The periodontium is the specialized tissues that provide two functions, surrounding and supporting the teeth. In addition to maintaining them within the maxillary and mandibular bones. The word is derived from the Greek terms peri-, which means "around" and -odont, which means "tooth". In a literary sense, periodontium translates to "around the tooth". Periodontics is the dental specialty that specifically docuses on the care and maintenance of these specific tissues. The specialty provides the support that is necessary to maintain functioning teeth. The practice consists of four main components which include the following:
- Gingiva
- Periodontal ligament (PDL)
- Cementum
- Alveolar bone proper
The tissues found in the periodontium combine together to form an active group of tissues. The alveolar bone is almost completely surrounded by the subepithelial connective tissue of the gingiva. The connective tissue of the gingiva is covered by the various characteristic gingival epithelia. The cementum, which overlays the tooth’s root, is attached to the adjacent cortical surface of the alveolar bone. It is attached by the alveolar crest, horizontal and oblique fibers of the periodontal ligament.
The gingiva commonly has a textured surface which is referred to as being stippled or having engraved points. Stippling only presents itself on the attached gingiva that is connected to underlying alveolar bone. It does not present itself on the freely moveable alveolar mucosa. In the past, stippling was thought to indicate good oral health. However, it has since been proven that smooth gingiva does not always indicate the presence of disease, unless it is smooth as a result of a loss of previously existing stippling.
Stippling occurs as a result of the microscopic elevations and depressions of the surface of the gingival tissue due to the connective tissue projections within the tissue. The degree of keratinization and the prominence of stippling appear to be connected. More specifically, stippling occurs at sites of fusion of the epithelial ridges, which is also known as rete pegs. It corresponds to the fusion of the valleys created by the connective tissue papillae.
Below is a list of the types of gingiva is and is not stippled.
- Attached gingiva – stippled
- Interdental gingiva – stippled
- Marginal gingiva – not stippled
Attached gingiva is bound to the underlying alveolar bone and not the freely movable alveolar mucosa.
Where is Stippling Seen Microscopically?
- Stippling is seen at the sites of fusion of the epithelial ridges or Rete Pegs. It corresponds to the fusion of the valleys created by the connective tissue papillae
- Microscopic elevations and depressions are located on the surface of the gingival tissue as a result of the connective tissue projections within the tissue
- The degree of keratinization and stippling are connected and dependent on one another
Gingiva is comprised of two different categories, free gingiva and attached gingiva. Free gingiva surrounds the tooth and creates a collar around the crown. It is the portion of the gingiva that extends from the attached gingiva on to the surface of the tooth. The attached gingiva extends from the free gingiva coronal to the alveolar mucosa. Stippling is typically seen in the attached gingiva as it is firmly attached to the underlying cementum and alveolar bone with the help of the collagen fibers of the connective tissue. Stippling is often lost as age progresses. In most adult patients above 50 years old, there is no stippling of gingiva.
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