The Gingiva

 

The gingiva is not really a "dental tissue" at all. And in fact the science of gingival health and disease is a specialty unto itself called "Periodontics" which means "around the tooth." But for the purposes here, there is a connection between the tooth and the gingiva that needs to be explore.

For many centuries, the gingiva was commonly called the "gums" and that persists today as well. My older patients will actually pronounce it "gooms" which just sounds icky and spooky to me!  Whether we call it gums or its rightful name, the gingiva is the layer of cells that connects to, covers up, and protects the bone around your teeth. It exists in the mouth whether you have any teeth or not. When teeth are present however, the gingiva must also "wrap around" the tooth itself and then attach to the tooth as well as the bone.

Properties of the Gingiva

The inside of the mouth is not covered with skin, like the rest of your body. It is covered with a different type of epithelium called mucosa. The gingiva is a special mucosa that protects the attachment of your tooth to the bone of your jaw.  When it is healthy, gingiva is pinkish in color and stippled on its surface owing to something called "keratin." Unattached mucosa is not a keratinized tissue. Therefore it will look shiney and smooth and is ill-suited to form a viable attachment to your teeth.

Being an attachment structure, gingiva is made up of many types of cells, and we will not go into all of them at this time. The focus instead will be on connective tissue - the collagen fibers and cells that produce them to make this important attachment - and the blood vessels that supply the important nutrition to keep this attachment healthy.

Gingiva is constantly in a state of regeneration and repair. It is a living tissue that has the capacity to adapt to the harsh realities of the mouth. When the gingiva is healthy and pink we can assume that there is no inflammation - or gingivitis - present. When it becomes inflamed, the tissue begins to swell and turn red due to capillary engorgement in response to some kind of irritation. 

The complicated array of cells in the gingiva will dictate the course of this inflammatory response. When the source of the irritation is removed, the gingiva will return to its happy, normal self. If the irritation, and hence the inflammation persists, irreversible damage to the attachment can occur.

So if you look closely at the picture below, you will see a very defined, pink, attached gingival layer around the teeth. Somewhere around the dotted lines it transitions from attached gingiva to unattached mucosa.

 

From a dental standpoint, all we really need to know about the gingiva is how it is connected to the tooth, and how changes to the gingiva can affect the tooth itself. Later, in the section on "Periodontal Disease" we will focus on conditions that affect the gingiva, and the attachment to bone.

 

The Gingival Pocket

So, lets narrow in to one small area, where the gingiva wraps around the neck of the tooth forming a tight, biological seal, protecting both the bone and the periodontal ligament beneath it.

If we look at the picture to the right, you will recognize a lot of what you have already learned - how the enamel covers the crown of the tooth and how it tapers to nothing where it meets the cementum that covers the root; the dentinal tubules surrounding the inner pulp chamber.

But what you have not seen yet is how the gingiva attaches to the neck of the tooth, and to the bone underneath it, thus protecting the periodontal attachment. The biggest thing to note here is how the gingiva "bunches up" just before it attaches to the cementum at the root surface. This creates a pocket that exists, a place for food and bacteria to collect around the tooth.

When material accumulates in this pocket, the gingiva becomes irritated. When the gingiva becomes irritated, it becomes inflamed - the definition of gingivitis.

We will review this condition in much more detail in the section on "Periodontal Disease."

But for now, be aware that there is this pocket, a cuff of sorts, that completely encircles the tooth and creates a bit of a hygiene challenge to all patients.

 

The Gingival Attachment

In the same picture to the right, notice how the gingiva attaches to the root surface and the bone. There is one more tissue that attaches to the gingiva and that is the periodontal ligament. And remember that the periodontal ligament is also attached to the pulp within the tooth.

Why is this important? You will find out when we discuss how to interpret symptoms of the tooth. Sometimes a tooth that is very sensitive to hot or cold is due to a problem that began in the gingival attachment area, but ended up in the pulp, via the periodontal ligament.

The health of the gingival attachment is critical to protecting the bone that actually holds the tooth in your jaw. Once the attachment seal is "broken" anywhere around the neck of the tooth, inflammation, infection, and bone loss can occur. Ultimately, if left untreated, this can cause the loss of the tooth.

 

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