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 Chronic gingivitis
     The manifestations of gingival inflammation vary considerably between individuals and from one part of the mouth to another. This variation reflects the aetiological factors at work and the tissue response to these factors. This response is essentially a mixture of inflammation and fibrous tissue repair. When the former predominates, signs and symptoms are more obvious; when the fibrous tissue component predominates, clinical manifestations can be much more subtle and recognized only by careful examination.
     In making a diagnosis it is important to keep in mind the appearance of health, departures from which may indicate disease.
     Clinical features are:
     l . Altered gingival appearance.
     2. Gingival bleeding.
     3. Discomfort and pain
     4. Unpleasant taste
     5. Halitosis.
    
     Altered gingival appearance
     Changes in appearance are usually described according to color, shape, size, and surface characteristics.
     Healthy gingivae are pale pink and the margin is knife edged and scalloped; a streamlined papilla is often grooved by a sluice-way and the attached gingiva is stippled.
     Because the interdental embrasure is the site of greatest plaque stagnation gingival inflammation usually starts in the interdental papilla and spreads around the margin. As the blood vessels dilate the tissue becomes red and swollen with inflammatory exudate. The knife-edged margin becomes rounded, the interdental sluice-way is lost and the surface of the gingiva becomes smooth and glossy. As the gingival fiber the inflammatory process the gingival cuff loses tone and comes away from the tooth surface so that a shallow pocket is formed breaks up bundles. If the inflammation becomes more diffuse and spreads into the attached gingiva the stippling disappears. If inflammation is severe it can spread across the attached gingiva to the alveolar mucosa and so obliterate the normally well-defined mucogingival junction.
     Usually the most pronounced inflammatory swelling is seen in adolescents and young adults so that false pocketing is formed. It is called false as opposed to real or periodontal pocketing which is formed by apical migration of the crevicular epithelium as the periodontal ligament is destroyed by inflammation. Where several aetiological factors combine, e. g. plaque deposition plus lack of lip-seal plus the endocrinal changes of puberty, gingival swelling, especially papillary swelling, can be pronounced.
     If plaque irritation is longstanding and low grade, the main tissue reaction will be fibrous tissue production so that the gingiva may remain firm and pink but become thickened and lose its streamlined shape.
     Gingival bleeding
     Gingival bleeding is probably the most frequent patient complaint. Unfortunately gingival bleeding is so common that people may not take it seriously and even believe it to be normal; however, unless bleeding obviously follows an episode of acute trauma, bleeding is always a sign of pathology. It occurs most frequently on toothbrushing. Bleeding may be p本论文由英语论文网提供整理，提供论文代写，英语论文代写，代写论文，代写英语论文，代写留学生论文，代写英文论文，留学生论文代写相关核心关键词搜索。