Range of Histologic Variation in Clinically Normal Gingiva

Abstract

H ISTOPATHOLOGIC studiesl-4 have rather precisely defined the clear-cut microscopic abnormalities that accompany gingival lesions. Inflammations, degenerations, dystrophies, infiltrations, and tumors have been categorized, illustrated, and contrasted with the description of the hypothetic normal.5' 6 Concepts of normal gingival structure remain static, in contrast to the dynamic understanding of pathologically induced variations.Normal oral mucosa has been studied with emphasis on variations in selected areas of the mouth,7 from the point of view of age and sex differences,8 functional changes,9 and the whole range of metabolic and hormonal deviations.10 An indication of the broadness in pattern which gingival histology .may take is given in one text which grants the possibility of considering the surface epithelium in keratinized, parakeratinized, or nonkeratinized forms as within the normal range.' Boundaries of gingival normality, as rigidly defined in texts, require extension to include a broader range of variation.Of seventeen specimens studied in one report,"2 not one could be found which registered complete adherence to the picture of "ideal normal gingiva." Features tabulated included cellular infiltration, degree of cornification, and the presence of inflammatory cells in the subepithelium. The inclusion in this study of subepithelial structures focuses attention on the lability of corium tissue. The health status of the gingivae has been equated with thickness and keratinization of the epithelial mantle,'3 while consideration of variant patterns of subepithelial architecture has been relatively less stressed. Epithelial nutrition and physiologic changes derive from the lamina propria of vascular and reactive corium. This internal effect requires consideration as well as external phenomena, such as trauma and superficial inflammation.It is the purpose of this report to broaden the concept of normal gingiva] structure through a study of variations. The line of demarcation between normal and pathologic gingivae is not sharp and clearly defined histologically; pathology implies recognition of degree of variation from normal. The study explores the degree of variation apparent in gingival specimens which, despite mutual microscopic differences, are classified as normal on the basis of clinical and symptomatic findings. METHODS AND MATERIALSThirty-eight gingival biopsy specimens were removed from both in-and outpatients at Montefiore Hospital, New York. The subjects ranged in age from 19 to 64 years; twenty-two were men and sixteen women. Patients were

Permeability of the dento‐gingival blood vessels

“…In the present study abnormal vascular permeability of clinically healthy gingiva was only observed, when an irritant causing an inflammatory response was applied. In the gingiva, however, there are always chronic inflammatory foci present (Bernier 1950, Zachinsky 1954, Brill 1962, Egelberg 1964, but abnormal permeability could not be observed either with vascular labelling or with gingival fluid measurements. The interest for further studies is therefore focused on the permeability of the blood vessels in well-developed chronic gingival inflammation.…”

Histopathology of spontaneous periodontitis in dogs

“…It was a constant finding that in both health and in disease the dog periodontium exhibited histological characteristics similar to those in man (Melcher & Bowen 1969, Schroeder & Listgarten 1971, Loe & Listgarten 1973, Stahl 1973. Thus gingival specimens from radiographically normal periodontium regularly showed mild inflammation as in clinically healthy human specimens (Bernier 1950, Zachinsky 1954, Zachrisson & Schultz-Ha'idt 1968 as well as in dogs (Attstrom 1970. Inflammatory infiltrates have also been observed in gingival specimens from germ-free beagles (Listgarten & Heneghan 1971.…”

Variability of histologic criteria in clinically healthy human gingiva

“…Accepted for publication June 16, 1987 introduction Based on a variety of human and animal models ( I ) the pathogenesis of periodontal diseases has been characterized into five stages. The criteria for a healthy or "normal" gingiva have been described (2)(3)(4)(5)(6)(7)(8)(9). In all these studies healthy gingival tissues were identified as harboring some inflammatory cells and, hence, the definition of a healthy gingiva remains controversial.…”