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# Gums (gingiva)

The gums (gingiva) are the pink tissue covering the jawbones and sealing around each tooth; inflamed gums can lead to bone loss around the teeth.

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## What it is

The pink tissue that covers the tooth-bearing bone of the jaws and fits tightly around the neck of each tooth.

## What it does

Protects the bone and the roots, and seals the tooth sockets against germs.

## Key points

- Free (marginal) gingiva forms a collar around each tooth with a shallow groove inside, the gingival sulcus; attached gingiva is bound firmly to bone and tooth
- Gingivitis is reversible inflammation of the gum alone; periodontitis adds loss of periodontal ligament and bone (attachment loss) and does not reverse
- Bleeding gums on brushing or probing is the earliest common sign of gum inflammation

## Key facts

**Where**
Mucosa covering the alveolar processes and the necks of the teeth; attached gingiva bound to bone, free margin around each tooth

**Blood supply**
Branches of the [maxillary artery](https://durgical.com/en/anatomy/maxillary-artery/) (alveolar, palatine, buccal) and, for the lower gums, the inferior alveolar, lingual and facial arteries

**Nerve**
V2 (superior alveolar, greater palatine, nasopalatine nerves) for the upper gums; V3 (inferior alveolar, buccal, lingual nerves) for the lower gums

**Function**
Seals around the teeth and protects the bone; inflamed in gingivitis and lost with bone in periodontitis

## Relations

**Course**
A continuous band along both jaws on the outer (vestibular) side and the inner side, blending with the palatal mucosa above and the floor of the mouth below

**Deep**
Alveolar bone of the [maxilla](https://durgical.com/en/anatomy/maxilla/) and [mandible](https://durgical.com/en/anatomy/mandible/) and the periodontal ligament; at the tooth, the junctional epithelium attaches to the enamel near the cementoenamel junction

## How to find it

Seen at the necks of the teeth: firm, pale pink attached gingiva, the scalloped free margin and the papillae filling the spaces between teeth. The mucogingival junction is the line where it meets the redder, movable alveolar mucosa.

## Examination

- Periodontal probing: a thin probe slid into the sulcus measures its depth and shows bleeding; a healthy sulcus is shallow (up to about 3 mm), while deeper pockets with attachment loss point to periodontitis

## On imaging

The gum itself does not show on radiographs; it is assessed by looking and probing. Bitewing, periapical or panoramic radiographs show what lies under it: the alveolar bone crest, normally just below the enamel-cementum junction. Horizontal or vertical bone loss and calculus point to periodontitis; in gingivitis alone the bone is normal. Cone beam CT is kept for implant or surgical planning.

## Common problems

- Gingivitis: red, swollen gums that bleed when brushing.
- Periodontitis: the gum and the bone recede and the teeth loosen.

## Clinical notes

- Gum overgrowth occurs in pregnancy, with an exaggerated response to plaque and sometimes a localised pregnancy epulis (pyogenic granuloma)
- Drug-induced gum overgrowth is classically caused by phenytoin, calcium channel blockers such as nifedipine, and ciclosporin
- Bleeding gums can also reflect a general disorder such as leukaemia, a low platelet count or scurvy (vitamin C deficiency)
- Necrotising gingivitis (painful, ulcerated papillae and foul breath) appears with stress, smoking and weakened immunity

## Development

Its epithelium comes from the ectoderm lining the primitive mouth; the junctional epithelium that seals the gum to the tooth first forms from the reduced enamel epithelium as the tooth erupts.

## Related conditions

- [I-cell disease (mucolipidosis II)](https://durgical.com/en/conditions/i-cell-disease/)
- [Scurvy (vitamin C deficiency)](https://durgical.com/en/conditions/scurvy/)
- [Periodontitis](https://durgical.com/en/conditions/periodontitis/)
- [Stevens–Johnson syndrome and toxic epidermal necrolysis](https://durgical.com/en/conditions/stevens-johnson-syndrome-and-toxic-epidermal-necrolysis/)
- [Pemphigus vulgaris](https://durgical.com/en/conditions/pemphigus-vulgaris/)
- [Lichen planus](https://durgical.com/en/conditions/lichen-planus/)
- [Kaposi sarcoma](https://durgical.com/en/conditions/kaposi-sarcoma/)
- [Mucous membrane (cicatricial) pemphigoid](https://durgical.com/en/conditions/mucous-membrane-pemphigoid/)
- [Von Willebrand disease](https://durgical.com/en/conditions/von-willebrand-disease/)
- [Inherited platelet function disorders (Glanzmann thrombasthenia, Bernard–Soulier syndrome)](https://durgical.com/en/conditions/inherited-platelet-function-disorders/)
- [Recurrent aphthous stomatitis](https://durgical.com/en/conditions/recurrent-aphthous-stomatitis/)
- [Leukocyte adhesion deficiency](https://durgical.com/en/conditions/leukocyte-adhesion-deficiency/)

## Test yourself

Think of the answer, then tap the question to see it.

## What is the difference between gingivitis and periodontitis?

Gingivitis is reversible inflammation of the gum alone; periodontitis adds loss of periodontal ligament and bone (attachment loss) and does not reverse.

## What is the earliest common sign of gum inflammation?

Bleeding gums on brushing or probing.

## What does periodontal probing of the gingival sulcus show?

Its depth and any bleeding: a healthy sulcus is shallow (up to about 3 mm); deeper pockets with attachment loss point to periodontitis.

## Which drugs classically cause gum overgrowth?

Phenytoin, calcium channel blockers such as nifedipine, and ciclosporin.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Anatomy, Head and Neck, Oral Gingiva](https://www.ncbi.nlm.nih.gov/books/NBK560662/); [Histology, Oral Mucosa](https://www.ncbi.nlm.nih.gov/books/NBK572115/).

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Source: https://durgical.com/en/anatomy/gums/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/gums/