DEPARTMENT OF PERIODONTICS
A SEMINAR ON
GINGIVAL BLEEDING Presented by SYED NABI AHMED C.R.I.
INTRODUCTION
The
two
earliest
symptoms
of
gingival
inflammation proceeding established gingivitis are (1) (1)
incr increa ease sed d gin gingi giva vall cre crevi vic cular ular flui fluid d pro prod ducti uction on rate rate
(2) (2)
blee bleedi ding ng from from ging gingiv ival al sulc sulcus us on gent gentlle prob probin ing. g.
Gingival bleeding varies in severity, duration and
the ease with which it is provoked.
Bleeding on probing is easily detectable clinically
& therefore is of value for the early diagnosis and prevention of were advanced gingivitis.
Pregnancy gingivitis.
It has been known that bleeding on probing
appears earlier than a change in color or other
visual
signs of inflammation, in addition the use of bleeding rather than color changes to diagnose
early
gingival inflammation is advantages in that bleeding is a were
objective
estimation.
sign
that
requires
less
subjective
CLASSIFICATION Gingival bleeding can be due to a series of factors,
which
can
categories such as
Local
Systemic
be
grouped
broadly
into
two
Local factors a. Infectious Acute
:
1. ANUG (Acute Necrotizing Ulcerative Gingivitis) 2. AHGS (Acute Herpetic Gingive Stomatitis)
Chronic
:
1. Gingivitis 2. Periodontitis
b. Traumatic 1.
Brushing
2.
Food impaction
3.
Irritation (due to prosthesis)
4.
Tooth pick injury
5.
Gingival burns
c. Post Surgical d. Congenital (eg) Hemangioma
Systemic factors a. Deficiencies i)
Hereditary : Haemophilia A & B, Von.wille brand’s disease
ii)
Liver disease: vit K deficiency
iii)
Deficiency of factor II,VII,IX,X
iv)
Idiopathic: eg eg.Thrombocytopenic pu purpura
v)
Leubemic
vi)
Nutr utritional nal :vit A, vit C and prot rotein defic ficiency ncy
b. Dysfunction i) Multiple myeloma ii) Systemic Lupus Erythematous c. Drugs & chemical allergies Salicylates, anticoagulant d. Excess: Thrombocytosis e. Defective aggregation f. Infections: Infections mononucleuses g. Hereditary: Haemorhagic telengetiasis h. Hormones: Pregnancy, Menstruation I. Malignancies
HISTOPATHOLOGICAL
ALTERATION
IN
GINGIVAL
the
following
BLEEDING In
gingival
inflammation
histopathological alterations result in abnormal bleeding:
Dilatation & eugargeuant of capillaries is thinning or ulceration of sulcular epithelium.
Gingival Inflammation
Because the capillaries are engorged and closes to the surface & the thinned, degenerated epithelium is less protective, stimuli that are ordinarily
innocuous cause rupture of capillaries and gingival bleeding.
GINGIVAL BLEEDING CAUSED BY LOCAL FACTORS This can be divided into:
Chronic & recurrent bleeding
Acute
CHRONIC AND RECURRENT BLEEDING
The most common cause of abnormal gingival
bleeding on probing is chronic inflammation.
The bleeding is chronic or recurrent & is provoked
by mechanical trauma (e.g. from tooth brushing, picks or food impaction) or by biting into such as apples.
Chronic Generalized diffused Gingivitis
tooth
solid foods
ACUTE BLEEDING
Acute episodes of gingival bleeding are caused by
injury or occur spontaneously in acute gingival disease.
Laceration of gingival by tooth brush bristles
during aggressive tooth brushing or by sharp of hard food can cause gingival bleeding
pieces even in the
absence of gingival disease.
Gingival burrs from foods or chemicals increase
the ease of gingival bleeding.
Gingival enlargement seen in a patient taking a calcium channel blocker.
Gingival bleeding associated with systemic changes.
In
some
haemorrhage
systemic occurs
disorders,
spontaneously
gingival or
after
irritation and is excessive and different to control. Such
conditions
have
the
common
hemostatic mechanism failure and bleeding in the skin, internal tissues including the oral
feature
result in abnormal organs and other
mucosa.
The various systemic conditions that can result
in gingival bleeding have been listed in the classification.
of
CLINICAL EVALUATION OF GINGIVAL BLEEDING Sites that bleed on probing have a greater area of inflamed connective tissue (i.e., cell-ribs, collagens per tissue) than do sites that do not bleed. In most cases the cellular infiltrate of sites that bleed on probing is predominantly lymphocytic. The severity of bleeding and the ease with which it is provoked depend on the intensity of inflammation. Hence they can be grouped into two categories: 1.
Spontaneous
2.
Bleeding on provocation
SPONTANEOUS
BLEEDING or
bleeding
on
slight
provocation can occur in acute necrotizing ulcerative gingivitis. In this condition, engorged blood vessels in the
inflamed
connective
tissue
are
exposed
by
ulceration of necrotic surface epithelium.
spontaneous bleeding of the gingiva
BLEEDING ON PROVOCATION can be seen in varying
stages
of
the
disease.
In
case
of
moderate
or
advanced periodontitis, the presence of bleeding on probing
is
considered
destruction.
bleeding of the gums upon probing.
a
sign
of
active
tissue
Thus bleeding can be considered of diagnostic value in many of the gingival diseases. However its relationship to disease progression is unclean. A periodontal probe or a wooden interdental cleaves can be used in the evaluation of gingival bleeding. It has to known that any force greater than 0.25N tissues.
can
produce
gingival
bleeding
in
healthy
GINGIVAL BLEEDING INDICES
The clinical assessment of gingival color, form and texture is subjective in nature, gingival bleeding is an objective diagnostic sign of inflammation.
Periodontal probes are used with most indices
however toothpicks and dental floss are used to
elicit
bleeding with some indices.
Gingival bleeding indices are used in clinical
practice, surveys of population groups and clinical trials of antiplaque and antigingivitis agents.
Although there are many indices are available for
assessment of gingival bleeding.
Some which are used were commonly are as follows: 1.
Gingival sulcus bleeding index
2.
Gingival index-loe & sillness
3.
Gingival bleeding index
4.
Eastman interdental bleeding index
5.
NIDCR pr protoacd fo for re recording gi gingival bl bleeding
MANAGEMENT OF GINGIVAL BLEEDING
Increased gingival bleeding and tenderness
requires routine periodontal monitoring.
Periodontal maintenance should be titrated to
the individual patients need.
Preventive care including a vigorous program of oral hygiene is also vial.
Hilder gingivitis eases respond well to scaling
and root planning with frequent oral hygiene reinforcement.
Some cases of gingivitis & bleeding may require
microbial culturing, antimicrobial mouthwashes and local site delivery, or antibiotic therapy.
Periodontal maintenance appointments may
used to be frequent when periodontal instability is noted.
CONCLUSION Gingival bleeding therefore is critical in early diagnosis and prompt treatment of diseases involving the
periodontium.
Proper
awareness
should
be
inoculated in patients to consider bleeding as a early sign
of
gingival
disease.
The
woven
diagnostic
techniques should also be used for their purpose.
