GINGIVA

Oral Mucosa

The oral mucosa consists of the following three zones:

1. Masticatory mucosa : The gingiva and the covering

of the hard palate .

2. Specialized mucosa: The dorsum of the tongue

3. Oral mucous membrane: lining the remainder of

the oral cavity
 Components of the Periodontium
• Gingiva
• Periodontal ligament (PDL)
• Cementum
• Alveolar process

The gingiva is that part of the

oral mucosa that covers the
alveolar processes of the jaws
and surrounds the necks of
the teeth
Macroscopically, the gingiva can be divided into four anatomic zones

Marginal Gingiva
Attached Gingiva
Interdental Gingiva
Gingival Sulcus

Marginal gingiva: “free gingiva,”

it forms the terminal unattached border of gingiva
surrounding the cervical area of a tooth.
It is sometimes separated from the attached gingiva
by a free gingival groove.
Gingival sulcus: a shallow, v-shaped crevice around
every tooth that is bound on the inside by the tooth
surface, outside by the sulcular epithelium, and at the
apical region by the gingival epithelial attachment
(junctional epithelium, JE).

Histologic depth : 1.8 mm

Clinical probing depth : 2 to 3 mm
Attached gingiva : Is continuous with the marginal
gingiva. It is firm, resilient, and tightly bound to the
underlying periosteum of alveolar bone.
The facial aspect of the attached gingiva extends to
the relatively loose and movable alveolar mucosa.
It is demarcated by the mucogingival junction

The width of the attached gingiva is another important

clinical parameter.
It is the distance between the mucogingival junction
and the projection on the external surface of the bottom
of the gingival sulcus or the periodontal pocket.

It should not be confused with the width of the keratinized gingiva, although this also includes the marginal gingiva
 The width of the attached gingiva

Incisor region :3.5 to 4.5 mm in the maxilla.

3.3 to 3.9 mm in the mandible.

Posterior segments :1.9 mm in the maxillary

first premolars
1.8 mm in the mandibular

first premolars

Lingual aspect of the mandible: the attached gingiva terminates

at the junction of the lingual alveolar mucosa, which is
continuous with the mucous membrane that lines the floor of
the mouth.

The palatal surface of the attached gingiva in the maxilla blends

imperceptibly with the equally firm and resilient palatal mucosa.
Interdental gingiva/papilla: occupies the interproximal
space/embrasure cervical to the contact points of
teeth.

The papilla is “pyramidal” in shape (single apex/tip

cervical to the contact point) between anterior teeth
and “col” shaped (two tips, facial and lingual, just
cervical to the contact area with a valley-like
depression connecting them) between posterior
teeth.
Interdental papillae (arrow) with a
central portion formed by the
attached gingiva. The shape of the
papillae varies according to the
dimension of the gingival embrasure
An absence of interdental papillae and
col where the proximal tooth contact is
missing
Normal gingiva in a young adult. Note the
demarcation (mucogingival line) (arrows)
between the
attached gingiva and the darker alveolar
mucosa.
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Microscopic Features

EPITHELIAL COMPONENTS

CONNECTIVE TISSUE COMPONENTS

The primary cell type of stratified squamous epithelium is the keratinocyte.

Degrees of keratinization
• Orthokeratinization: completely keratinized, with a well-demarcated superficial horny
layer (stratum corneum) with no nuclei and a well-defined underlying stratum
granulosum

• Parakeratinization: less differentiated and keratinized, with pyknotic nuclei in the most
superficial layers; the stratum granulosum is not well defined. This is most common in
the gingiva

• Non-keratinized: surface cells are nucleated, showing no signs of keratinization

 Clear cells or Nonkeratinocytes
Langerhans cells
Merkel cells.
Melanocytes.

Melanocytes
Dendritic cells located in the basal and spinous layers of the gingival
epithelium.
They synthesize melanin in organelles called premelanosomes or
melanosomes
Langerhans cells
Dendritic cells located among keratinocytes at all suprabasal levels.
Important role in the immune reaction as antigen-presenting cells for lymphocytes.
They contain g-specific granules (Birbeck granules), and they have marked
adenosine triphosphatase activity

Merkel cells
Located in the deeper layers of the epithelium
They
. harbor nerve endings, and they are connected to adjacent cells by
desmosomes.
They have been identified as tactile perceptors
 Structural and Functional Characteristics of Oral Epithelium (OE)

Function Protection
Location Covers crest of marginal gingiva
Outer surface of marginal and attached gingiva
Degree of keratinization Mostly parakeratinized; sometimes orthokeratinized
Differentiating features Rete pegs are present and interdigitate with underlying connective tissue
core
• Though mainly composed of keratinocytes,
nonkeratinocytes/clear cells typically found are:
• Langerhans cells— antigen-presenting cells helping with host defense
• Melanocytes—melanin producing cells
• Merkel cells—nerve endings for tactile Perception
 Structural and Functional Characteristics of Sulcular Epithelium (SE)

