The attached gingiva of the maxillary and mandibular arches is visually examined using both direct and indirect vision. The tissues should appear pale pink and homogenous in color and texture (Figure 55). Following the visual examination, the attached gingiva is palpated using a digital technique as shown in Figure 56.
Figure 55. Normal attached gingiva, facial surfaces of the maxilla and mandible.
Figure 56. Digital palpation of the mandibular facial attached gingiva.
The tissue should feel firm to touch and tightly attached to the bone. The most common atypical finding in the area of the attached gingiva is exostoses (Figure 57).
Figure 57. Extensive exostoses on the maxillary facial surfaces.
Pathologic findings include:
Inadequate zones of attached gingiva – the clinician should determine the presence of adequate amounts of attached gingiva in all areas. Less than 1 mm of attached gingiva is considered to be inadequate in most cases and the patient should be referred to a periodontist for evaluation of the affected area.
Mucogingival involvement – areas with no attached gingiva or areas of extreme recession
Frena problems – tight frenum attachments or pulls
Traumatic lesions – ulcers, abrasions, burns
Mucosal disease such as lichen planus, pemphigus vulgaris, mucous membrane pemphigoid, lupus, and allergic type responses