Normal periodontal tissues. Gingival epithelium comprises:
• oral epithelium— extends from mucogingival junction to crest of gingival margin and has rete ridges
• sulcular epithelium—joins the oral and junctional cpithclia
• junctional epithelium—tends to be flattened and forms a union with the tooth in the epithelial attachment extending to the amclodcntinal junction in normal mature tissue, deep to which is the periodontal ligament.
Connective tissue gingival fibres support the gingival margin as a cuff around the tooth. Transeptal fibres join adjacent teeth and, more deeply, horizontal fibres join the tooth to the socket wall (Figs 29 & 30 and Fig. 34, p. 18).
Acute ulcerative gingivitis
Aetiology Otherwise healthy young adults affected.
Aetiology unknown but is associated with:
• poor oral hygiene
• upper respiratory tract infections
Microbiology Overwhelming proliferation of Gram-negative anaerobic bacteria traditionally termed Fusobacterium nucleatum and Rorrelia (Treponema) vincenti. Other anaerobes may also be involved.
A smear shows fusospirochaetal complcx (Fig. 31) and polymorphs.
Pathology Gingival necrosis and non-specific ulceration covered by slough containing fusiforms and spirochactes. Tissue is invaded by spirochaetcs with progressive destruction of marginal gingivae (Fig. 32) and then of deeper supporting tissues. There is no generalized stomatitis.
fig. 29 Normal human adult buccal gingiva. fig. 30 Normal human adult interdental gingiva.
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