Oral mucous membrane

1
 CONTENT

 Introduction
 Functions of oral mucosa
 Organization of oral mucosa
 Classification of oral mucosa
 Clinical features of oral mucosa
 Histology of oral mucosa
 Ultrastructure of epithelial cells

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 
 Oral epithelium
- epithelial proliferation
- epithelail maturation
 Keratinized epithelium
 Nonkeratinized epithelium
 Masticatory mucosa
 Lining mucosa
 Specialized mucosa
 Dentogingival junction
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 INTRODUCTION

 MUCOUS MEMBRANE
moist lining of the gastrointestinal tract, nasal
passages, and other body cavities that communicate
with the exterior.

 ORAL MUCOUS MEMBRANE (ORAL MUCOSA)

moist lining of oral cavity

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 FUNCTIONS

 PROTECTION

Separates & protects deeper tissue and organs from

the external environment of oral cavity.

Shows many adaptations to withstand mechanical

forces & surface abrasions caused by diet.

Prevents normal population of microorganisms &

their toxic products from gaining access to underlying
tissues.
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 
 SENSATION

Various receptors in oral mucosa perceive

sensation of temperature, touch, pain, taste etc.

Reflexes such as swallowing, gagging, etching,

and salivating are also initiated by receptors in the
oral mucosa.

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 
 SECRETION

Major – saliva – maintenance of a moist surface.

Sebaceous glands – frequently present but their

secretion are probably insignificant.

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 
 THERMAL REGULATION

Dog dissipates body heat by panting.

No role in human oral mucosa.

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ORGANIZATION OF THE
ORAL MUCOSA

ORAL CAVITY

ORAL CAVITY
OUTER VESTIBULE
PROPER

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 CLASSIFICATION OF ORAL
MUCOSA

Based on the function, divided into 3 types :-

 MASTICATORY MUCOSA (25%)

(gingiva & hard palate)

 LINING OR REFLECTING MUCOSA (60%)

(lip, cheek, vestibular fornix, alveolar mucosa, floor of
mouth & soft palate)

 SPECIALIZED MUCOSA (15%)

(dorsum of the tongue & taste buds)
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 
According to keratinization :-

 KERATINIZED EPITHELIUM – orthokeratinized

parakeratinized
(masticatory mucosa & vermilion border of lip)

 NONKERATINIZED EPITHELIUM
(lining mucosa & specialized mucosa)

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 
According to location :-

 Buccal Mucosa
 Lingual Mucosa
 Gingival Mucosa
 Alveolar mucosa
 Labial Mucosa

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 CLINICAL FEATURES

 Colour – pale pink
in inflammed condition – red

 Oral mucosa has moist surface and the absence of

appendages.

 Represented by minor salivary glands.

 Sebaceous glands are present in upper lip and buccal

mucosa, which appears as pale yellow spot and
sometimes are called FORDYCE’S SPOT. 13
 
 Regional characteristics : Papillae on dorsum of
tongue
Rugae on hard palate
Stippling of gingiva
Linea alba

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 

15
Papillae of tongue Palatal rugae
 

Linea alba
Stippling on
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Attached gingiva
 
 OMM differs in its firmness and texture.

 Injections into masticatory mucosa is difficult &

painful.

 Lining mucosa gapes when surgically incised &

require suturing while masticatory mucosa does not.

 Also inflammation of masticatory mucosa is more

painful as accumulated fluid does not find space to
disperse.
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 HISTOLOGY OF ORAL
MUCOSA

 Consists of 2 main components –

1- Stratified squamous epithelium, ORAL

EPITHELIUM

2- underlying connective tissue, LAMINA PROPRIA

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 
 The two layers form an interface that is folded into
corrugations.

 Papillae of connective tissue protrude toward the

epithelium carrying blood vessels and nerves.

 Some of the nerves actually pass into it, epithelium is

formed into ridges or pegs, sometimes called rete
ridges or pegs that protrude toward the lamina
propria.
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 
 The ridges interdigitate with the papilla and are
called epithelial ridges.

 Junction between epithelium and connective tissue

shows two structures – basal lamina and basement
membrane.

 Basal lamina is evident at the electron microscopic level

and is epithelial in origin
 Basement membrane is evident at the light microscopic
level (a connective tissue structure) 20


MAIN TISSUE
COMPONENTS
OF THE ORAL
MUCOSA

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

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 ULTRASTRUCTURE OF
EPITHELIAL CELLS

CELLS OF BASAL LAYER :-

 Least differentiated cells.

 Contains :-
a) organelles
b) filamentous strands – TONOFILAMENT (aggregate
to form bundle –TONOFIBRILS
c) INTERCELLULAR BRIDGES or DESMOSOMES
d) filament represent a class of intracellular protein –
CYTOKERATIN, characteristics of epithelial cells.

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CYTOKERATINS :-

 Forms the cytoskeleton of all epithelial cells, along the
microfilament & microfibrils.

 Function as stress bearing structure within epithelial cells

& important in maintaining cell shape.

 Termed as intermediate filament as their dia (7-11nm) is

intermediate between larger microtubes (25nm) & smaller
microfilaments (4-6nm).

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 
 Molecular wt – 40 to 200 Kda than microtubules (55
Kda) & microfilaments (25 Kda).

 Classified into 2 main types :-

1) type I (Basic cytokeratins) - 1 to 8
2) type II (Acidic cytokeratins) - 9 to 20

 Always occur in pair, in absence of pair – unstable &

are susceptible to degradation by proteases.
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 
 CK 1 & 10 - suprabasal layers of masticatory mucosa.

 CK 4 & 13 - suprabasal cells of lining mucosa.

 CK 5, 6 & 13 – ventral surface of tongue.

 CK 7, 8 & 18 – soft palate.

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KERATIN :-

 Epithelial cells because of its content of keratin
filament is called keratinocytes.

