The Relationship of Palato-Gingival Grooves to

Localized Periodontal Disease

James A. Withers,* Michael A. Brunsvold,f William J. Killoy,^ and
Alton J. Rahe§

The purpose of this investigation was to determine the prevalence of the palato-gingival
groove in maxillary incisor teeth and the health status of the lingual periodontal tissues
adjacent to maxillary incisor teeth with and without the grooves. A total of 531 individuals
aged 17 to 35 years were examined for the presence or absence of palato-gingival grooves in
their maxillary incisor teeth. A Plaque Index (P1I), Gingival Index (GI), and Periodontal
Disease Index (PDI) were recorded for the lingual aspect of the four maxillary incisors. Tooth
mobility was also recorded. The prevalence of the palato-gingival grooves in the 531 individuals
examined was 8.5%. Of the 2,099 maxillary incisor teeth examined, 2.33% had a palato-gingival
groove. Most of the palato-gingival grooves (93.8%) were in maxillary lateral incisor teeth.
Statistical analyses revealed no differences in groove prevalence on the basis of sex or race.
Results of the study also indicate that the palato-gingival groove is associated with poorer
periodontal health as measured by the GI and PDI and more plaque accumulation as
measured with the P1I.

The palato-gingival groove is a developmental anom- prevalence of the palato-gingival groove in maxillary
aly of the maxillary incisor teeth which has been reported incisor teeth and the health status of the lingual peri-
to be associated with severe localized periodontal dis- odontal tissues adjacent to maxillary incisor teeth with
ease.1"5 The anomaly also has been termed the radicular and without the palato-gingival groove.
anomaly,3 the disto-lingual groove,4 and the radicular MATERIALS AND METHODS
lingual groove.5 Prichard1 was the first to state that
lingual grooves on maxillary incisor teeth are a predis- A total of 531 basic military trainees aged 17-35 years
posing factor to localized severe periodontal destruction. were examined at Lackland AFB, Texas for the presence
Lee et al.2 reported on 13 patients who were seen with or absence of palato-gingival grooves in their maxillary
localized periodontal lesions associated with these anom- incisor teeth. Only those grooves which could be detected
alies. Simon et al.3 described unsuccessful attempts to
treat the periodontal defects associated with palato-gin-
at apical to the cementoenamel junction were counted
or
aspalato-gingival grooves. The age, sex and race of each
gival grooves and felt that extraction of the involved subject were recorded. A Plaque Index6 (PII), Gingival
tooth was the treatment of choice. Everett and Kramer4 Index6 (GI) and Periodontal Disease Index7 (PDI) were
reported that the prevalence of the disto-lingual groove recorded for the lingual aspect of the four maxillary
on 625 extracted maxillary incisor teeth was 1.9%. These
incisor teeth. Tooth mobility was also recorded (0 =

grooves may present radiographically as a radiolucent normal, 1=

more than 1 mm of horizontal mobility but
parapulpal line.4 Their relationship to localized peri- less than 2 mm, 2 = more than 2 mm of horizontal
odontal destruction has not been studied systematically.
mobility, and 3=
the tooth was depressable in its alveolar
The purpose of this investigation was to determine the
housing). Multiway frequency tables were used to see if
groove prevalence was consistent for sex or race. The
*
DDS, MS, Major, USAF, DC, OLA Malcolm Grow USAF Med relationship between the presence of a palato-gingival
Cen/SGDB (MAC), Boiling AFB, Washington, DC 20332. groove and periodontal status was analyzed using two-
t DDS, MS, Colonel, USAF, DC, Director of Research, Department factor contingency tables. Chi-square tests were used to
of Periodontics, Wilford Hall USAF Medical Center (AFSC), Lackland test the hypothesis that there was no difference in the
AFB, TX 78236.
DDS, MS, Director of Graduate Periodontics, University of Mis- pattern of the various indices among the groups consid-
souri at Kansas City, School of Dentistry, Kansas City, MO 64108; ered.
formerly Chairman, Department of Periodontics, Wilford Hall USAF RESULTS
Medical Center (AFSC), Lackland AFB, TX 78236.
§ MS, Mathematical Statistician, Data Sciences Division, US Air The mean age of the study population was 19.37 years.
Force School of Aerospace Medicine, Brooks AFB, TX. The race and sex distribution of the study population is
41
 J. Periodontol.
42 Withers, Brunsvold, Killoy, Rahe January, 1981

