Gingival cytology of children from three to five years of age.

Collections of exfoliated cells on Millipore filters, which retain the topographical relationships of the cells collected, previously have been used to examine keratinization and inflammation of adult gingivae. In the present study, samples of epithelial and inflammatory cells were obtained from the anterior maxillary gingivae of threeto five-year-old children using this technique. The oral hygiene index (OHI) these children was recorded and the degree of gingival inflammation clinically assessed. Variation in the width of the band of leukocytes collected from the gingival margin indicated a greater range of gingival inflammation within the sample studied than was apparent from clinical assessment. The degree of leukocytic exudate From the gingival margin appeared to correlate with the degree of keratinization of the adjacent epithelium. Brauer, 1 examining the microanatomy of the gingivae of young children, compared it to skin in its ability to resist mechanical forces. The attached gingivae is bound by dense fibrous tissue, and the stratified squamous epithelium has a keratinized or parakeratinized surface associated with stippling of the oral aspect. In 1940, Weinmann2 described the keratinization of human oral mucosa and in 1959, Weinmann and Meyer 3 listed four types of keratinization: (1) full keratinization, (2) parakeratosis, (3) nonkeratinization, and (4) complete keratinization. They also noted that with an increase in gingival inflammation, there was a decrease in the amount and degree of keratinization. Full keratinization occurred primarily in the absence of inflammation and became infrequent when inflammation was present. The purpose of the present study was to examine the pattern of gingival cytology of children who appeared clinically free of gingival disease. Special attention was given to the level of marginal inflammation, indicated by the amount of leukocytes present on the collected samples. Methods and Materials A group of 10 threeto five-year-old children with intact dentitions were selected for the study from the undergraduate Pedodontic Clinic of the University of Iowa College of Dentistry. These patients were considered to have normal gingivae due to a lack of redness or edema of the gingival margin. Superficial cells for cytological examination were obtained by the filter imprint technique described by Seavall and Grand4 as modified by Lainson and Mackenzie? The subjects were instructed not to brush their teeth for at least two hours prior to taking the filter imprints. Conformation to these instructions was confirmed by the parents. Millipore,filters were used, and eight pie-shaped pieces of equal size were cut from each originally round Millipore filter and marked at their apex with India ink. The gingivae of the anterior teeth were dried briefly with air. The filter piece, apex pointed coronally, was applied to an area in the region of the maxillary right primary central incisor covering the free gingival margin, attached gingivae, and alveolar mucosa into the vestibule. The filters were pressed firmly in place, without sliding the filters on the mucosa and avoiding contact with labial alveolar mucosa. Rubber surgical gloves were used when handling the filters to prevent contamination with exfoliated cells from the examiner’s fingers. The filter imprints were removed with cotton pliers, immediately fixed in 95% ethanol, and then stained by a modification of the Papanicolaou method. 6 After obtaining the filter imprints for each child, an assessment of oral hygiene was made using a modification of the simplified oral hygiene index (OHI-S) described by Greene and Vermilion. 7 This index scores plaque and accumulations of debris from I to 3 on the facial and lingual surfaces of six selected teeth after these teeth have been stained with disclosing solution. The possible scores thus ranged from 0 to 36.