 Stratified oral epithelium – posses keratin – 5 & 14

 Keratinized epithelium - 1, 6, 10 & 16
 Nonkeratinized epithelium – 4, 13 &19

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 ORAL EPITHELIUM

 Stratified squamous epithelium

 Acts as primary barrier between the oral environment

and deeper tissues.

 Cells of epithelium consists of 2 functional populations

:-
1) PROGENITOR POPULATION
2) MATURING POPULATION
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 Epithelial proliferation :-

 Progenitor cells are located in the basal layer.

 Consists of 2 functionally distinct subpopulation of cell

:-

1) STEM CELLS - cycles slowly

produce basal cells & retain the
proliferative potential of tissue

2) AMPLIFYING - increase the no. of cells available

CELLS for subsequent maturation 29
 Epithelial maturation:-

 Process of maturation follows 2 pattern :-

1) KERATINIZATION
2) NON - KERATINIZATION

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KERATINIZED EPITHELIUM
 DIFFERENTIATION :-

Keratinocytes during mitosis become committed to
biochemical and morphological changes.

 DESQUAMATION :-
Differentiation ends with formation of keratinized
squama, a dead cell filled with densely packed protein
contained within a toughened cell membrane. On
reaching surface it is shed off.

 MATURATION :-
The process of cell migration from basal layer to
surface.

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 TURNOVER TIME :-

Time necessary to replace all the cells in the epithelium.
Derived from knowledge of the time taken for a cell to
divide and pass through the entire epithelium.

Skin :- 52 – 75 days
Gut :- 4 - 14 days
Gingiva :- 41 - 57 days
Ckeek :- 25 days

(nonkeratinized buccal epithelium turns over faster than

keratinized gingival epithelium.) 32
 
 The mucosal surface results from the formation of a
surface layer of keratin, and the whole process from
the onset of determination is called
KERATINIZATION or CORNIFICATION.

 Masticatory mucosa (hard palate & gingiva)

 Some specialized mucosa (dorsum of tongue)

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 
 4 cell layers :-

1) Basal layer ( Stratum Basale)

2) Spinous layer ( Stratum Spinosum)
3) Granular layer ( Stratum Granulosum)
4) Cornified layer ( Stratum Corneum)

Unlike skin, Stratum lucidum (clear layer) is absent from

oral mucosa between stratum granulosum & corneum.
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

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 Stratum basale :-

 Basal cells – made up of single layer of cuboidal cells

 Synthesize DNA and undergoes mitosis

 Site of cell division

 Some mitotic figures may be seen in spinous cells

just beyond the basal lamina.

 Basal cells and parabasal cells are referred to as the

STRATUM GERMINATIVUM . 36
 
 Made up of 2 populations :-
1) serrated
2) nonserrated

 SERRATED CELLS – heavily packed with

tonofilaments, which are adaptation for attachment.

 NONSERRATED – composed of slowly cycling

stem cells.

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 
 The serrated cells - single layer of cuboid or high
cuboid cells that have protoplasmic processes
(pedicles).

 Cells possess keratin intermediate filament or

tonofilament

 Specialized structures – HEMIDESMOSOMES,

which abut on the basal lamina, found on basal
surface.
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 
 The lateral borders of adjacent basal cells are closely
apposed and connected by DESMOSOMES.

 Least differentiated cells within oral epithelium.

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 Stratum spinosum :-
 Above basal layer. 
 Irregularly polyhedral and larger than basal cells.

 Cells shows 1st stage of maturation.

 The transition from stratum basale to spinosum is

characterised by appearance of new cytokeratin
types, which contribute to formation of conspicuous
tonofilaments.

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 
 On the basis of light microscopy, appears that the
cells are joined by intercellular bridges.

 On the basis of electron microscopy, intercellular

bridges are desmosomes & tonofibrils are bundles of
tonofilaments.

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 
 These cells frequently shrinks away from each other,
remaining in contact only at one point – intercellular
bridges or desmosomes – thus named – thus give
spiny or prickle like profile appearance.

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 
 The spinous cell resemble a cockleburr or sticker that
has each spine ending at a desmosomes.

 Most active layer of all 4 in protein synthesis.

 In terms of number and length the desmosomes of

spinous layer occupy more of the membrane in
tongue, gingiva & palate than in either alveolar or
buccal mucosa.
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 
 Stratum basale and stratum spinosum both
constitute from half to two third of the thickness of
the epithelium.

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 Stratum granulosum :-

 Contains flatter, wider cells.

 Cells are larger than spinous cells

 It contains basophilic keratohyalin granules, hence

the name derived of this layer.

 Nuclei shows signs of degeneration and pyknosis.

 Shows variable rates of protein synthesis 45

 
 Tonofilaments are more dense in quantity –
associated with keratohyaline granules.

 Keratohyalin granules form the matrix in which

filaments are embedded and the protein making up
the bulk of these granules has been named
FILAGGRIN, histidine rich protein and also a sulfur
rich component LORICIN.

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 
 A small organelle –
lamellar granule,
keratinosomes, Odland
body or membrane
coating granule forms in
the upper spinous and
granular cell layers (has
internal lamellated
structure), 250nm in size,
contains glycolipid.

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 
 Lamellar granules – discharge their contents into the
intercellular space forming an intercellular lamellar
material which contributes to the permeability
barrier, forms at the junction of granular and cornified
layer.

 At approximately same time during differentiation,

the inner unit of cell membrane thickens forming the
“cornified cell envelope”

 Important protein contributing to this structure -

INVOLUCRIN. 48


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 Stratum corneum :-

 Cells become dehydrated and are extremely
flattened and assume the form of HEXAGONAL
DISKS called as SQUAMES.

 Larger and flatter than granular cells

 Thickness varies at different sites in the oral cavity

and is thicker than most areas of the skin.

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 
 All of the nuclei and other organelles such as
ribosomes, mitochondria have disappeared.

 Layer is acidophilic – histologically amorphous

 Keratohyalin granules have disappeared.

