Gingiva

The gingiva, also known as the gums (Latin: gingiva), is a dense and thick mucosa covering alveolar arches of the maxilla and mandible and it is a part of the digestive system. The gingiva surrounds the teeth, and participates in forming the oral cavity. The gingiva is a mucous membrane which is very tightly bonded with the periosteum of the alveolar arches and necks of the teeth. The primary function of the gingiva is the protection of underlying tissue and teeth.

Gingiva's visual appearance

The gums in a healthy individual have a pink color, although color can vary in ethnic groups also depending on person's skin tone and amount of melanin. Hyperpigmentation of the gingiva can present in individuals having darker skin, and the amount and intensity of pigmentation can increase with age. Gums are tough to touch and react to temperature, pressure changes, and pain. Gingival stippling is a normal appearance and healthy characteristic of gums, looking like a textured surface with different looking dot patterns. Stippling happens due to microscopic elevations and depressions of the underlying connective tissue projecting on the gingiva's surface.

Anatomy of the gingiva

Gingiva starts at the base of the alveolar arches and ends at the level of the necks of teeth. Gums divide into two parts depending on the side that covers alveolar arches. The buccal or the lip aspect is the side that faces the cheeks and lips, but the lingual or oral aspect is the side that faces the tongue and oral cavity proper.

Gums form a part of the periodontium, together with the dental alveoli of the bony alveolar arches (also called the alveolar bone), periodontal ligament, and the cement of the teeth. The periodontium is the dense connective tissue between the roots of the teeth and the dental alveoli.

Gums divide into three anatomical parts or types - the marginal, attached, and interdental parts.

The marginal gingiva

The marginal gingiva, also called the unattached or free gingiva, is the end parts of the gums that connect with the teeth and surround the necks of the teeth as collars or horseshoe-like endings. This anatomical type is moveable. The point where the gingiva and tooth meets is the gingival sulcus, a space between the margin of the unattached gingiva and the tooth. The marginal gingiva's width usually varies between one to two millimeters (0.039 to 0.079 inches). The free gingival groove is a part of the marginal gingiva - a linear depression in the unattached gingiva connecting it with the attached gingiva. It is the border between both types.

The interdental gingiva

The interdental gingiva, also called the interdental papilla, is the part that fills the space between two adjacent teeth and borders with the gingival sulcus. Usually, healthy gums have a form of a pyramid. The facial papilla is the side of the interdental gingiva facing the oral vestibule, but the lingual papilla faces the oral cavity proper. The col region is the valley-like slight depression that connects both sides of the interdental gingiva - the facial papilla with the lingual papilla.

The attached gingiva

The attached gingiva lies between the marginal gingiva and alveolar mucosa. In contrast with the marginal gingiva, it is not moveable. Usually, this type of gingiva's width varies between four to five millimeters (0.157 to 0.197 inches). This type is very dense and firm, stippled, and very tightly bound to underlying tissue. The mucogingival line or junction connects the attached gingiva with the alveolar mucosa.

Microanatomy of the gingiva

The gums do not have submucosa comparing to other oral cavity parts, and they also do not contain any glands. The gingiva mainly consist of thick and dense connective tissue fibers. It contains a high amount of collagen fibers firmly fused with the periosteum alveolar arches. The gingiva has many sensory nerve endings, and it is highly vascular. It has a large number of capillaries. The mucus covers stratified squamous keratinized epithelium. In the tooth neck region, collagen fibers from the gums connect with tooth collagen fibers from the round ligament of the tooth, so the gingiva and each tooth connect very closely. It is the only place where the epithelium does not have signs of keratinization. Between the surface of the tooth and gingiva is a physiological gum pocket. In healthy gums, it is very microscopic, but it becomes more prominent and pathological in several diseases.

Gum functions

The primary function of the gingiva is the protection of teeth and underlying bone structures. As the gingiva has a close connection with teeth, it helps to retain teeth in their place. The gingiva also works as a barrier for microorganisms and traumas. It is not easy for harder and coarser food participles to injure the gingiva because of its thick and dense structure. With poor gum hygiene and gum disorders, the teeth are more exposed to develop various diseases. The gingiva also provides rigidity and anatomical structure invariance in the mastication process. It evenly distributes the pressure caused by the mastication process. As the gingiva contains many sensory nerve endings, it reacts, for example, to temperature or injury. And finally, it also has an esthetic function improving the visual appearance.

Gingival neurovascular supply

Arterial blood supply

The arterial blood supply for gums covering alveolar arches of the maxilla is provided by branches of the maxillary artery, a terminal branch of the external carotid artery. The posterior superior alveolar artery perfuses the gums' posterior part, while the anterior superior alveolar arteries supply the frontal and middle regions of the gums. The anterior superior alveolar arteries are branches of the infraorbital artery.

The gums overlying the mandible get the arterial blood supply from the inferior alveolar artery, which is a maxillary artery branch.

Venous and lymphatic drainage

Venous drainage is provided by the gingival veins that flow into the plexus pterygoideus.

Lymphatic drainage from the buccal aspects of the gums is provided by the submental and submandibular lymph nodes. The upper part of the lingual aspects are drained via the deep cervical and lateral retropharyngeal lymph nodes. In contrast, the lower part is drained to the submandibular lymph nodes.

Innervation

The innervation of the gingiva is provided by the maxillary (CN V2) and mandibular nerves (CN V3) from the trigeminal nerve - the fifth cranial nerve.

The mandibular gingiva is supplied by the gingival branches arising from the inferior alveolar nerve. The lingual and buccal nerves also participate in the innervation.

The maxillary gingiva is mostly innervated by the anterior, middle, and posterior superior alveolar nerves that arise from the infraorbital nerve. The nasopalatine and greater palatine nerves also innervate the gingiva of the upper jaw.

