Gingivitis and Its Clinical Features by @alend "King of Dentistry"

GINGIVITIS

Gingivitis is the state of inflammation of the gingival tissues.

The pathologic changes of gingivitis are initiated by a host response to oral microorganisms attached to the tooth near the sulcus tissues. The organisms synthesizing products which reflects inflammatory reactions such as collagenase, hyaluronidase, protease, chondroitin sulfate and others cause damage to the epithelial and connective tissue cells including collagen and ground substance which eventually lead to the spaces between junctional epithelial cells during early gingivitis

Junctional epithelium : "The junctional epithelium (JE) is an epithelial component that is directly attached to the tooth surface and has a protective function against periodontal diseases."SOURCE LINK  

IMAGE SOURCE

The image above shows the junctional epithelium 

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 (Latin for groove) is bounded by two entities: apically by the gingival fibers of the connective tissue attachment and coronally by the free gingival margin. A healthy sulcular depth is three millimeters or less, which is readily self-cleansable with a properly used toothbrush or the supplemental use of other oral hygiene aids"SOURCE LINK

IMAGE SOURCE 

The G letter above shows the Gingival Sulcus, normal length is 2-3mm 

Likewise, injurious agents derived from bacteria or the bacteria themselves gain access to the connective tissue which affect the gingival surface texture

 The sequence of events in gingivitis is broadly categorized as four namely:

• Initial Stage
• Early Stage
• Established Stage
• Advanced Stage

 

THE INITIAL STAGE

This is the first manifestation of gingival inflammatory process which consist mainly of vascular changes such as dilated capillaries and increased blood flow

This stage of gingivitis is not clinically detectable because it is not apparent and it is therefore known as subclinical gingivitis

The following features can be discovered on the microscope if a biopsy is taken such as widening of small capillaries and venules , adherence of neutrophils to vessels wall and some lymphocytes can be noticed at times

 

THE EARLY STAGE LESION

This stage evolved from stage 1 (initial stage) within about 1 week. Erythema is noticed in this stage and its therefore the first clinical sign of gingivitis. The inflammation is established here by bleeding on probing

Microscopic investigation reveal the following :

Leukocyte infiltration in the connective tissue beneath the junctional epithelium which mainly consists of T lymphocytes. Moreover, all of the changes seen in the initial lesion continue to progress.

The junctional epithelium becomes increasingly infiltrated with neutrophils and therefore to show the development of rete pegs or ridges. Most of the collagens are destroyed around the cellular infiltrate

The main gingival fiber groups that are affected by the inflammatory process appear to be circular and dentogingival fibers

 

THE ESTABLISHED LESION

This is the stage 3 and it is majorly characterised by a predominance of the plasma cell and B lymphocytes.

Chronic gingivitis occurs 2 to 3 weeks after the beginning of plaque accumulation, the vascular system become engorged and congested, impairment of venous return and the blood flow becomes slow and sluggish

Haemoglobin degradation into its constituents is reported to deepen the colour of chronically inflamed gingiva

The established lesion can be described as medium to severely inflamed  

Under microscopic investigation :

The most important sign noticed here is the increased number of plasma cells. The connective tissue collagen fibers are destroyed and disorganized around the infiltrate of intact and disrupted plasma and PMNs

 This stage of gingival inflammation is usually reversible after successful periodontal therapy

 

THE ADVANCED LESION

This is the most progressive stage of gingivitis, and microscopically fibrosis of the gingiva is observed and there is widespread of inflammatory and immunopathologic tissue breakdown

At this stage, the plasma cells usually dominates the connective tissue and neutrophils continue to dominate the junctional epithelium

Uncontrolled gingivitis could lead to periodontitis or it could lead to periodontitis in individuals who are susceptible

That is all for now  

THUMBNAIL SOURCE