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 
 Composed of densely packed filaments develop
from tonofilaments and coated by basic protein of
keratohyalin granule FILAGGRIN.

 Such keratinization with absence of nucleus is

termed as ORTHOKERATINIZATION.

 If cells retain shrunken or pyknotic nuclei-

PARAKERATINIZATION.
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

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

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 NONKERATINIZED
EPITHELIUM

 Lining mucosa - lips
buccal mucosa
alveolar mucosa
soft palate
underside of tongue
floor of mouth

 Thicker than keratinized epithelium and show

different ridge pattern at connective tissue interface.

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 
 Various cell layers in nonkeratinized epithelium are
:-

1) Stratum basale
2) Stratum intermedium
3) Stratum superficiale

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 Stratum basle :-

 Cuboidal cells containing separate tonofilaments and
other cell organelles.

 Site of most cell divisions.

 Made up of two functionally different types of cells.

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 Stratum intermedium :-

 Also called STRATUM FILAMENTOSUM.

 Cells are larger than cells of the stratum spinosum

 Larger ovoid cells containing dispersed

tonofilaments.

 Filament become numerous.

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 
 The intercellular space is not obvious or distended
and hence the cells do not have a prickly appearance.

 Cells are attached by desmosomes and other

junctions.

 Slightly flattened cells containing many dispersed

tonofialments and glycogen.

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 
 Keratohyaline granules are rare.

 Fillagrin is absent.

 Loricrin is present.

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 Stratum superficiale :-

 Also called STRATUM DISTENDUM.

 Slightly flattened cells with dispersed filament and

glycogen.

 Fewer organelles are present

 Nuclei persists.

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 NONKERATINOCYTES IN
THE ORAL EPITHELIUM

 Cells that do not possess cytokeratin filaments –
NONKERATINOCYTES.

 Constitute 10% of epithelial cell population.

 Present in both keratinized & nonkeratinized

epithelium.

 As they lack desmosomes (except Merkel cell) ,

during histologic processing the cytoplasm shrinks
around the nucleus to produce a clear halo.( clear-
lack keratin intermediate filaments) . 62
 
 So these cells are called “Clear cells”.

 It includes :-

1) Melanocytes
2) Langerhan’s cells
3) Merkel cells
4) Inflammatory cells

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 Melanocytes :-

 Embryologically they arises from neural crest cell (at
11 wk they enter the epithelium).

 Level in epithelium – basal layer

 Contact with about 30-40 keratinocytes through their

dendritic process.

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 Ultrastuctural features – 
* possess long dendritic process
* desmosomes & tonofilaments absent
* premelanosomes present
* melanosomes present

 Produce melanin pigment, using enzyme tyrosinase.

 Are synthesized within melanocytes as a small structure

called melanosomes ( inoculated into cytoplasm of
adjacent keratinocytes by dendritic process of
melanocytes)
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 
 Groups of melanosomes – melanin granules

 Factors affecting color difference in individual –

1) Relative activity of melanocytes in producing
melanin.
2) Rate of degradation of pigment
3) Quantity of melanin within melanosomes

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 
 Seen in connective tissue also (in case of heavy
melanin pigmentation) – macrophages takes up
melanosomes of epithelium – Melanophage

 Oral mucosal region where melanin pigmentation

are commonly seen – gingiva
hard palate
buccal mucosa
tongue

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 Langerhans cells :-

 Level in epithelium – predominantly suprabasal

 Ultrastrucutral features –
* dendritic
* no desmosomes or tonofilaments
* characteristics langerhans granule

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 
 LANGERHANS GRANULE :-
small, trilaminar, rod or flask
shaped granules in the
cytoplasm, also called
BIRBECK GRANULE

 Convoluted nucleus

 Limited division capability,

move in & out of epithelium.

 Source – bone marrow

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 
 They are antigen presenting cells.

 Functions :-

1) Antigen trapping and processing

2) Role in skin in producing contact hypersensitivity
reaction
3) In anti-tumor immunity
4) In graft rejection

70
 Merkel cells :-

 Level in epithelium – basal layer

 Ultrastructural features –
* non dendritic
* sparse desmosomes, tonofilaments
* characteristics electron dense vesicle
* associated nerve axon

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 
 Function –tactile sensory cells
 Migrate from the neural crest

 May arise from division of an epithelial cell

(keratinocytes).

 Common in masticatory mucosa

 Generally absent from lining mucosa

 Nucleus – deeply invaginated and may contain a

characteristics rodlet 72
 
 They contain numerous characteristic electron-dense
granules that are located almost exclusively at the
side of cytoplasm in contact with axon terminals.

 Function of these granules are unknown.

73
 Inflammatory cells :-

 Level in epithelium – variable

 Ultrastructural features –
* large circular nucleus
* scanty cytoplasm
* few organelles
* no desmosomes or tonofilaments

74
 
 They do not reproduce themselves in epithelium as
nonkeratinocytes do.

 Commonly seen cells are – lymphocytes.

 Not common – polymorphonuclear leukocytes &
mast cells

 Lymphocytes often are associated with langerhans

cells, which are able to activate T lymphocytes.
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 EPITHELIAL-CONNECTIVE
TISSUE INTERFACE

 The undulating interface between connective tissue
and epithelium, at which papilla of connective tissue
interdigitate with epithelial ridges.

 It is 1 - 4µm wide and relatively cell free.

 It represents as a mechanical adhesion and major

interface for metabolic exchange between the
epithelium and connective tissue & plays a role in
response to tissue injury.
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 
 Stained by Periodic Acid Schiff reaction (appearing
as bright, structureless band), indicating that it
contains neutral mucopolysaccharides.

 At ultrastructure level, basal lamina consists of 3

zones :-

1) clear zone – LAMINA LUCIDA (20-40nm)

2) dark zone – LAMINA DENSA (50nm)
3) lamina fibroreticularis – SUBLAMINA DENSA
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 
 LAMINA LUCIDA
just below the epithelial, consists of glycoprotein
called LAMININ that cements non-fibrillar type IV
collagen in lamina densa to epithelial cells.