presented in Table 1. Of the 531 individuals examined, gingival groove was 2.31; the mean GI was 1.37 for the
45 had palato-gingival grooves (8.5%). Of the 2,099 right maxillary lateral incisor tooth in subjects with no
maxillary incisor teeth examined in the 531 trainees palato-gingival grooves on any of the maxillary incisor
(1,045 maxillary lateral incisor teeth and 1,054 maxillary teeth present. This difference was statistically significant
central incisor teeth), 49 had palato-gingival grooves, (P < 0.001 from chi square tests). The mean PDI for
giving a prevalence of 2.33%. The prevalence in maxil- right maxillary lateral incisor teeth with a groove was
lary lateral incisor teeth was 4.40%; in maxillary central 2.88; the associated mean for subjects with four maxillary
incisor teeth it was 0.28%. Bilateral palato-gingival incisor teeth without grooves was 1.51 (P < 0.001). The
mean P1I for right maxillary lateral incisor teeth with a
grooves were present in 0.75% of the study population
(four trainees). The distribution of teeth with palato- groove was 2.00; the associated mean for subjects with
gingival grooves is presented in Table 2. It is evident that four maxillary incisors without grooves was 1.32 (P <
most of the grooves were present in maxillary lateral 0.01). In regard to tooth mobility, there was no significant
incisor teeth (93.8%), with a few present in maxillary difference between right maxillary lateral incisor teeth
central incisor teeth (6.2%). with a groove and the associated teeth for subjects with-
Table 3 shows the number of trainees with a groove in out grooves in any of the four maxillary incisor teeth
one or more teeth for each sex and race combination. (0.115 vs. 0.021, respectively).
These data were analyzed using Multiway Frequency Likewise, the values for maxillary left lateral incisor
Tables and no significant interaction was detected be- teeth with palato-gingival grooves were significantly
tween sex and race on groove prevalence. Additionally higher than values for the associated teeth in the individ-
the prevalence was consistent (within statistical fluctua- uals without grooves in any of the four maxillary incisor
tion) between males (9.5%) and females (6.5%). Likewise, teeth (mean GI 2.25 vs. 1.37, < 0.001; mean PDI 3.30
the prevalence for Caucasians (9.1%) did not significantly vs. 1.52, < 0.001; mean P1I 2.15 vs. 1.32, < 0.001;
differ from the prevalence in Blacks (5.2%). and mean mobility 0.10 vs. 0.015, < 0.01).
The relationship between palato-gingival grooves and There is variability in the sample size of Group 2 in
periodontal status was analyzed using two-factor contin- Table 4 because of missing data for some teeth on 18
gency tables. Table 4 demonstrates probability levels for subjects. There were 486 subjects in this group, however,
the analyses. Means are given for each variable on each 8 of them had data missing for tooth No. 7. Hence the
tooth to provide quick .descriptive information recording sample size of 478 in Table 4 for this tooth. Sample sizes
the direction in which the group differences generally for the other teeth can be explained similarly.
ran. Comparisons were not made for teeth Nos. 8 and 9 Although no statistical comparisons were made be-
because of the small sample sizes in Group 2. The mean tween maxillary central incisor teeth with palato-gingival
GI for right maxillary lateral incisor teeth with a palato- grooves and subjects with four maxillary incisor teeth
without grooves, there appears to be a tendency for
Table 1
Race and Sex Distribution of Study Population
higher GI, PDI, and P1I scores for the teeth with the
grooves.
Male Female Total further test the hypothesis that teeth with
Finally, to
Caucasian
Black
300
47
153
31
453
78
palato-gingival grooves are associated with poorer peri-
odontal health than teeth without grooves, the paired
Total 347 184 531
data for maxillary lateral incisor teeth were analyzed
(Table 5). In the values for patients with no groove in
Table 2 either maxillary lateral incisor tooth, disagreements be-
Distribution of Palato-Gingival Grooves by Tooth in Study tween the scores (Tooth No. 7 greater than Tooth No. 10
Population
and Tooth No. 10 greater than Tooth No. 7) were rather
Tooth No. No. of trainees
22
evenly distributed for each variable. However, the data
7 only for groups with a palato-gingival groove in Tooth No. 7
8 only 1
or No. 10 show that the disagreements are nearly all in
9 only 2
10 only 16 the direction of the tooth with a groove, i.e., the index
7 and 10 4 scores for maxillary lateral incisor teeth with grooves
were nearly always greater than the scores for maxillary

