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Classification

I. According to duration:

1. Acute gingivitis

2. Chronic gingivitis

II. According to distribution:

1. Localized gingivitis

2. Generalized gingivitis

3. Marginal gingivitis

4. Papillary gingivitis

5. Diffuse gingivitis

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Gingival Diseases Various Stages Of Gingivitis 4 stages of gingivitis: • Stage I Initial lesion • Stage II Early lesion • Stage III Established lesion • Stage IV Advanced lesion

Initial lesion 2-4 days

Early lesion 4-7 days

Established lesion 14-21 days

dvanced lesion

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Stage I Gingivitis: The Initial Lesion--no visible changes --presence of exudation of fluid from the gingival sulcus subclinical gingivitis --The following features are observed in stage I1. Classic vasculitis of vessels subjacent to the junctional epithelium. 2. Exudation of fluid from gingival sulcus. 3. Changes in the coronal most portion Junctional epithelium 4. Increased migration of the leukocytes into the Junctional epithelium and gingival sulcus. 5. Presence of serum proteins. 6. Loss of perivascular collagen.

tage I Gingivitis: The Initial Lesion

exudation of fluid from subclinical gingivitis.

The following features are observed in stage I of vessels subjacent to

of fluid from gingival sulcus.

coronal most portion of the

of the leukocytes into the d gingival sulcus.

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Stage II Gingivitis: The Early LesionClinically, erythematous gingiva and on probing may be evident. Microscopic features of the early lesion 1. All the changes seen in the initial lesion continue to intensify. 2. The junctional epithelium may begin to show the development of rete pegs or ridges 3. Accumulation of lymphocytes beneath the junctional epithelium. 4. Further loss of collagen fiber network supporting the marginal gingiva. 5. Fibroblasts show cytotoxic alteration with a decreased capacity for collagen production.

Stage II Gingivitis: The Early Lesion Clinically, erythematous gingiva and bleeding

ic features of the early lesion include:

1. All the changes seen in the initial lesion

2. The junctional epithelium may begin to show development of rete pegs or ridges.

lymphocytes beneath the junctional epithelium.

fiber network marginal gingiva.

show cytotoxic alteration with a decreased capacity for collagen production.

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Stage III Gingivitis: The Established Lesion --Same as early lesion, with blood stasis --Changes are seen in color consistency and surface texture. --Bluish hue around the reddened gingiva --Proliferation, apical migration and lateral extension of junctional epithelium --Atropic areas --Plasma cells are predominant --Further loss of collagen. --Increased enzyme levels like acid and alkaline phosphatase, β glucuronidase and others.

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Stage IV Gingivitis: The Advanced Lesion The advanced lesion is also known as phase of advanced periodontal breakdown. The following clinical and microscopic features are seen: 1. Persistence of features described in the established lesion. 2. Extension of the lesion into the alveolar bone and PDL leading to significant amount of bone loss. 3. Continued loss of collagen. 4. Formation of periodontal pockets. 5. Conversion of bone marrow into fibrous tissue. 6. Presence of almost all the types of inflammatory cells.

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Clinical Findings

Changes in

color,

contour,

consistency,

size,

position,

severity of bleeding,

surface textur

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Changes in the Position of Gingiva Normal attachment CEJ In disease Coronally pseudopocket Apically gingival recession Types 1..Visible 2..hidden

Changes in the Position of Gingiva

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PD Miller’s Classification of Gingival Recession

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Etiology of Gingival Recession

Plaque-induced gingival inflammation

Faulty tooth brushing

Tooth malpositions

Presence of dehiscence and fenestrations

Smoking

Primary trauma from occlusion

Iatrogenic factors

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Clinical Significance of Gingival Recession 1. The exposed root surface may be extremely sensitive.

2. Hyperemia of the pulp may result due to gingival recession.

3. Interproximal recession creates oral hygiene problems

thereby resulting in plaque accumulation.

4. Finally, it is aesthetically unacceptable.

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