 LAMINA DENSA
adjacent to connective tissue, consists of type IV
collagen coated on each side by glycosaminoglycan
heparan sulfate.

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 
 ANCHORING FIBRILS
contains type VII collagen, forms loop and are
inserted into the lamina densa. Collagen fibers of
type I and II run through these loops.

 All major products of basal lamina appears to be

synthesized by epithelial cells.

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

80
 LAMINA PROPRIA

 The connective tissue supporting the oral epithelium is
termed LAMINA PROPRIA.

 Consists of 2 layers –
1) superficial PAPILLARY LAYER
2) deeper RETICULAR LAYER

81


82
 
 PAPILLARY LAYER :–
* associated with epithelial ridges
* collagen fibers – thin & loosely arranged
* many capillary loops are present

 RETICULAR LAYER :–
* lies between papillary layer & underlying structure
* collagen fibers – thick bundles & lie parallel to
surface plane

83
 
 Lamina propria consists of :-
* cells
* blood vessel’s
* neutral elements
* fibers embedded in ground substance

84
 Cells :-

 Consists of following cells :-

1) Fibroblasts
2) Macrophages
3) Mast cells
4) Inflammatory cells

85
 Fibrobalsts

 Principal cells of lamina propria

 Responsible for elaboration & turnover of fibers and

ground substance. Play a key role in maintaining
tissue connective integrity.

 Light microscope – cigar shaped (fusiform)

star shaped (stellate)
with long process that tend to lie parallel to bundles
of collagen fibers
86
 
 Ultrastructurally, active fibroblasts consists of :-
* mitochondria
* rough endoplasmic reticulum
* golgi complex
* membrane bound vessicles

 Distributed throughout lamina propria.

87
 Histiocytes

 Tissue macrophages
 Spindle-shaped or stellate
 Often dark-staining nucleus

 Function – resident precursor of functional

macrophages

 Distributed throughout lamina propria

88
 Macrophages

 Stellate or fusiform cells

 Have - smaller and denser nuclei

- less granular endoplasmic reticulum

89
 
 Function – * ingest damaged tissue or foreign
material in phagocytic vacuoles that
fuse, intra- cytoplasmically, with
lysosomes & initiate breakdown of these
material.

* Stimulation of fibroblasts proliferation

necessary for repair

90
 Mast Cells

 Large spherical or elliptical mononuclear cells

 Nucleus – small relative to size of cells

 Cytoplasm – granules

 Role in maintaining normal tissue stability &

vascular homeostasis

91
 Inflammatory cells

 Lymphocytes & plasma cells

 When in significant number – influences the

behaviour of overlying epithelium

 In acute conditions – polymorphonuclear leukocytes

– dorminant cell type.

92
 
 In chronic – lymphocytes
plasma cells
monocytes
macrophages

93
 Fibers :-

 Consists of :- collagen
elastin

 COLLAGEN :-
primarily – type I & III
- type IV & VII (part)
inflamed tissue – type V

94
 ELASTIC FIBERS :-

consists of 2 protein component –
1) principal protein – ELASTIN
2) GLYCOPROTEIN

95
 Ground Substance :-

 Consists of :- proteoglycan
glycoprotein

96
 MASTICATORY MUCOSA

 Covers those part that are exposed to compressive &
shear forces and to abrasion during mastication of
food.

 Keratinized

 Made up of :-
1) hard palate
2) gingiva
97
 Hard palate :-

 The mucous membrane of the hard palate is tightly
fixed to the underlying periosteum and immovable.

 The epithelium is well keratinized surface, pink in

color.

 It has two parts :- anterior & posterior

 Anterior part has thick lamina propria than posterior

part and has numerous long papillae.
98


99
 
 ZONES OF HARD PALATE :-

1) Gingival region (adjacent to the teeth)

2) Palatine raphe (median area) extending from

the incisive or palatine papillae posteriorly
3) Anterolateral area (fatty zone)
between the raphe and gingiva
4) Posterolateral area or glandular zone
between the raphe and gingiva
100
 
 Palate has distinct submucous layer

 Submucosa is
 Absent below the palatine raphe, or median area
and where the palatine tissue is identical with the
gingiva.
 Present b/w palatine gingiva & palatine raphe

 It is immovably attached to the periosteum of the

maxillary and palatine bones.
101
 
 There are adipose tissue in anterior part and glands
in the posterior part

 Presence of fat or glands – act as cushion

 Lateral areas of hard palate – bands of dense fibrous

C/T connecting lamina propria to periosteum are
arranged at right angles to the surface and divide
submucous layer into irregular shaped spaces
102
 
 At the junction of alveolar process and the horizontal
plate of the hard palate the anterior palatine vessels
and nerves course, surrounded by loose connective
tissue called as wedge shaped area.

 This area is large in posterior part and smaller in

anterior part.

103
 
INCISIVE PAPILLA / ORAL INCISIVE (PALATINE)
PAPILLA :-
 Formed of dense connective tissue.

 Contains the oral parts of vestigial nasopalatine ducts.

 These ducts are blind ducts of varying length lined by

simple or pseudostratified columnar epithelium, rich in
goblet cells.

 Small mucous glands open into the lumen of the duct

104
 
 In most mammals the nasopalatine ducts are patent
and together with JACOBSON’S organ are called as
auxillary olfactory sense organs.

 JACOBSON’S organ (vomeronasal organ) is a small

ellipsoid structure lined with olfactory epithelium
that extends from nose to the oral cavity.

 Seen in humans from 12th to 15th fetal week.

105


106
 
PALATINE RUGAE (transverse palatine ridges) :-

 These are irregular and asymmetric in humans are

ridges of mucous membrane extending laterally
from the incisive papillae and the anterior part of the
raphe.

 Their core is made up of a dense connective tissue

layer with fine interwoven fibers.