Table 3
lateral incisor teeth without the grooves. These changes
Distribution and Prevalence of Subjects Presenting With a Palato- are statistically different from the hypothesized even split

Gingival Groove in One or More of Their Maxillary Incisor Teeth by at the 0.001 level for each variable (GI, PDI and P1I)
Race and Sex
except mobility.
Male Female Total
DISCUSSION
Caucasian 30(10%) 11(7.2%) 41(9.1%)
1 (3.2%) 4 (5.2%)
Black
Total
3 (6.5%)
33 (9.5%) 12 (6.5%) 45 (8.5%)
high percentage of subjects with palato-gingival
The
grooves (8.5%) was unexpected. The prevalence of pal-
Volume 52
Number 1 Palato-Gingival Grooves 43

Table 4
Summary of. Comparisons Among Groups on Each Variable and Tooth

Probability levels for

Tooth No. Variable Group 1* Group 2f comparisons Gp 1 vs.
Gp 2
GI 2.31 (26)4: 1.37 (478) P< 0.001
PDI 2.88 1.51 < 0.001
P1I 2.00 1.32 < 0.01

Mobility 0.12 0.02 NS(P>0.05)

GI 2.00 (1) 1.43 (483)
PDI 2.00 1.58
P1I 3.00 1.33
Mobility 0.00 0.02

GI 1.50 (2) 1.45 (481)

PDI 2.50 1.58
P1I 1.50 1.33
Mobility 0.00 0.02

10 GI 2.25 (20) 1.37 (476) P< 0.001

PDI 3.30 1.52 < 0.001
P1I 2.15 1.32 < 0.001
Mobility 0.10 0.015 < 0.01
*
Group 1 A palato-gingival groove on the tooth under consideration.
=

t Group 2 Data for patients where the tooth under consideration has no palato-gingival groove and
=

all the other maxillary incisor teeth present had no grooves.

£ Sample size.
Table 5
Summary of Results From Paired Comparisons Between Maxillary Incisor Teeth

Group A trainees with no groove on

=
tooth No. 7 or No. 10; Group = trainees with a groove in tooth
No. 7 only or tooth No. 10 only.
No. of trainees with No. of trainees with No. of trainees with
variable on tooth No. variable on tooth No. variable on tooth No.
Group Variable
10 greater than that 7 the same as that on 7 greater than that on
on tooth No. 7 tooth No. 10 tooth No. 10
GI 55 373 51
PDI 58 363 57
PU 14 449 10
Mobility 1 480 1
Variable on tooth Variable on tooth Variable on tooth
with a groove less with a groove equal to with a groove greater
than that on the Con- that on the Contralat- than on the Contralat-
tralateral tooth with- eral tooth without a eral tooth without a
out a groove groove groove
GI 19 19
PDI 18 20
PU 23 14
Mobility 26 2