Gingival disorders

Changes in color, swelling, bleeding, pain sensation, abnormal sensitivity, loss of stippling are indicators of various diseases

The best possible prevention for all the diseases involving gums includes taking care of oral cavity hygiene and regular dental visits. 

Early-stage gum diseases are easy and fast to treat. Untreated disorders can impact overall health and spread through the bloodstream to other body parts, affecting cardiovascular system organs or joints, causing arthritis. Lack of products containing vitamin C in nutrition has an impact on overall gum health as well. The gums contain a significant amount of collagen fibers, and to form them, vitamin C is needed. Otherwise, teeth can start to loosen.

Gingivitis

Gingivitis is the most common disorder affecting the gums, often starting without any symptoms. It is the inflammation of the gingiva causing changes in its appearance. It happens due to microorganisms that colonize the gingival pockets, rarely causing the widening of them. 

It is characterized by mild swelling, redness of the gingiva, and also gum bleeding

The best possible prevention is regular and good oral hygiene. Factors such as smoking, systemic and underlying diseases such as diabetes, genetics, aging, stress, hormonal changes, pregnancy, medications, unhealthy nutrition, and many more to follow can cause gingivitis. Still, the most common risk factor is poor oral hygiene.

Periodontitis

Untreated gingivitis can result in a more severe condition - periodontitis. The inflammation from gums can spread to other periodontium-forming structures. The bacterial plaque spreads and grows below the gingival sulcus. Gums then separate from the teeth, forming pathological pockets that get infected. If the process continues, the pockets widen and deeper more, and the inflammation goes deeper. In the worst cases, the tooth can get loose and infected and finally result in tooth removal. Some systemic diseases present with periodontitis.

Gingival hyperplasia

Gingival hyperplasia is a gum enlargement or overgrowth. Usually, it happens around the necks of the teeth. In severe cases, the overgrowth can be very visible, and gums can almost completely cover the teeth. 

The most common factor causing this condition is poor oral hygiene. It can also present as a side effect of certain medical drugs. Those drugs include immunosuppressants, antiseizure medications, and calcium channel blockers that are used to treat several cardiovascular conditions. Once a person stops taking the pills, hyperplasia improves. Certain diseases can present as gingival hyperplasia, including HIV, diabetes, Crohn's disease. They can become enlarged in pregnancy. 

Symptoms of this condition include gum swelling, tenderness, and pain, red and bleeding gums.

Summary on gums

What is gingiva?

The gingiva is dense and thick mucosa covering alveolar arches of the maxilla and mandible and surrounding the tooth.

Where is gingiva?

The gingiva is a part of the oral cavity covering alveolar arches of the maxilla and mandible and surrounding the tooth.

Is gum gingiva?

Yes, it is. The anatomical term for gums is gingiva.

What are two types of gingiva?

The two main types of gingiva are marginal or unattached gingiva and attached gingiva.

What is the function of the gingiva?

The primary function of the gingiva is the protection of the teeth and underlying structures.

What is the width of the attached gingiva?

The width of the attached gingiva varies between 4 to 5 millimeters (0.157 to 0.197 inches).

How do you know if you have attached gingiva?

Everyone has attached gingiva. It lies between the marginal gingiva and alveolar mucosa. It is very dense and firm, stippled, and very tightly bound to underlying tissue.

What is unattached gingiva?

The unattached gingiva is the end of the gums that connects with the teeth and surrounds their necks as collars or horseshoe-like endings.

What is the space between the free gingiva and the tooth called?

The space between the free gingiva and the tooth is called the gingival sulcus.

Is the attached gingiva keratinized?

Yes, the attached gingiva is lined by keratinized epithelium.

What is mucogingival junction?

The mucogingival line or junction connects the attached gingiva with the alveolar mucosa.

Why is stippling present in the gingiva?

Gingival stippling is a normal appearance and healthy characteristic of gums. Stippling happens due to microscopic elevations and depressions of the underlying connective tissue projecting on the gingiva's surface.

What is the sulcus of a tooth?

The tooth sulcus is where the gingiva and tooth meet, a space between the unattached gingiva's margin and the tooth.

What are the parts of the periodontium?

Gingiva, alveolar bone's dental alveoli, periodontal ligament, and cement of the teeth form the periodontium.

Is gingival stippling normal?

Yes, stippling is a sign of healthy gingiva.

What are gingival fibers?

Gingiva mainly consists of thick, dense connective tissue fibers. It contains a high amount of collagen fibers firmly fused with the periosteum of the alveolar arches.

What is the free gingival groove?

The free gingival groove is a part of the marginal gingiva, a linear depression in unattached gingiva connecting it with the attached gingiva. It is the border between both types.

What is healthy gingiva?

Gums in a healthy individual have a pink color and no signs of pathological processes.

What is the most common gum disease?

The most common gum disease is gingivitis.

How do I know if I have periodontitis or gingivitis?

Both present as an inflammation, although in the case of gingivitis usually, it is in a very mild form. In gingivitis, teeth typically are in their places, but periodontitis presents as loose teeth.

Can gum disease be a sign of something else?

Yes, gum disease can be a sign of underlying disease as, for example, diabetes can cause gingivitis.

Can gum infection spread?

Yes, untreated gum infections can spread via the bloodstream.

Can gingivitis turn into periodontitis?

Yes, untreated gingivitis can turn into periodontitis. Gingiva is one of the structures forming periodontium.

What is gingival hyperplasia?

Gingival hyperplasia is a gum enlargement or overgrowth.

What are the drugs causing gingival hyperplasia?

Immunosuppressants, antiseizure medications, and calcium channel blockers can cause gingival hyperplasia.