107
 
EPITHELIAL PEARLS :-

 They are found in lamina propria in the region of

the incisive papillae.

 They consist of concentrically arranged epithelial

cells that are frequently keratinized.

 They are remnants of the epithelium formed in the

line of fusion between the palatine processes
108
 
 Clinical significance :-

* Tissues should be recorded in resting position

 * If the tissues displace during impression procedures,
they tend to return to normal
 * Such dentures cause soreness of mouth

109
 
MID PALATINE RAPHE :-

 Extends from the incisive papilla to posterior region

of hard palate
 Mucosal layer is practically in contact with
underlying bone
 Tissue covering the suture is non resilient

110
 
Clinical significance :-

 * Little or no pressure should be applied to this

region .
 * This area is highly sensitive.
 * Excessive pressure in this area causes pain .
 * Relief should be given in this area.

111
 Gingiva :-

 Gingiva is that part of masticatory mucosa that
covers the alveolar process of jaws and surrounds
the cervical portion of teeth.

 It extends from the dentogingival junction to the

alveolar mucosa.

112
 
 Made of stratified squamous epithelium –
keratinized or nonkeratinized but most often
parakeratinized.

75% - parakeratinized
15% - keratinized
10% - nonkeratinized

113
 
 Mucosa is firmly attached by collagen fibers to
cememtum & periosteum of alveolar process.

 Gingiva is limited on outer surface of both jaws by

mucogingival junction, which separates it from the
alveolar mucosa.

 Alveolar mucosa is red and contains numerous small

blood vessels close to the surface.

114
 
 On inner surface of lower jaw – demarcation found
between gingiva and floor of the mouth but in palate it
is not so sharp.

 Normally pink in color, sometimes have a grayish tint

 Divided into :-
Free gingiva
- Attached gingiva
- Interdental papilla

115


116


117
 
FREE GINGIVA :-

 Free gingiva is part of gingiva that forms collar of

tissue around the tooth and not attached to tooth.

 Also called as marginal gingiva.

 Free gingival groove – dividing line between free

gingiva and (attached) gingiva – runs parallel to the
margin of the gingiva at a distance of 0.5 to 1.5mm

118
 
 Appears histologically as a shallow V shaped notch
at a heavy epithelial ridge.

 Develops at the level of or apical to the bottom of

gingival sulcus.

 Gingival sulcus is the space or potential space

between the tooth surface and the narrow
unattached cervical margin of gingiva that is free
gingiva.

119
 
 Sulcular
(crevicular)
epithelium – faces
the gingival
sulcus.
(nonkeratinized)
 Absence of sulcus
– no free gingiva

120
ATTACHED GINGIVA :-

 Attached gingiva is the band of keratinized mucosa
that is firmly bound to the underlying bone. It is
present between the free gingival margin and more
movable alveolar mucosa.

 Width is around 4 -6mm.

 Mucogingival junction is 3-5mm below the level of

crest of the alveolar bone.
121


Stippling of gingiva – characteristic

- portion of epithelium appears elevated, between them

shallow depressions
- Depression – corresponds to center of heavier
epithelial ridges
- Functional adaptations for mechanical impacts
- Disappearance of stippling – indication of odema –
progressing gingivitis
- Age and sexual variations observed - Younger
females – lesser amount
males – heavily stippled gingiva
122
 
 Interdental grooves – gingiva appears slightly
depressed between adjacent teeth, corresponding to
the depression on the alveolar process between
eminences of the sockets.

123
 
INTERDENTAL GINGIVA :-

 Interdental gingival also called as papillary gingiva is

part of gingiva that fills the interproximal spaces.

 Viewed from oral or vestibular aspect, the surface of

interdental papilla is triangular.

 In 3D view – interdental papillae of posterior teeth –

tent shaped , pyramidal – anterior teeth
124
 
 The interdental COL is
valley buccolingually,
the depression of
interdental papilla
between the facial and
lingual papillae that
conforms the shape of
contact area.

125
 
 Nonkeratinized
 Initially derived from reduced enamel epithelium
 More vulnerable to periodontal disease

 Pigmentation is most abundant at the base of the

interdental papilla.

126
Lamina propria:-

 Dense connective tissue does not contain large
vessels

 Small no. of lymphocytes, plasma cells and

macrophages are present subjacent to the sulcus and
are involved in defense and repair

 Papillae – characteristically long, slender and

numerous.

 Few elastic fibers, Oxytalan fibers are present

127
 
 Gingival fibers of periodontal ligament enter into
lamina propria, attaching the gingiva firmly to the
teeth.

 Gingiva is immovably and firmly attached to the

periosteum of the alveolar bone – therefore termed
as mucoperiosteum.

 Dense connective tissue – consist of coarse collagen

bundles extending from bone to lamina propria.
128
 
 Submucosa underlying the alveolar mucous
membrane is loosely textured.

 The fiber bundles are thin and regularly interwoven

 Gingival ligament – the collagen fibers in the lamina

propria of gingiva are arranged in various groups–

129
1) Dentogingival –

extends from the
cervical cementum into
the lamina propria of
the gingiva, most
numerous group.

2) Alveologingival – arise
from alveolar crest into
lamina propria of
gingiva.
130
3) Circular – encircle the

tooth, interlase with other
fibers, small groups of
fibers

4) Dentoperiosteal – occur
only in labial & lingual
gingiva. Arises from
cementum – periosteum of
alveolar bone & of
vestibular and oral surfaces
of alveolar bone.
131
 
5) Longitudinal – extend for long distances within the
free gingiva, some possibly for the whole length of
the arch

132
 
6) Transseptal – pass
horizontally from root
of one tooth, above
alveolar crest, to be
inserted into root of
adjacent tooth.

133
7) Semicircular – connect the

cementum on one side of the
tooth to the opposite side
after crossing through the
free gingiva

8) Transgingival – passes
from cementum of one tooth
to the marginal gingiva of
the adjacent tooth merging
with circular & semicircular
fibres.
134
 
9) Interdental –
connecting buccal &
lingual papillae.

