The periodontium includes specialized tissues which serve two different functions including surrounding and supporting the teeth to maintain them in the maxillary and mandibular bones. The word periodontium is derived from the Greek terms peri-, which means "around" and -odont, which means "tooth". When the phrase is taken literally, periodontium translates to "around the tooth". Periodontics is the dental specialty which focuses on the care and maintenance of these tissues. It provides support required to maintain the full function of the teeth. The practice consists of four main areas which includes:

  • Alveolar Bone Proper
  • Cementum
  • Gingiva
  • Periodontal Ligament (PDL)

The gingiva, or the gums, typically contain a textured surface which is referred to as being stippled. This can be thought of as resembling a texture similar to an orange peel. Stippling occurs from the connective tissue projections within the gingival tissue which create microscopic depressions and elevations. Stippling is only present on the attached gingiva which is connected to alveolar bone. It does not exist on the freely moveable alveolar mucosa. Historically, experts thought that stippling was an indicator of a patient having good oral health. Experts have since found that smooth gingiva does not always indicate disease being present, unless the gingiva is smooth from the loss of stippling which existed previously.

Stippling occurs from the microscopic elevations and depressions which are found on the surface of the gingival tissue and is due to the connective tissue projections within the tissue. There appears to be a connection between the amount of keratinization and how prominent the stippling is. Stippling occurs in locations of fusion of the epithelial ridges. It corresponds to the fusion of the valleys which are created by the connective tissue papillae.

In cases where gingival inflammation has occurred, gingival stippling can be lost, however, it will be re-established once the gingival health is restored. The presence, configuration, and amount of gingival stippling can vary for each patient based on their age, gender, and the location of the stippling. Using gingival stippling as a diagnostic tool can be challenging without having knowledge of the patient’s gingiva characteristics. However, the absence or presence of stippling can aid in the early diagnoses of clinical conditions including gingivitis. The early diagnoses and treatment of gingivitis prior to its progression into advanced periodontal disease, can help prevent long-term or permanent damage to the gingiva.

Below is a summary of the different types of gingiva and if it is stippled or now:

  • Attached gingiva: stippled
  • Interdental gingiva: stippled
  • Marginal gingiva: not stippled

The attached gingiva is connected to the underlying alveolar bone and not the freely movable alveolar mucosa.

Gingiva is comprised of two different categories including the free gingiva and attached gingiva. The free gingiva encompasses the tooth and creates a collar which surrounds the crown. This is the portion of the gingiva which extends from the attached gingiva to the surface of the tooth. The attached gingiva extends from the free gingiva coronal all the way to the alveolar mucosa. Stippling is often observed in the attached gingiva as it is firmly attached to the underlying cementum and alveolar bone. It is common for stippling to be lost completely or at least reduced as a patient ages. Most adult patients over the age of 50 do not have stippling of the gingiva.