Normal And Abnormal Appearance Of The Gingiva 161c6f

Normal and Abnormal Appearance of the Gingiva: Stippling and Pigmentation

What is Stippling?

STIPPLING 

 



Small depressions or “pits” in the epithelium of healthy attached gingiva (bound to underlying alveolar bone) Has an orange-peel appearance. Consequence of rete pegs/ridges, which are deep epithelial projections into the underlying connective tissue. If the gingiva appears smooth, clinically, this does not neccesarily indicate pathology.

STIPPLING in healthy gingiva

How does Stippling appear Clinically & Histologically? Free gingiva*

* Free gingiva is not stippled

 

A= Stippling of gingiva B= Keratin layer

Attached gingiva

Stippled Appearanc e

Causes of Altered Stippled Gingiva 

Any condition that enlarges the attached gingiva will cause stippling to disappear!



Causes of Gingival Enlargement:     

Inflammation (e.g. gingivitis) Drug-induced (e.g. Ca2+ channel blockers, anticonvulsants) Conditioned enlargement (e.g., pregnancy, puberty, Vit C deficiency, pyogenic granulomas) Systemic disease (e.g., leukemia, granulomatous diseases, neoplasms) Bony/dental tissue lesions

Examples of Gingival Enlargement

GINGIVAL PIGMENTATION & Dark Patches

Gingival Pigmentation 



Gingival pigmentation results from melanin granules, which are produced by melanoblasts. The degree of pigmentation depends on melanoblastic activity. Variations in gingival color may be correlated with the racial diversity of an individual or may be a reflection of pathologic influences.

How Does Gingival Colour Differ Between Races?  

The colour of the gingiva generally matches the skin colour of the person. High levels of oral melanin pigmentation are normally observed in:   



Africans/decendants of Africans (gums appear dark/close to black) Hispanics (gums vary from light pink to dark brown) East Asians (gums appear coral pink to light brown)

People with fair skin (Caucasians) will not demonstrate overt tissue pigmentation; thus their gums appear pink.

Hyperpigmentation 





Hyperpigmentation of the gingiva is caused by excessive melanin deposition by the melanocytes mainly located in the basal and suprabasal cell layers of the epithelium. Melanin increases with exposure to the sun; thus, individuals with darker complexions and those who spend a lot of time outdoors tend to have darker gums (e.g., children with a high smile line). Hyperpigmentation is observed in the gingiva closest to the teeth, often as dark patches; the portion hidden under the lips usually appear pink.

How Does Hyperpigmentation Affect Individuals? 





Hyperpigmentation is not commonly an indication of a medical problem! It is considered a genetic trait in some populations; medically, it is known as racial or physiological gingival pigmentation. The effects may be esthetic problems and embarassment, especially if the pigmentation is visible during speech and smiling.

What Can Be Done to Alter Hyperpigmentation?  

The gingiva can be de-pigmented! Yes, the “blackness” of the gums is superficial and can removed.

Removal of Dark Patches 



Various de-pigmentation techniques can be employed. The most popular one is the surgical removal of the undesired pigmentation:  

 

Done under local anesthesia Only the outer layer of gum epithelium is removed, with a layer of the underlying connective tissue; healing via secondary intention is allowed The new epithelium that forms is devoid of melanin Immediate results are evident on the day of the procedure

De-pigmentation of Gingiva

Pathological Influences in Gingival Pigmentation 

These include:   

hypoadrenocorticism (Addison's disease) Nevi (pigmented birthmarks) Depositions of heavy metals