10 ) Vertical – arises in
alveolar mucosa or
attached gingiva & passes
coronally towards the
marginal gingiva and
interdental papilla.
135
 
BLOOD SUPPLY :-

UPPER GINGIVA -

 ANTERIOR BUCCAL - ANTERIOR SUPERIOR

ALVEOLAR ARTEY
 ANTERIOR PALATAL - GREATER PALATINE
ARTERY
 POSTERIOR BUCCAL - BUCCAL ARTERY
 POSTERIOR PALATAL - POSTERIOR SUPERIOR
ALVEOLAR ARTERY

136
 
LOWER GINGIVA

 ANTERIOR BUCCAL - Mental artery

 ANTERIOR LINGUAL- Incisive artery
Sublingual artery
 POSTERIOR BUCCAL - Inferior alveola artery
Buccal aretry
 POSTERIOR LINGUAL - Inferior alveola artery
Sublingual artery

137
 
NERVE SUPPLY :-

UPPER GINGIVA;-
 Anterior, posterior, middle superior alveolar branch
of maxillary nerve

LOWER GINGIVA;-
 inferior branch of mandibular nerve
 buccal branch of mandibular nerve
 sublingual branch of lingual nerve
138
 LINING MUCOSA

 Found on lip, cheek, alveolar mucosa, ventral surface
of tongue, floor of mouth & soft palate

 Characterized by a relatively thick nonkeratinized

epithelium and a thin lamina propria

 Epithelium is thicker than masticatory mucosa

 The surface is flexible and able to withstand stretching.

139
 Lips :-

 Outer surface – skin
 Inner surface - labial mucosa

 Between these 2 tissue – VERMILLION ZONE

( RED or TRANSITIONAL ZONE OF THE LIP )

 Epithelium – stratified squamous nonkeratinized

epithelium.

140


141
 
 Lips have striated
muscles in their core
that are part of muscles
of facial expression.

 Substantial amounts of
minor mucous salivary
glands are present in
Submucosa beneath the
oral mucosa.

142


143
 
 VERMILLION ZONE :-

* EPITHELIUM – orthokeratinized, but thin and

translucent.

* lacks appendages of skin

* sebaceous gland – occasionally found, especially at

angle of mouth

* lacks mucous gland – it requires constant

moistening with saliva by tongue to prevent drying 144
 
* LAMINA PROPRIA – long & narrow papillae, and
contains capillary loops

The junctional region between the vermillion zone

and the oral mucosa is sometimes known as the
INTERMEDIATE ZONE .

145
 
 INTERMEDIATE ZONE :-

* EPITHELIUM – parakeratinized

* LAMINA PROPRIA - long ,irregular papillae, elastic

fibers ,collagen fibers

* SUBMUCOSA - mucosa is firmly attached to

muscle, sebaceous gland, minor
salivary gland ,fat

* in infants this becomes thickened and forms the

suckling pad
146


147
 Labial mucosa :-

 EPITHELIUM – thick (500µm), non-keratinized

 LAMINA PROPRIA – long, slender papillae,

collagen & some elastic fiber

 SUBMUCOSA – minor salivary glands, fat,

sometimes sebaceous glands

 Strands of dense connective tissue bind the mucosa down

to the underlying orbicularis oris muscle.
148


149
 Cheeks (Buccal
Mucosa) :-

 EPITHELIUM – non-keratinized

 LAMINA PROPRIA – dense with short, irregular

papillae

 SUBMUCOSA – fats cells, minor salivary

glands, beneath which lies
fibres of buccinator muscles.
150


151
 
 epithelium becomes
keratinized – along a
line coincident with
occlusal plane,
forming a white line -
LINEA ALBA

152
 
 Sebaceous glands are
sometimes present,
appear as a yellow
patches – FORDYCES
SPOTS

153
 Alveolar mucosa :-
 EPITHELIUM

- thin, nonkeratinized

 LAMINA PROPRIA - short papillae

elastic fibers

 SUBMUCOSA - loose connective tissue,

containing thick elastic
fibers attaching to
periosteum of alveolar
process, minor salivary
glands
154
Floor of the
oral cavity:-

 EPITHELIUM – very thin (100µm) and non-
keratinized

 LAMINA PROPRIA – short papillae, elastic fibers,

extensive vascular fibers,
sort anastomosing capillary
loops

 SUBMUCOSA – loose fibrous connective

tissue, fat, minor salivary
glands
155
 Ventral surface of tongue :-
 EPITHELIUM

- thin, non-keratinized

 LAMINA PROPRIA - thin, numerous short papillae

elastic fibers
few minor salivary glands
subpapillary layer – capillary network
reticular layer – avascular

 SUBMUCOSA - thin, irregular

fat & small vessels
when absent – bound to C/T
surrounding tongue masculature 156
 Soft palate :-
 EPITHELIUM

– thin (150µm), non-
keratinization

 LAMINA PROPRIA – thick numerous papillae

highly vascular – developed
capillary network

 SUBMUCOSA – diffuse tissue containing

minor salivary glands

 Also contains taste buds

157
 SPECIALIZED MUCOSA

 It consists of –

1) dorsum of tongue
2) taste buds

158
 Dorsum of tongue :-

 Dorsum of tongue is covered by a functionally
masticatory mucosa but which is also a highly
extensible and has different types of lingual papillae,
some of which have mechanical function and other
gustatory function by virtue of presence of taste
buds.

