The gingiva is the clinical term for gums. These are found in the oral cavity or mouth of a human being surrounding part of the teeth. They consist of mucosal tissue that covers the alveolar processes of the maxilla and mandible and finish at the neck of each tooth. This article will highlight the two main types of gingiva, the histological composition of the gingiva and the main pathological transformation of the gingival tissues.
There are two types of gingiva that are clearly recognizable and they are known as the marginal gingiva that is mobile and the attached gingiva.
The marginal gingiva is a 1.5 mm strip of gingival tissue which surrounds the neck of the tooth and is known as such due to the fact that the inner wall forms the gingival wall of the sulcus. This means that when a probe is placed at the gingival margin in a healthy mouth, it can be inserted up to three millimeters into the sulcus formed between the tooth and the mucosa, due to the fact that the soft tissue is moveable.
The attached gingiva is the gingival tissue which lies between the mobile gingiva and the alveolar gingiva. It is four to five millimeters in width and is irremovable from the underlying structures without causing damage.
The gingival epithelium encompasses the external surface of the gingiva including the mobile and fixed areas as well as the gingival sulcus and the junctional epithelium. It is divided up into three major sections known as the:
- oral epithelium
- the sulcular epithelium
- the junctional epithelium
The oral epithelium is comprised of stratified squamous keratinizing epithelium and covers the oral and vestibular gingival surfaces. It is limited by the mucogingival junction and the gingival margin and also merges with the palatal epithelium at the borders of the palate.
The sulcular epithelium is continuous with the oral epithelium and lines the gingival sulcus. At the bottom of the gingival sulcus in its apex, the junctional epithelium lines the dentoepithelial junction.
Gingivitis is the most common pathological alteration that can be seen in all ages, sexes and races. It is caused by bacteria that colonizes in the shallow pocket between the neck of the tooth and beginning of the gingival tissues. This continued accumulation of aerobic and anaerobic bacteria, oral debris and saliva can lead to an inflammatory reaction of the adjacent soft tissues which results in redness, swelling, tenderness and bleeding gums that can be spontaneous or provoked.
The best way to avoid gingivitis is to adhere to a regular oral hygiene routine that will limit the extent in which bacteria can collect in the gingival pockets. Those who have already been diagnosed with moderate to severe gingivitis, professional cleaning and regular monitoring of patients progress is the regular protocol.