Gingiva is another word for the gums, or the soft, pink tissue that surrounds and protects the bottom of the teeth where they enter the jawbone. The gingiva is attached to the tooth, which forms a seal between the mouth and the underlying bone. Poor oral hygiene causes a buildup of plaque in the crevices of the teeth and gums, which if left untreated, can cause an infection called gingivitis, or gum disease. Gum disease causes inflammation of the gums and weakens the seal, allowing bacteria to enter the tooth root and bone structure. When this happens, the infection progresses to periodontitis, which often results in permanent tooth and bone loss. The gums play an integral role in the overall oral health of a patient and are crucial to keep healthy. Poor gum health contributes to poor oral health and a wide variety of other dental problems.
Gingival crevicular fluid, also called GCF, was recognized as an important factor in diagnosing periodontal disease over six decades ago. It is an inflammatory exudate that is derived from periodontal tissue and contains primarily the byproducts of tissue breakdown, antibodies, inflammatory mediators, and serum. It also contains structural periodontal cells, leukocytes, and normal oral bacteria that is usually present in the mouth. The serum component of this fluid is mostly derived from postcapillary venules, or microvascular, leakage. This fluid has an important role in maintaining the antimicrobial defense of the periodontium and maintaining the structure of the junctional epithelium. The bacteria most often responsible for periodontal disease are Treponema denticola and Porphyromonas gingivalis. The bacteria create broad-spectrum neutral proteinases to attack healthy tissue, which are then found in both samples of gingival crevicular fluid and plaque in patients who have periodontal disease. Patients with periodontal disease have an excess of GCF, whereas patients with healthy gums have very little.
A gingival flap is created during gingival flap surgery, a procedure where gum tissue is separated from surrounding teeth and deflected back to allow a dental surgeon access to the jawbone and the root of the tooth. A gingival flap is created prior to bone grafting and before a dental implant is placed, but it can also be used before treating periodontitis, or gum disease. During the procedure, the gums are numbed with a local anesthetic and a surgeon uses a small scalpel to make a u-shaped incision and fold the flap of gum tissue back. Then, the surgeon will graft bone or place the implant, replace the flap, and suture it closed. This is usually done with dissolvable sutures for patient comfort. With most dental implant procedures, a gingival flap must be made twice and possibly even three times. First to graft bone, then to place an implant, then to remove the cover screw and place the abutment.
Gum recession is a common problem among adults and affects between 4-12% of both men and women. Gum tissue recedes gradually and is often unnoticeable until it becomes severe. Untreated gum disease can cause damage to the bone underneath, resulting in tooth loss. If too much damage has been done to underlying bone, a dental implant may not be able to be placed. A gum tissue graft, also called a gingival graft, involves taking healthy oral tissue from one area of the mouth, usually the hard palate or roof of the mouth, and transplanting it to the desired area. However, some oral surgeons prefer to use donor tissue instead of grafting from the roof of the mouth. Gingival grafts may be done in conjunction with a bone graft or dental implant procedure, since gum disease often creates a need for multiple surgical procedures to repair the bone and gum tissue.
Receding gums, or more accurately known as gingival recession, is the exposure of the root of one or more teeth due to the retraction of the gingival margin or the loss of gum tissue over time. Most commonly, gingival recession is a problem faced by adults over the age of 40, however, younger individuals may also begin to notice signs of receding gums around the age of puberty or during their teen years. Gum recession may occur with the loss of alveolar bone underneath, which decreases the ratio of crown-to-root, affecting an individual’s cosmetic appearance and overall facial aesthetics. Gingival recession is classified using Miller’s classification system, and the causes of this condition are numerous. Most often, gum recession is the result of gum disease, or periodontal disease. It can also be caused by genetics, poor flossing habits, tooth crowding, overaggressive brushing habits, and the use of dipping tobacco.
The gingival sulcus is the point at which the tooth and gums meet, which is the primary component of the emergence profile. This is a highly visible area of the mouth and can impact the overall aesthetics of a patient’s smile. Ideally, the gingival sulcus is close to the tooth, with 3mm or less of space where food particles and bacteria can enter. Beyond this depth, traditional brushing and flossing habits aren’t able to reach and particulates build up over time. This results in bacterial overgrowth and periodontitis, an infection of the gums and potentially the bone tissue underneath. The deeper the gingival sulcus, the more difficult it is to properly clean it without professional care. As time progresses, the infection causes the sulcus to further deepen, compounding the issue and potentially resulting in tooth loss as the alveolar ridge degrades. The depth of the sulcus is easily checked with a dental probe.