ato-gingival grooves in maxillary incisor teeth reported disease. Also the localized periodontal destruction may
in this investigation (2.33%) compares with that reported be easily confused with endodontic problems.5
by Everett and Kramer4 of 1.9%. However, they exam- The results of this study indicate that the presence of
ined only extracted maxillary lateral incisor teeth and a palato-gingival groove is associated with poorer peri-
did not include maxillary central incisors. In the present odontal health, as measured by the GI and PDI, and
investigation, the prevalence of palato-gingival grooves more plaque accumulation as measured by the P1I. The
in maxillary lateral incisor teeth was 4.40%, more than difference in mobility between teeth with the groove and
twice that reported by Everett and Kramer. The preva- teeth without the groove was not always significant. This
lence of the groove in maxillary central incisor teeth was may be due, in part, to the young age of the study
0.28%. The localized periodontal destruction sometimes population where marked periodontal attachment loss in
associated with these grooves may not be obvious clini- association with the palato-gingival groove may not have
cally and may result in undiagnosed progression of the had time to develop. Older groups might show even
 J. Periodontol.
44 Withers, Brunsvold, Killoy, Rahe January. 1981
more severe periodontal disease changes than the group ever, such grooves do represent a significant problem
studied. and the practitioner should be aware of it.
The palato-gingival groove usually starts near the REFERENCES
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Send reprint requests to: Dr. James A. Withers, Major U.S. Air
Not all maxillary incisor teeth with a palato-gingival Force, OLA Malcolm Grow USAF Med Cen/SGDB (MAC), Boiling
groove will show localized periodontal destruction. How- AFB, Washington, DC 20332.

Abstracts
The Etiology, Diagnosis, and Treatment of TMJ anatomic feature with the progression of periodontal disease. The
Dysfunction-Pain Syndrome. Part I. Etiology enamel covering of the pearl would prevent a connective tissue attach-
ment, so that once disease was initiated, the progression could be more
Weinberg, L. A.
J Prosthet Dent 42: 654, December, 1979. rapid. The anatomy of the pearl is conducive to retention of plaque.
Department of Periodontics, School of Dental Medicine, University of
A review of the etiology of temporo-mandibular joint (TMJ) dys- Connecticut Health Center, Farmington, Connecticut 06032.
function-pain syndrome revealed that craniomandibular pain has five Dr. Farid Boustany
major causes: neurologic, vascular, temporomandibular joint, muscle
and hysterical conversion. Analysis of these causes was undertaken in
combination with a description of representative clinical examples.
Acute Recurrent Gingivitis. A Clinical Entity
When the pain source is purely in the muscle it has been termed
myofascial pain dysfunction (MPD). However, when the TMJ itself is Page, L. R., Bosman, C. W., Drummond, J. F., and Ciancio, S. G.
involved it is called the dysfunction-pain syndrome. 57 W. 57th Street, Oral Surg 49: 337, April, 1980.
New York, New York, 10019. Dr. Antonis Konstantinidis A new clinical entity has been identified for which the name acute
recurrent gingivitis (ARG) is recommended. A case diagnosed in a 35-
Enamel Pearls as a Contributing Factor in Periodontal year-old white male was reported. ARG differs from both simple
Breakdown inflammatory gingivitis and necrotizing ulcerative gingivitis and is
characterized by the following: an acute course, it occurs despite
Goldstein, A. R. excellent plaque control, and is recurrent. The signs and symptoms of
J Am Dent Assoc 99: 210, August, 1979. ARG are acute pain, edema of the marginal and papillary gingiva,
This is a case report of a 25-year-old black woman, who had a little or no ulcération, spread to adjacent marginal and papillary
relatively healthy periodontium with the exception of 7-mm pockets gingiva, regional lymphadenopathy and resolution within 10 days.
on the distal of the maxillary left first molar and the mesial of the ARG responds to penicillin which suggests a bacterial etiology. Uni-
second molar. A radiograph showed an enamel pearl on the distal versity of Kentucky, College of Dentistry, Department of Periodontics,
aspect of the first molar, The report was presented to correlate this Lexington, KY. 40536. Dr. Philip Pack