Vascular supply
 Thickness of epithelium
 Degree of keratinization
 Presence of pigment
containing cells.

Color to be correlated with

cutaneous pigmentation
Physiologic Pigmentation(melanin)
Melanin (non hemoglobin derived brown
pigment)

Prominent in blacks, diminished in albinos

Distribution of Oral Pigmentations in

blacks:
 Gingiva -60%
 Hard Palate -61%
 Mucous membrane -22%
 Tongue -15%

As a diffuse , deep purplish discoloration or

as irregularly shaped brown and light brown
patches and may appear as early as 3 hours
after birth.
 SIZE
Sum total of the bulk of
cellular and intercellular
elements and their
vascular supply.

Alteration in size is a
common feature of
gingival disease
 CONTOUR
Marginal gingiva envelops the teeth in
collarlike fashion and follows a
scalloped outline on the facial and
lingual surfaces.

Loss of scalloping- along teeth with

relatively flat surfaces.

accentuated - pronounced
mesiodistal convexity (e.g., maxillary
canines) or teeth in labial version

horizontal and thickened - in lingual

version.
Contour depends on
 the shape of the teeth and their alignment in the arch
 the location and size of the area of proximal contact
 the dimensions of the facial and lingual gingival
embrasures
 SHAPE
Interdental - governed by the
contour of the proximal tooth
surfaces and the location and
shape of the gingival embrasures.

Anteriorly- the interdental

papilla is pyramidal in form.

The papilla is more flattened in a

buccolingual direction in the
molar region.
Shape depends on:
 Presence/absence of contact
 Distance btw contact point and osseous crest
 Course of CEJ
 Width of the approximate tooth surfaces
 Presence/absence of recession
 CONSISTENCY
Firm and resilient

Firmness determined by -
Collagenous lamina propria and its
contiguity with the
mucoperiosteum

The gingival fibers contribute to

the firmness of the gingival margin.

Diseased – edematous and fibrotic

changes
 SURFACE TEXTURE
Orange peel – stippled

Stippling is best viewed by drying Gingiva.

Attached Gingiva is stippled, marginal gingival

is not.

Central portion of interdental papilla is usually

stippled, but marginal borders are smooth.

Less prominent on lingual surfaces and may be

absent in some.

Stippling –produced by alternate round

protuberance and depressions in the gingival
surface.
Stippling varies with age
 absent in infancy, appears in some children at about 5 years of age,
increases until adulthood, and frequently begins to disappear in old age

Reduction of stippling – common sign of Gingival disease.

Stippling returns when gingiva is restored to health.

Keratinisation – protective adaptation , increased by tooth brushing.

In 40% of adults Gingiva show stippling.

Generalized absence of stippling is seen in:

 Infancy
 Diseased conditions like gingival enlargements, mucocutaneous lesions
affecting gingiva, inflammation etc
 POSITION
The level at which the
gingival margin is attached
to the tooth.

 At CEJ
 Above CEJ – normal 1-2mm
 Below CEJ
Continuous eruption, even after meeting their
functional antagonists occurs through out life

Active Eruption :Movement of teeth in the direction of

occlusal plane

Passive Eruption: exposure of the tooth by apical

migration of Gingiva
 REPAIR/HEALING OF GINGIVA
Mitotic rate is higher in non keratinized areas and increase
in gingivitis

Turnover rate: gingiva - 10-12 days ; junctional epithelium

1-6 days

It is one of the best healing tissues in the body with little
or no scarring.

However the reparative capacity is lesser than that of

periodontal ligament and epithelial tissue
 AGE CHANGES
Stippling usually disappears with age.

Width of the attached gingiva increases with age.

a. Gingival epithelium:

 Thinning and decreased keratinization
 Rete pegs flatten
 Migration of junctional epithelium apically.
 Reduced oxygen consumption.

b. Gingival connective tissue:

 Increased rate of conversion of soluble to insoluble collagen
 Increased mechanical strength of collagen
 Increased denaturing temperature of collagen
 Decreased rate of synthesis of collagen
 Greater collagen content.