Periodontal Anatomy – Gingiva
The gums, also called gingiva, include the mucosal tissue which cover the mandible and maxilla found inside the mouth. Good gum health is important to both oral health and overall health. Gum disease has been found to have a negative effect on a patient’s general health.
The gums are included in the soft tissue which lines the mouth. The gingiva surrounds the teeth and act as a seal surrounding them. They differ from the soft tissue linings of the lips and cheeks, as most of the gums are tightly bound to the underlying bone. This aids in resisting the friction of food and debris passing over them. When the gums are healthy, they serve as an effective barrier to the periodontal insults to deeper tissue.
In most cases, healthy gums are typically a coral pink color in lighter skinned people. Gums which are health also have a smooth curve or are scalloped in their appearance surrounding each tooth. They fill and fit in the space located between the teeth. Healthy gums are securely held firmly to each tooth. Gums which are health are firm in their texture and resistant to movement. When the gums are healthy, they do not react to normal disturbances which may include brushing and flossing.
When there is a change in color, especially increased redness, combined with swelling and possible bleeding, it suggests there may be inflammation from the accumulation of bacterial plaque. In cases where the gum tissue is not healthy, it can act as a gateway for periodontal disease to progress into the deeper tissue of the periodontium. This can cause a negative prognosis for retaining the teeth. Based on the condition of the gingiva, the dentist will provide the patient with specific periodontal therapy and oral hygiene instructions to practice at home.
The gums are separated into three different anatomical categories which include marginal, attached and interdental areas.
The term marginal gum is used to describe the edge of the gums which closely surround the teeth. For nearly half of all patients, it is demarcated from the adjacent, attached gums by a shallow linear depression, which is called the free gingival groove. This minor depression found on the outer surface of the gum does not correlate with the depth of the gingival sulcus. Rather, it correlates to the apical border of the junctional epithelium. This outside groove can vary in depth based on the area of the oral cavity. The groove on the mandibular anterior teeth and premolars is especially prominent.
The marginal gum can vary in its width from about 0.5 to 2.0 mm. This width is measured from the free gingival crest to the attached gingiva. The marginal gingiva follows the scalloped pattern, which is established by the contour of the cementoenamel junction (CEJ) of the teeth. The marginal gingiva is more translucent in its appearance compared to the attached gingiva. However, it has a similar clinical appearance being pink, dull, and firm. In comparison, the marginal gingiva does not have stippling present. In addition, the tissue is mobile from the underlying tooth surface. The marginal gingiva is made stable with the gingival fibers, which do not have bony support. The gingival margin, at the most superficial part of the marginal gingiva, should also be easily observed in a clinic setting. The gingival margin should also be recorded in the patient's chart.