Clinical Features of Gingivitis

Stages of Gingivitis

	Initial Lesion: in 2-4 days, gingiva is infiltrated by PMNs, increase in gingival crevicular fluid, vascular dilatation.
	Early lesion: in 4-7 days, gingiva is infiltrated by Lymphocytes, erythematous, bleeds upon probing, vascular proliferation
	Established lesion: in 14-21 days, gingiva is infiltrated by Plasma cells, increase bleeding and vascular proliferation

Localized or Generalized   Marginal, Papillary, or Diffuse

	Important clinical sign of gingival disease
	Normal: coral pink
	Chronic inflammation intensifies the red or bluish red color
	Change in color is due to vascular proliferation and reduction of keratinization
	Changes start in the interdental papillae and gingival margin and spread to attached gingiva

	Bleeding on gentle probing and increase gingival crevicular fluids are the two earliest signs of gingival inflammation
	Gingival bleeding varies in severity, duration, and the ease with which it is provoked.
	Bleeding on probing appear earlier than change in color or other visual signs
	It is more sensitive sign than change in color
	Bleeding can be provoked by mechanical trauma (e.g. from toothbrushing, toothpicks, or food impaction) or by biting into solid foods such as apples
	The severity of bleeding and the ease with which it is provoked depend on the intensity of inflammation

Mild inflammation

Moderate inflammation

Severe inflammation

Gingival bleeding without other signs of gingival inflammation or which is persistent after treatment should be carefully investigated for the presence of systemic diseases or disorders.

Abnormal gingival bleeding may be seen in the following disorders:

	Vascular abnormalities (e.g. Vita. C def.)
	Platelet disorders (Thrombocytopenia purpura)
	Hypoprothrombinemia (Vita. K def.)
	Excessive amount of NSAID or anticoagulants
	Hemophilia
	Leukemia

	Normally: the gingiva is firm and resilient
	With inflammation, the gingiva becomes spongy, edematous and friable
	The change in consistency is due to degeneration of connective tissue and epithelium with vascular proliferation and increase in extra cellular fluids volume

	Normally: the gingiva is stippled
	Loss of stippling is an early signs of gingivitis
	The surface is smooth and shiny due to epithelial atrophy

Associated mainly with gingival enlargement   Marginal, Papillary, or Diffuse

	One of the most important steps in clinical examination is evaluation of the patient oral hygiene
	Disclosing solutions can be used to detect plaque
	The amount of plaque not necessarily related to the severity of the disease present

Measure the distribution of plaque   Measure the amount of plaque