Periodontal Conditions – Periodontics is the field of dentistry which deals with the tissues that surround the tooth (pen., from the Greek word meaning around). The tissues involved include the gingiva, tooth surface (especially the cementum), alveolar bone, and the periodontal ligament.


The periodontium is the combined term used for all the tissues that support the teeth and keep them firmly in place. It consists of:

  • Gingiva
  • Periodontal ligament
  • Cementum
  • Alveolar bone.


The gingiva, or gum tissue, is the soft tissue that surrounds the teeth and covers the bone. The outer layer of gingival tissue is epithelial tissue. This epithelial tissue is keratinized, which makes it tougher and gives it the ability to withstand the wear and tear that goes on while food chewing is taking place.

The colour of healthy gingiva is usually a very pale pink. Some individuals may show some brown pigmentation in the gingiva. The gingiva should be firm and stippled. Healthy gingiva should not bleed during proper brushing, flossing, or probing.

The areas of gingiva are usually given a more specific name according to their location:

Free Gingiva

The unattached gingiva that surrounds the tooth like a collar, is know as Free Gingiva. It is sometimes also referred to as marginal or unattached gingiva because it is not attached to the tooth or underlying bone. It is measured from the edge of the gingiva to the base of the sulcus.

Interdental Gingiva

Interdental gingiva is the gingiva that is located between the two adjacent teeth. It’s also known as interdental papilla.

Attached Gingiva

Attached gingiva is firmly attached to the underlying bone and tooth. The zone, or area, of attached gingiva runs from the base of the sulcus (at the base of the free gingiva) to the mucogingival line (junction) where the redder, looser alveolar mucosa begins. This zone of attached gingiva is important because of its role in supporting the tooth. It also prevents the gingival tissue from receding (moving apically) to expose the root of the tooth.

Alveolar Mucosa

The alveolar mucosa is the tissue that begins at the mucogingival line and continues on to line the inside of the cheeks. It is not keratinized arid, therefore, is more delicate than the gingival tissue.

Gingival Sulcus

The gingival sulcus is the space, or crevice, between the free gingiva and the tooth. When the gingiva is healthy, this space is very shallow. A periodontal probe can be inserted under the free gingiva to measure the sulcus in order to determine gingival health. A normal sulcus measurement is 1.0—3.0 mm. In disease, this space is called a pocket. In severe cases, a periodontal pocket may be more than 10 mm deep.

Periodontal Ligaments

The periodontal ligament is connective tissue that surrounds the root of the tooth. It contains fibers that attach the tooth to the bone. The fibers of the periodontal ligament, known as Sharpey’s fibers, are embedded in the bone of the tooth socket and work to keep the tooth attached to the bone.


The cementum is a hard or calcified material that covers the root of the tooth. The periodontal fibers are inserted into it.

Alveolar Bone

The alveolar bone is the bone that surrounds and supports the teeth. The coronal border of the bone is referred to as the alveolar crest.


Recent research into the etiology of periodontal disease has revealed that the amount of plaque present does not always dictate how the severity of the disease. Rather, the content (type of bacteria) that is present is a better indicator of the disease process. The patient’s own immunity in fighting off the effects of this bacterial plaque also plays a significant role.

Periodontal diseases can be broadly divided into two main disorders:

• Gingivitis

• Periodontitis.


It is the inflammation of the gums or the gingiva, which is associated with its reddening and puffiness. Gingivitis is an infection that is limited to the soft gingival tissue. It does not affect the underlying bone. In most cases, gingivitis is painless and the patient may not be aware that he or she has the disease. Some of the signs of gingivitis are:

• Red, puffy gingiva

• Gingiva that bleed when brushed

• Bad breath.

Contributory Factors of Gingivitis. The factors that contribute to onset of gingivitis include:

• Plaque

• Systemic factors such as disease, hormonal effects, and effects of medication.

• Predisposing factors such as poor nutrition, smoking, stress, and poor oral hygiene.

Types of Gingivitis

There are several different types of gingivitis. Plaque-associated gingivitis. This type of gingivitis occurs from inadequate plaque removal, The gingiva becomes red and swollen. Bleeding may occur during brushing. This condition is the most common type of gingivitis and is rarely painful.

