Oral Health: Gingivitis vs. Periodontitis

Learning Outcomes

• Students should be able to describe the clinical features of healthy gingiva, gingivitis, and periodontitis.
• Students should be able to explain the basic histological presentation of healthy gingiva, gingivitis, and periodontitis.
• Students should be able to define the terms "false pocketing," "true pocketing," and "clinical attachment loss."
• Students should be able to explain the symptoms that the patient may experience with gingivitis and periodontitis.
• Students should be able to explain the differences between gingivitis and periodontitis.

Revision of Inflammation

• Inflammation is characterized by redness, swelling, heat, and pain.
• There are four patterns of inflammation: acute, chronic, granulomatous, and suppurative.
• Acute inflammation is a rapid onset, often associated with pain, and a short duration.
• Chronic inflammation is a prolonged inflammatory process with a weaker and less intense response.

Revision of Gingival Histology

• The gingiva is composed of keratinized epithelium.
• The gingival epithelium is attached to the underlying connective tissue via a hemidesmosome.
• Gingivitis does not impact the hemidesmosome, but periodontitis does.

Consideration of Health vs Disease

• The clinical appearance, histological understanding, and patient symptoms should be considered when evaluating periodontal health versus disease.

Three Basic States of the Periodontium

• There are three basic states of the periodontium: healthy, gingivitis, and periodontitis.

Gingivitis versus Periodontitis Definition

• Gingivitis is a bacterial infection confined to the gingiva, resulting in reversible destruction.
• Periodontitis is a bacterial infection of all parts of the periodontium, leading to irreversible destruction.

Clinical Appearance

• The color of healthy gingiva is light pink.
• The color of gingivitis is red, due to increased blood flow caused by swelling.
• The contour of healthy gingiva should be stippled, tight, and firm.
• The contour of gingivitis is related to the amount of collagen present.
• The texture of healthy gingiva should be smooth.

Bleeding

• Society has normalized bleeding gums, however, this is not normal.
• Bleeding is not cured by Corsodyl, it should be treated by mechanical plaque removal.
• A stable mouth with bleeding gums is not considered to be a healthy mouth.