 Hence it is considered as specialized mucosa

159
 
 It consist of lingual papilla that serves mechanical
function as well as sensory function

 Tongue anatomically is divided into two parts by V

shaped groove “sulcus terminalis”

 Anterior two third is known as body (palatal surface)

 Posterior one third is known as base (pharyngeal
surface)
160
 
 Ant. Part of tongue – Papillary portion
Trigeminal nerve

 Post. Part of tongue - Lymphatic portion

Glossopharyngeal nerve

161


162
 EPITHELIUM

– thick
- keratinized & non-keratinized
- lingual papillae’s are present
- taste buds

 LAMINA PROPRIA – long papillae

- minor salivary glands posteriorly
- rich innervations near taste buds
- Capillary plexus in papillary layer
large vessels lying deeper

 SUBMUCOSA – no distinct layer

163
FILIFORM PAPILLAE –

 Hair-like, thread shaped
 Numerous fine pointed
 Velvet like appearance
 Present over entire anterior part of tongue
 Consist of cone shaped structures, that have core of
connective tissue covered by thick keratinized
epithelium
 Epithelium is non keratinized between the papillae
 NO TASTE BUDS
164


165


166
FUNGIFORM PAPILLAE –

 Fungus-like
 These are present on the anterior portion of tongue
 Single fungiform papillae (elevated mushroom
shaped) are present between numerous filiform
papillae at the tip of tongue
 Non keratinization
 150-400µm in dia
 Taste buds (few)
 Smooth, round structure & reddish
167


168
FOLIATE PAPILLAE –

 Leaf-like
 Non keratinized
 These pink papillae contain 4 to 11 ridges that
alternate with grooves in the mucosa
 Leaf like projections present on lateral margins of the
posterior part of tongue
 Few taste buds are present on lateral wall of ridges

169


170
CIRCUMVALLATE PAPILLAE –

 Walled papillae

 These are present anterior to sulcus terminalis
 Generally these are 8 to 10 in number
 Keratinized –superiorly
 Nonkeratinized- laterally
 Large structures surrounded by deep, circular groove
into which opens the ducts of minor salivary glands
(Von Ebner glands)
 Contains taste buds on internal wall of trench of
epithelium
171


172


173
 Taste buds :-

 Special chemoreceptors organs responsible for taste

 Small ovoid or barrel shaped intraepithelial organs

 About 80µm high and 40µm thick

 Extend from the basal lamina to the surface of the

epithelium

174
 
 Outer surface is
almost covered
by epithelial cells
and has a small
opening known
as taste pore

175
 
 Outer cells - are of the bud are arranged the staves of
barrel

 Inner cells - are shorter and spindle shaped

 And between these spindle cell are arranged 10 to 12

neuroepithelial cell

“Neuroepithelial cells”- are dark staining cells that

carry finger like projections at their superficial ends
(receptors for taste stimuli)
176
 
 Rich plexus of nerves are found below the taste buds

 Located within epithelium particularly around –

* wall of circumvallate papillae

* upper surface of fungiform papillae (small number)
* lateral wall of foliate papillae
* mucous of soft palate
* epiglottis

177
 
LINGUAL TONSILS –

 Collections of lymphoid follicles on posterior 1/3rd

of tongue
 Form a component of Waldeyer’s ring
 These follicles are deep crypts lined within
epithelium & containing mass of lymphoid material

178


179
 
 Simple cytokeratins expressed by taste buds are –

CK 7, 8 & 19
CK 18 (fewer)

180
 Taste sensation :-

 Primary taste sensations that are considered are
salty, sweet, bitter and sour

 These are perceived at different regions of tongue

and palate

181
 SWEET 
:- Fungiform Papilla
Tip of the tongue

 SALTY :- Fungiform Papilla

Lateral border of the tongue

 BITTER :- Circumvallate Papilla

Palate + Post. Part of tongue (Middle area)

 SOUR :- Foliate Papilla

Palate + Post. Part of tongue (Lateral area)182


183
 
 Bitter and sour sensation - are mediated by
glossopharyngeal nerve

 Sweet and salty - nerve by the chorda tympani

 At the angle of sulcus terminalis is present foramen

caecum that is remenant of thyroglossal duct

184
 DENTOGINGIVAL JUNCTION

 Junction between tooth & gingiva

 The epithelium of gingiva which gets attached to

tooth – JUNCTIONAL / ATTACHMENT
EPITHELIUM

 The union between this epithelium & tooth is

referred to as EPITHELIUM ATTACHMENT

185
Junctional epithelium

is non-differentiating, non-
keratinizing tissue lacking a gradient of change in cell
types such as present in the gingival epithelium.

 It extends up to 2mm on the surface of the tooth.

 Highest turnover rate of 5-6 days, therefore it

regenerate readily.

 Also permits easy flow of crevicular (gingival fluid).

186
 Highly permeable

 Coronally: 15-30 cells thick. Apically: narrows to 1-3
cells

 Length: 0.25 – 1.35mm

187
 
 Junction of gingiva & tooth is of great physiologic and
clinical importance:-
 A point of lessened resistance to mechanical forces
and bacterial attack

 Dense resilient lamina propria takes up impacts

produced by mastication

 Both epithelium and connective tissue undergoes

repair and contributes to the integrity of
dentogingival junction 188
 
 Firmness of this junction is maintained by the
gingival portion of periodontal ligament.

 The adherence of epithelium to the tooth is a

function of the attachment epithelium

189
 Development of
Dentogingival Junction :-

 Post secretory ameloblasts leave a thin membrane on
the surface of the enamel – primary enamel cuticle

 Epithelial enamel organ – reduced to few layers of

flat cuboid cells – reduced enamel epithelium

 During eruption, tip of tooth approaches the oral

mucosa, and reduced enamel epithelium and the oral
epithelium meet and fuse
190


191


192


193
 
 Remnant of primary enamel cuticle after eruption is
called as Nasmyth’s membrane

 Once the tip of the crown has emerged, the reduced

enamel epithelium is termed the primary attachment
epithelium

 As the tooth erupts REE becomes shorter – gingival

sulcus is formed
194
Gingival sulcus

 Space b/w the inner aspect of gingiva & the tooth
 Extends from free gingival margin to the dentogingival
junction

 Lined by sulcular ep.