Function Protection
Location Extends from coronal limit of JE to crest of marginal gingiva

Degree of keratinization Non-Parakeratinized

Differentiating features Normally does not contain Merkel cells or rete pegs
Has the potential to keratinize if reflected and exposed to oral cavity or
if plaque is completely eliminated within the sulcus
• Semipermeable to bacterial products and tissue fluids (less permeable
than JE)
 Structural and Functional Characteristics of Junctional Epithelium (SE)

Function Attachment and host defense

Location Cuff/collar-like band of stratified epithelium around necks of teeth

Degree of keratinization Non-keratinized

Differentiating features No rete pegs; tapers from coronal end (10–29 cells thick) to apical
end (1–2 cells thick)
• Permeable to gingival crevicular fluid (GCF) and inflammatory/
immune cells.
• Exhibits extremely rapid turnover rate of cells (continuous self-
renewal) with mitotic activity in all layers
Gingival Connective Tissue
The major components of the gingival connective tissue
collagen fibers (about 60% by volume),
fibroblasts (5%),
vessels, nerves, matrix (about 35%).

The connective tissue of the gingiva is known as the

lamina propria, and it consists of two layers:
(1) A Papillary layer subjacent to the epithelium that
consists of papillary projections between the
epithelial rete pegs and
(2) A Reticular layer that is contiguous with the
periosteum of the alveolar bone.
Gingivodental fibers thatextend from the cementum
(1) to the crest of the gingiva,
(2) to the outer surface, and
(3) external to the periosteum of the labial plate.
Circular fibers .
 CELLULAR ELEMENTS

Fibroblast
 Numerous fibroblasts are found between the fiber bundles. Fibroblasts are of
mesenchymal origin and play a major role in the development, maintenance, and
repair of gingival connective tissue.
 Fibroblasts synthesize collagen and elastic fibers as well as the glycoproteins and
glycosaminoglycans of the amorphous intercellular substance.
 Fibroblasts also regulate collagen degradation through phagocytosis and the secretion
of collagenases

Mast cells
which are distributed throughout the body, are numerous in the connective tissue of
the oral mucosa and the gingiva
Functions of the Gingiva

• Gingival epithelium:
• Physical barrier against foreign agents;
• Host defense coordination;
• Rapid turnover, especially of JE cells, ensures effective
clearance of invading bacteria and their metabolic
products from the gingival sulcus.
• Gingival connective tissue:
• High turnover of cells and collagen matrix ensures
good repair and regenerative potential;
• Abundant blood and nerve supply ensures health,
healing after surgery, and very little scarring.
 The Dentogingival Unit
Epithelial Attachment
Consists of junctional epithelium
(JE) that adheres to tooth via an
internal basal lamina (IBL) and to
the connective tissue by means
of an external basal lamina (EBL).
Gingiva
IBL
Connective Tissue Attachment
Dentogingival fibers: radiate from cementum, just
under epithelium at sulcus bottom, into marginal
and attached gingiva (white lines).
2. Dentoperiosteal fibers: Run from cementum to
outer surface of alveolar bone to blend with the
periosteum(brown lines).
3. Transeptal fibers: Run from cementum of one
tooth to cementum of adjacent tooth over
alveolar crest interdentally; classified under

JE
EBL principal fibers of the periodontal ligament too
(not shown in this cross section).
Bone 4. Circular/Semicircular fibers: Run in a ring like
PDL fashion especially providing support for free
gingiva; better seen in horizontal sections
perpendicular to the plane shown in this figure
(violet circles)
 Blood Supply, Lymphatics, and Nerves

Supraperiosteal arterioles along the facial and lingual surfaces

of the alveolar bone from which capillaries extend along the
sulcular epithelium and between the rete pegs of the
external gingival surface. Occasional branches of the
arterioles pass through the alveolar bone to the periodontal
ligament or run over the crest of the alveolar bone.
2. Vessels of the periodontal ligament, which extend into the
gingiva and anastomose with capillaries in the sulcus area.
3. Arterioles, which emerge from the crest of the interdental
Septa and extend parallel to the crest of the bone to
anastomose with vessels of the periodontal ligament, with
capillaries in the gingival crevicular areas and vessels that
run over the alveolar crest.
Diagram of an arteriole penetrating the
interdental alveolar bone to supply the interdental
tissues (left) and a supraperiosteal arteriole overlying
the facial alveolar bone, sending branches to the
surrounding tissue
 Gingival innervation is derived from fibers that arise from nerves in the
periodontal ligament and from the labial, buccal, and palatal nerves

The lymphatic drainage of the gingiva brings in the lymphatics of the connective
tissue papillae.It progresses into the collecting network external to the periosteum of
the alveolar process and then moves to the regional lymph nodes, particularly the
submaxillary group. In addition, lymphatics just beneath the junctional epithelium
extend into the periodontal ligament and accompany the blood vessels