Acute primary herpetic gin givostomatitis. This type of gingivitis is most commonly found in children. It’s characterized by gingival inflammation and small vesicles (blisters, or fluid- filled pockets) on the gingiva. It may be accompanied by pain and fever. It is caused by a virus (Herpes simplex type 1), and is usually last for 14 days.

Acute necrotizing ulcerative gingivitis (AJ’sJUG). This type of gingivitis is a disease that develops quickly. The gingiva becomes swollen, bleeding, and very painful. The patient may experience a metallic taste in his or her mouth and have foul breath. The interdental gingiva may have a grayish appearance and look as if the tissue in this area was eroded. This disease is more likely to occur in the anterior portion of the mouth and in individuals who smoke, have poor oral hygiene, have poor nutritional habits, or are experiencing stress.

Hormone-influenced gingivitis. This type of gingivitis exhibits a marked inflammation of the interdental papifia and marginal gingiva. This inflammation corresponds to fluctuating level of hormones. A patient who is going through puberty, taking birth control pills, or is pregnant may experience hormone-influenced gingivitis.

Medication-influenced gingival enlargement. This type of gingivitis is characterized by gingival enlargement or gingival overgrowth in patients taking certain medication such as:

  • Anticonvulsive drug used in the treatment of epilepsy.
  • Immunosuppressive drug used to prevent rejection of transplanted organs.
  • Calcium channel blockers, drugs used to treat certain heart diseases.

Desquamative gingivitis. It occurs in patients who are experiencing systemic diseases such as lichen planus and benign mucous membrane pemphigoid, which are both characterized by small, shiny, white blisters on the oral mucosa. The epithelial surface of the gingiva desquamates, or sloughs, from the underlying connective tissue.

Human Immunodeficiency Virus (HIV)— associated gingivitis. This type of gingivitis is characterized by very red gingiva that bleeds spontaneously. It occurs in individuals who have RN infection or AIDS.


Periodontitis is the term used for the condition of inflammation of periodontal ligaments. It occurs when the infection has spread from the gingiva to the underlying bone and periodontal ligaments.. Periodontitis leads to periodontal pocket formation, gingival recession, and bone loss. Gingivitis always occurs before periodontitis, but gingivitis does not always turn into periodontitis. Like gingivitis, most cases of periodontitis are painless and many times patient may not be aware he or she is having periodontitis. Periodontitis may initially include these signs:

• Vague aching, itching, or other gingival discomfort

• Gingival recession

Increase in probing depth.

More advanced cases of periodontitis may include these signs:

• Loosening of teeth

• Spaces appearing in between the teeth.

There are several different classifications of periodontal diseases:

Adult Periodontitis

This type of periodontitis occurs in adults and is the most common form of periodontitis.

Patients exhibit varying degrees of gingival inflammation, bone loss, pocket formation, and recession. There are many different bacteria associated with the onset and progression of adult penodontitis.

Early-onset Periodontitis

This type of periodontitis occurs in individuals under the age of 20. This rare disease is characterized by rapid destruction of tooth- supporting tissues. There is no pain and the gingiva may appear healthy. Early onset periodontitis is further divided into two categories:

(i) Prepubertal Periodontitis. Occurs while primary teeth are present.

(ii) Juvenile Periodontitis. It has its onset with puberty. When it occurs in a localized manner, the first molars and incisors are affected. When it occurs in a generalized manner, all teeth of the dentition are affected. Most patients have the bacteria Actinobacillus actinomycetemcomitans associated with the lesions.

Each of these early-onset diseases can affect the whole dentition (generalized effect) or only involve certain teeth (localized effect).

Rapidly Progressive Periodontitis

This type of periodontitis affects patients under 35 years of age. It is characterized by rapid destruction of tooth-supporting tissues.

Refractory Periodontitis

This type of periodontitis occurs when the tissues of an adult who has received periodontal treatment do not respond positively to treatment and the disease process continues.

Periodontitis Associated with Systemic Diseases

This type of periodontitis occurs in patients with such systemic diseases as HIV infection or diabetes.

Acute Necrotizing Ulcerative Periodontis

This type of periodontitis occurs in a patient who has had repeated episodes of ANUG (acute necrotizing ulcerative gingivitis). This disease progresses to affect the underlying supportive tissues. Necrotizing ulcerative periodontitis is associated with HIV infection also.