Learning Objectives

• Recognize normal anatomy of healthy periodontal tissue.

• Describe the contribution of microbes to the periodontal disease process.

• Describe cellular and molecular events that lead to clinical signs and symptoms of periodontal disease.

• Describe how periodontal tissue recovers from injury caused by bacteria or tissue trauma.

• Describe how tooth development influences periodontal disease and treatment.

Case

A 25-year old healthy female dental student is seen for a periodontal exam as part of a clinical peer-to-peer exercise. See Fig. 1.1 for clinical presentation and Fig. 1.2 for radiographic presentation. She is currently satisfied with her dental condition, but had minor restorative treatment in the past and receives routine preventive dental care. She brushes and flosses regularly at least twice a day. These are the findings:

• Soft tissue exam: No pathology other than the presence of small lingual tori.

• Tooth condition: Small occlusal and interproximal amalgam restorations, and a slightly chipped maxillary incisor.

• Periodontal measurements: Probing depths less than 5 mm, no bleeding on probing, no clinical attachment loss, furcation involvement, tooth mobility, and gingival recession. The gingiva is coral pink with patches of light pink on the maxilla, firmly attached to underlying hard tissue and stippled. The gingival margin follows the contours of the teeth in a scalloped fashion, and no plaque or calculus is present.

Findings in the periodontal chart are as follows:

What can be learned from this case?

This dental student displays a good example of periodontal health. The description of the gingiva matches characteristics of periodontal health. Periodontal health is most commonly seen in young, healthy adults who receive frequent preventive care and practice effective oral hygiene.

Periodontal Health

Characteristics of Healthy versus Diseased Periodontal Tissues

As seen in the previous case, periodontal health means absence of signs and symptoms of periodontal disease. No signs of inflammation are present in any area of the gingiva (see Fig. 1.1), and all gingival landmarks are easily visible and in normal proportion to each other. Landmarks and areas of gingiva and mucosa are named as shown in Fig. 1.3.

Fig. 1.3 (a) Oblique facial view of gingiva in patient seen in the preceding case with the different gingival landmarks and areas labeled. (b) Diagram of gingival landmarks. Healthy gingiva usually contains patches of stippling in the attached gingiva zone. (c) Diagram of a cross-section of healthy gingiva and periodontium attaching up to the cemento-enamel junction (CEJ). E = epithelium, CT = connective tissue. (d) Atraumatic extraction of a periodontally involved tooth reveals a depression in the interdental papilla called a “col,” which forms around wide interproximal contact points. Periodontal disease also produced the rough, pebbly epithelial surface that lined the extracted tooth. This is the sulcular epithelium that normally adapts tightly to the tooth surface inside the periodontal sulcus.

The case illustrates what periodontal health looks like, and clinical data matches many elements of periodontal health as shown in Table 1.2.

Most patients’ periodontal disease experience will fall somewhere on a spectrum of periodontal disease between perfect periodontal health and severe disease, matching all characteristics listed in Table 1.2. The challenge for a clinician is to decide whether a patient has sufficient signs and symptoms of the disease to warrant treatment.

Table 1.2 Findings in periodontal health vs. periodontal disease

		Healthy	Diseased
Symptoms		None	May complain about: Pain or soreness Receding gums Longer appearing teeth Loose teeth Red, swollen gum tissue Bleeds when brushing/eating
Gingival appearance/ signs of periodontal disease	Color	Coral—pink May have racial pigment	Erythematous (“red,” “beefy red”) May have slightly purple/bluish hue
	Firmness	Firm	Spongy, boggy, soft
	Shape	Pointed interproximal papilla Scalloped gingival margin Often shows marginal groove	Blunted, swollen papilla Loss of papilla Flattened scallop pattern Gingival swelling masks marginal groove
	Adaptation	Flat (“knife-edged”) margin Tightly adapted to teeth	Edematous/Swollen (“rolled”) margin Easily deflectable
	Other	Commonly has orange-peel texture (“stippling”)	Smooth and shiny gingival margin May have fistula/sinus tracts Margin may be friable
Clinical measurements/signs of periodontal disease	Probing depth	Low (1–3 mm usually)	High (>?4 mm) Probing may be painful
	Gingival bleeding	None or insignificant	Present (at least 10% of sites)
	Clinical attachment	Intact (ideally 0 mm) Sulcus feels firm and tight	Loss of attachment (>?0 mm, especially if interproximally)
	Tooth mobility	None (or little for mandibular incisors; small teeth; petite individuals)	May be easily detectable
	Recession	Ideally none	Common
	Amount of gingiva	Greater than probing depths	May be less than probing depth
	Furcation	Ideally none	Common
	Plaque	None to low	Clearly detectable
	Calculus	None to low	Clearly detectable
Radiographs		No bone loss	May have bone loss
Medical history		Typically healthy	Often has medical condition
Dental history		Usually has regular preventive care; frequent oral hygiene	Typically sporadic dental care and oral hygiene
Age		Typically younger	Typically older

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

1. Gathering Periodontal Data
2. Reducing Pockets
3. Treating Teeth with Furcation Involvement
4. Controlling Gingival Inflammation
5. Correcting Gingival Recession and Mucogingival Defects
6. Managing Tooth Mobility

Stay updated, free dental videos. Join our Telegram channel

Join