Review of Gingival Anatomy

Review of Gingival Anatomy

Two types of soft tissue exist in the oral cavity, keratinized gingiva (B) and non-keratinized mucosa (C). Keratinized gingiva is a thicker, more robust tissue and protects teeth from abrasion. It also resists inflammation and its deleterious effects on the periodontium. Mucosa is a thin tissue that serves only as a covering layer.  It offers minimal protection and is more susceptible to breakdown.

Gingival recession is defined as when the gingival margin is apical to the cemento-enamel junction (CEJ) of a tooth (A). A mucogingival defect is interpreted as having occurred when there is no attached gingiva associated with the tooth.  However, because the vast majority of recession and mucogingival defects are asymptomatic with regards to pain and sensitivity, patients are less likely to seek treatment and dentists are less likely to recommend treatment and refer to a periodontist.  Certainly not all gingival recessions and mucogingival defects warrant treatment, but it is important to be able to identify the lesions that would benefit from soft tissue grafting.  Additionally, patients seem to be more likely to undergo treatment their general dentist is able to explain the reasoning behind a referral to a periodontist.

Several studies have indicated that in the presence of inflammation, sites that lack keratinized gingiva and only have mucosa break down and develop recession more rapidly.  These studies also show that if the patient can maintain gingival health and keep those areas free of inflammation they are not more likely to experience breakdown. However, the likelihood of maintaining mucosa-only sites free of inflammation is not good, and if there is only mucosa present this is a situation where a patient would benefit the most from a soft tissue graft, even if there is no measurable gingival recession.

It is critical for the general dentist to understand that the quality of the remaining soft tissue determines the need for treatment and not the amount of gingival recession.