 Non-keratinized
 Lacks ep. Ridges
 Smooth interface with lamina propria
 Express CK 4
 Continuous with gingival & attachment epithelial 195
 
Normal conditions

 45% of all measured sulci ----- below 0.5mm

average ------ 1.8mm

 Normal gingival sulcus depth ----- around 2mm

 Depth increases ------- periodontal diseases c/d

PERIODONTAL POCKET

196


197
 Shift of Dentogingival
Junction :-

 Position of gingiva on tooth changes with time as the
tooth erupts

 Tip of enamel emerges ------ epithelium covers

almost the entire enamel, epithelium separates
readily from the surface of the tooth.

 Crown emerges into the oral cavity ------ attachment

epithelium separates from the enamel surface
gradually.
198
 
 When tooth occlude with its antagonist ------
separation of attachment from the surface of tooth
slows down.

 Tooth reaches the plane of occlusion ------- 1/3rd to

1/4th of the enamel still remains covered by the
gingiva.

199
 
 Actual movement of teeth toward the occlusal plane
is termed - Active eruption

 Separation of primary attachment epithelium from

enamel – Passive eruption

200
 
 Further recession – exposure of cementum occurs

 Gradually REE is disappeared

 The replacement of primary attachment epithelium

by cells derived from the gingival epithelium is
called – secondary attachment epithelium .

201
 
PASSIVE ERUPTION –

describes the various levels of attachment that may

occur as gingiva recedes onto cementum

 It is described in 4 stages:-
 Ist 2 ------ physiologic
 Last 2 ------ probably pathologic

202
FIRST STAGE :-

 Bottom of gingival sulcus – region
of enamel-covered crown
 apical end of attachment
epithelium stays at CEJ
 Persists in primary teeth almost up
to one year
 permanent teeth – till 20 to 30 yrs

203
SECOND STAGE :- 
 bottom of gingival sulcus still on
enamel
 apical end has shifted to surface of
cementum
 entails dissolution of fiber bundles
that were anchored in the cervical
parts of the cementum, now covered
by epithelium and an apical shift of
gingival and transeptal fibers
 Persists to age of 40 or later
204
 
THIRD STAGE :-

 bottom of sulcus is at CEJ

 epithelial attachment entirely
on cementum
 enamel covered crown is fully
exposed
 epithelium gradually shifts
apically
205
 
FOURTH STAGE :-

 represents recession of
gingiva
 entire attachment is on
cementum
 gingiva may appear normal
but the process is regarded
pathologic

206
 
 Gradual exposure of tooth make it necessary to
distinguish b/w Anatomic & Clinical crowns of the
tooth.

 ANATOMIC CROWN - part of tooth covered by

enamel

 CLINICAL CROWN - part of tooth exposed in

the oral cavity
207
 
 Ist & IInd stage - Clinical crown < Anatomic crown

 IIIrd stage - Clinical crown = Anatomic crown

 IVth stage - Clinical crown > Anatomic crown

208


209
EPITHELIAL ATTACHMENT

 Ultrastructural attachment of ameloblasts (primary
attachment epithelium) to the tooth, to be basal
lamina to which hemidesmosomes are attached.

 This mode of attachment is referred to as the

epithelial attachment.
 40nm wide

 Secondary attachment epithelium composed of cells

derived from oral epithelium forms an epithelial
attachment identical with that of primary attachment
epithelium. i.e, a basal lamina & hemidesmosomes. 210
 
 The cells of the junctional epithelium immediately
adjacent to the tooth attach themselves to the tooth
by hemidesmosomes and a basal lamina

 The combination of the hemidesmosomes and basal

lamina is known as the attachment apparatus or
epithelial attachment

211
 
 The basal lamina in contact with the tooth is termed
the INTERNAL BASAL LAMINA.

 On the other surface of the junctional epithelium in

contact with the lamina propria is the NORMAL
BASAL LAMINA (THE EXTERNAL BASAL
LAMINA).

 The junctional epithelium is therefore unique in

having two basal laminae.
212
 
 Internal basal lamina differs from external basal
lamina in that they lack laminin, anchoring fibrils
and type IV collagen.

213


214
 DEVELOPMENT OF ORAL
MUCOSA

 Primitive oral cavity – fusion of embryonic
stomatodeum with foregut after rupture of
buccopharyngeal membrane, at about 26th day of
IUL.

 It is lined by epithelium derived from endoderm and

ectoderm.

 By 5 to 6 weeks of IUL single layer – two cell layer.

215
 
 The vestibular lamina separates from the primary
epithelial band at about 6 weeks.

 Degeneration of cells in the central part of this

process leads to the formation of labial & buccal
sulcus and the delineation of lips & cheeks from the
alveolar mucosa.

216
 
 By 8th week – significant thickening occur in region
of vestibular dental lamina complex.

 At 10 to 14th week – oral vestibule.

 At 7th week – circumvallate & foliate papillae,

followed by fungiform papillae.

 At 10th week – filliform papillae.

217
 
 By 10 to 12th week – future lining & masticatory
mucosa show some stratification of epithelium.

 Between 13 to 20th week – all oral epithelium thicken

& sparse keratinohyaline granules appear.

 Surface layer of epithelium show parakeratosis.

218
 
 By 6 to 8th week –extracellular reticular fibers begin
to accumulate in ectomesenchyme.

 By 8 to 12 week – capillary buds and collagen.

 Between 17 to 20 week – elastic fibers – prominent

only in connective tissues of lining mucosa.

219
 AGE CHANGES IN ORAL
MUCOSA
 Oral mucosa

:- smooth and dry
 Filliform papilla :- reduced
 Tongue :- smooth owing to reduction in
thickness of ep.
 Langerhans cells :- few
 In lamina propria :- cellularity decreases but collagen
content increases
 Minor salivary glands :- show atrophy with fibrous
replacement
 Loss of sensitivity to thermal, chemical & mechanical
stimuli, with decline in taste perception 220