Periodontal Anatomy – Stippling

The periodontium includes specialized tissues which surround and provide support to the teeth. These tissues aid in maintaining the teeth within the mandibular and maxillary bones. The word periodontium is derived from the Greek terms peri, which is translated to "around" and odont, which is translated to "tooth". In literal terms, this means that which is "around the tooth". Periodontics is the field of dentistry specializing in the care and maintenance of these tissues. The periodontium offers the teeth the necessary support required to maintain regular function. The four components of the periodontium include the gingiva, periodontal ligament (PDL), cementum and the alveolar bone proper
In most patients, the gingiva contains a textured surface which is known as being stippled. Stippling is thought to somewhat resemble the texture of an orange peel. Stippling occurs from the connective tissue projections which are located within the gingival tissue. These projections create microscopic elevations and depressions. Stippling only exists on the attached gingiva, which is attached to the alveolar bone. It is not present on the freely moveable alveolar mucosa. In the past, dental experts considered stippling to be an indicator of good oral health for a patient. However, experts have since identified that smooth gingiva does not always indicate the presence of disease, unless the gingiva is smooth due to the loss of stippling which previously existed.

There does appear to be an association between the amount of keratinization and the prominence of the stippling. Stippling occurs in areas where this is fusion of the epithelial ridges. It correlates with the fusion of valleys, which are created by the connective tissue papillae.

In cases of gingival inflammation, it is possible for gingival stippling to be lost. However, it will be restored once the inflammation has been treated and the gingiva is healthy once again. The specific presence, configuration, and amount of gingival stippling may vary for patients based on various factors which can include their age, gender, and the location in the mouth. Without having historical knowledge of a patient’s gingiva, using stippling as a diagnostic tool can be quite difficult. The absence or presence of stippling, however, can aid in the early diagnoses of conditions such as gingivitis. The early diagnoses and treatment of gingivitis before it is able to progress into advanced periodontal disease, can aid in the prevention of irreversible, long-term damage.

Both the attached gingiva and the interdental gingiva are stippled, while the marginal gingiva is not stippled. The attached gingiva is connected to the alveolar bone and not to the freely movable alveolar mucosa.

The gingiva is made up of two different categories which includes the free gingiva and the attached gingiva. The free gingiva surrounds the tooth and creates a collar surrounding the crown. This is the gingiva which extends from the attached gingiva all the way to the tooth’s surface. The attached gingiva extends from the free gingiva coronal to the alveolar mucosa. Because it is firmly attached to the underlying cementum and alveolar bone, stippling is often observed in the attached gingiva. In many patients, stippling is either lost entirely or significantly reduced as they age. Most adult patients who are over 50 years old, do not have gingival stippling present.