The Gingiva

Embryology, Anatomy, Histology & Biochemistry Dr. Feryal Khlayfat Periodontist

Periodontium

Tissues which surround & support the teeth. Gingiva

Periodontal ligament
Alveolar bone Cementum

GINGIVA
Oral mucosa is divided into:
masticatory
lining specialised

Part of masticatory mucosa

Fibrous mucosa surrounding the necks of teeth, covering the coronal portion of the alveolar process.

GINGIVA

Consists anatomically of 3 main parts:

1. Free gingiva 2. Attached gingiva 3. Interdental gingiva

Free gingiva

Extends from the gingival margin to the free gingival groove (FGG) at the level of the cementoenamel junction (CEJ). Can be separated form the tooth by a probe

Depth of gingival sulcus (crevice) : 0-3 mm.

Attached gingiva

Extends from the FGG to the mucogingival junction (MGJ), except on the palate Firmly attached to bone & tooth to withstand masticatory forces withstand tooth brushing prevent movement of marginal gingiva Width varies in different parts of the mouth & increases with age.

For Example

Maxilla, buccally: widest around incisors, narrowest around premolars

Mandible, lingually: narrowest around incisors, widest around molars.

Keratinised Gingiva
KG = FG + AG

Interdental gingiva

Interdental papilla.

Shape determined by:

Contact relationship between teeth

width of proximal surfaces

shape of the CEJ

Anterior : Pyramidal

Molars : Flattened in a buccolingual direction

Between buccal & lingual papillae

COL

Clinical Features of Normal (healthy) Gingiva

Colour: pink (physiologic/racial pigmentation) Contour: scalloped outline Margins: thin, knife-edge. Surface texture: stippled Consistency: resilient Pointed interdental papillae Probing depth: 0-3 mm.

No bleeding on probing (BOP).

HISTOLOGY

The gingiva consists of 2 main types of tissue: 1. Epithelium 2. Connective tissue

Epithelium is attached to the underlying connective tissue by a basement membrane.

Epithelium
Stratified squamous epithelium
(parakeratinised) Thickness 0.2 - 0.3 mm

Structure
Main cell type :keratinocyte

4 layers of these cells:

1. stratum basale
(basal cell layer)

2. stratum spinosum
(spinous cell layer)

3. stratum granulosum
(granular cell layer)

4. stratum corneum (corneal or cell layer)

Other cell types within gingival epithelium

Langerhans cells: modified monocytes found in the suprabasal layer, playing a role in immunity Merkel cells: in deeper layers of epithelium at tips of rete ridges, contain nerve endings. Melanocytes: in basal and spinous cell layer, contain melanin

Types of Gingival Epithelium

Oral epithelium Sulcular epithelium

Junctional epithelium

Oral epithelium
Faces the oral cavity, is parakeratinised, shows rete pegs and connective tissue papillae (?stippled texture). Turnover rate 10-12 days.

Sulcular epithelium
Faces the tooth without contacting it. Thin nonkeratinised stratified squamous epithelium (no granulosum and corneum layers), extends from the coronal end of the junctional epithelium to the crest of the gingival margin. Acts as a semipermeable membrane.

Junctional epithelium
Provides contact between gingiva & tooth. Stratified squamous nonkeratinised epithelium. 3-4 layers thick in early life, increasing to 10-20 later. Basal and suprabasal layers. Length = 0.25-1.35 mm. No rete pegs.

Junctional Epithelium
Attached to the tooth surface by an inner basal lamina & to gingival connective tissue by an outer basal lamina. The internal basal lamina consists of a lamina densa (adjacent to enamel) & the lamina lucida to which hemidesmosomes are attached

Internal basal lamina: no type IV collagen

The junctional epithelium is attached to cementum also by hemidesmosomes. Derived from the reduced enamel epithelium.

Function
Protection of underlying structures while permitting selective interchange with the oral environment Active production of cytokines, adhesion molecules, growth factors enzymes and antimicrobial peptides: laminins, laminin-receptors (integrins) Examples: -defensins, IL-1 , IL-8, EGF

The gingival epithelium is an important initiator, regulator and mediator of the host immune response against periodontal pathogens

Role of Epithelial ECM

Cell adhesion Adhesion to tooth & besement membrane Regulation of water, nutrients and toxins diffusion.

Renewal of gingival epithelium

Cell division Cell shedding

Epithelial thickness is maintained by a balance

between cell division in the basal & spinous cell

layers & cell shedding in the superficial layer.
Outer epithelium: 10-12 days J. epithelium: 1-6 days.

The Dentogingival junction

Enamel + cementum (CEJ) + junctional

epithelium + gingival fibres + adhesion

proteins.

Gingival Crevicular fluid (GCF)

Present

within gingival sulcus, has

cleaning & antimicrobial effects, increases adhesion of gingiva to tooth.