6Oral MucosaMucous Membrane: Moist lining of the gastrointestinal tract, nasal passages andother body cavities that communicate with the exteriorIn the oral cavity the lining is called as oral mucous membrane or oral mucosa
7Functions of the Oral Mucosa Protection: Barrier for mechanical trauma and microbiological insultsSensation: Temperature (heat and cold), touch, pain, taste buds, thirst;reflexes such as swallowing, etching, gagging and salivating3. Secretion: Salivary secretion4. Thermal regulation: Important in dogs not in humans
8Organization of the Oral Mucosa 3 types according to FUNCTION:Masticatory Mucosa: 25% of total mucosa. Gingiva (free, attachedand interdental) and hard palate. Primary mucosa to be in contact with foodduring mastication. MASTiCATORY MUCOSA IS USUALLY KERATINIZED.Lining Mucosa: 60% of total mucosa. Covers the floor of mouth, ventral(underside) tongue, alveolar mucosa, cheeks, lips and soft palate.Does not function in mastication and therefore has minimal attrition.Non-keratinized; soft and pliable.Specialized Mucosa: 15% of total mucosa. Covers dorsal tongue andcomposed of cornified epithelial papillae.
14General Features of Oral Mucosa Separated from the skin by vermillion zone of the lips which is more deeplycolored than rest of the oral mucosaFactors affecting color of the oral mucosa:a. Concentration and state of dilation of the blood vessels inunderlying connective tissueb. Thickness of the epitheliumc. Degree of keratinizationd. Amount of melanin pigmentationClinically, color of oral mucosa is very important. For example, inflamed oraltissues appear red rather than the normal pale pink
16How is the oral mucosa different from skin? ColorMoist surfaceAbsence of adnexal skin structures such as hair follicles, sweat glandsand sebaceous glands (exception in Fordyce’s disease)Fordyce’s disease: Sebaceous glands in oral cavity predominantly in upperlip, buccal mucosa and alveolar mucosaPresence of minor salivary glands in oral mucosaTexture of surface: Oral mucosa is smoother than the skin (few exceptionslike dorsal tongue – due to papillae; hard palate – rugae; gingiva – stippling)Firmness: Oral mucosa varies in its firmness. For example buccal mucosaand lips are loose and pliable whereas the gingiva and hard palate are firmso critical clinically while giving injections
18Fordyce’s Spots Pale yellow spots Normal variation Lips, buccal mucosa, alveolarmucosa and tonsillar pillar
19Structure of Oral Mucosa Overlying oral epitheliumUnderlying connective tissue (lamina propria and submucosa)In skin called epidermis and dermisRete ridges/pegsConnective tissue papilla
20structureless layer called basement membrane A: EpitheliumB: Connective tissueC: Salivary glandA: Startum basaleB: Startum spinosumC: Startum superficialeThe oral epithelium is keratinized or non-keratinized stratified squamous epitheliumThe interface between epithelium and connective tissue is comprised of astructureless layer called basement membraneThis interface is irregular and is composed of downward projections of epitheliumcalled rete ridges or rete pegs, and upward projection of connective tissue termedas connective tissue papillae
21Junction between oral epithelium and lamina propria is more obvious than that between lamina propria and submucosaNo muscularis mucosae layer seen in oral mucosaLoose fat and glandular tissue with blood vessels and nerves seen underneath oral mucosafrom underneath bone or muscle layer - this layer is termed SUBMUCOSA – provides flexibilityIn gingiva and hard palate, no submucosa is seen and the lamina propria is directlyattached to the periosteum of the underlying bone which provides firm, inelastic attachment –this is called ORAL MUCOPERIOSTEUM
22(Fordyce’s disease) and lymphoid tissue (tonsillar tissue) Connective tissue in oral cavity is comprised of salivary glands, sebaceous glands(Fordyce’s disease) and lymphoid tissue (tonsillar tissue)Salivary glands Sebaceous glands Lymphoid tissue (tonsil)High Power view of sebaceous glands
23Oral EpitheliumProgenitor population: Divide and provide new cells (Proliferation)Maturing population: Undergo differentiation (maturation)Estimated time necessary to replace all the cells in the epithelium: turnover timeSkin: 52 to 75 daysGut: 4 to 14 daysGingiva: 41 to 57 daysCheek: 25 daysNonkeratinized epithelium turns over faster than keratininzed epitheliumClinical correlation: Oral ulcers during cancer chemotherapeutic treatment
25Components of Oral Epithelium Lining Mucosa:Stratum Basale: Basal cell layer comprised of cuboidal cells. Progenitorcells that divide and provide new cells by mitotic division that migrate to thesurface to replace cells that are shed.Stratum Spinosum (or intermedium): Cells are oval and represent bulkof the epithelium.Stratum Superficiale: Cells are flat and contain small oval nuclei that arecontinuously shed.
26Histology of Lip Skin: keratinized stratified squamous epithelium with adnexal skin structuresOral Mucosa: Moist-surface, covered bynonkeratinized stratified squamous epitheliumassociated with small round seromucousglands of the lamina propria. In thesubmucosa fibers of orbicularis oris muscle isnoted.Vermillion zone: Very thin keratinizedepithelium that contains no adnexal skinstructures (can contain sebaceous glands)What gives the vermillion zone the red color?Epithelium is thinEpithelium contains eleidin, which istransparentBlood vessels are present near the surfaceEleidin is a semi-fluid clear substance presentin the stratum lucidum of the skin epitheliumA: SkinB: Vermillion zoneC: Oral (labial) mucosaD: Minor salivary glands
27Skin of the Lip Vermillion Zone and Labial Mucosa A: Sweat glandsB: Sebaceous glandsC: Hair folliclesA: Vermillion zoneB: Labial mucosaC: Orbicularis oris muscle
28Soft palate Nonkeratinized Highly vascularized so more pink than hard palate2. Lamina propria and submucosapresent (unlike hard palate whenonly lamina propria is noted –mucoperiosteum)Submucosa contains salivaryglands and muscle soft palateA: Hard PalateB; Soft palateC: Nasal cavity
29Cheeks (Buccal Mucosa) Similar to lips and soft palateNonkeratinized stratified squamous epithelium, lamina propria and submucosaSubmucosa of cheeks contain fat cells along with lobules of minor salivaryglands and muscle fibers
30Ventral surface of tongue Floor of mouthNonkeratinized stratified squamousepithelium, lamina propria andsubmucosaExtremely dense muscle fibersinterlacing connective tissue fibersin submucosaNonkeratinized stratified squamousepithelium, lamina propria and submucosaEpithelium is loosely attached tolamina propriaNo muscle
31Epithelium that covers gingiva and hard palate Masticatory MucosaEpithelium that covers gingiva and hard palateMucosa is thicker than nonkeratinized because of the keratin layerStratum basaleStartum spinosumStratum granulosum: Cells contain keratohyaline granulesStratum corneum: Contains thin, flat and nonnucleated cells which are filled withkeratin. In contrast to the hard keratin seen in nails and hair, keratin overlyingnormal masticatory oral mucosa is soft. Keratin is tough, nonliving material thatis resistant to friction and impervious to bacterial invasionSame as nonkeratinized epitheliumMiller SE. Histology for Pathologists. 3rd edition. LWW. 2007
33Types of Keratinized Epithelium Miller SE. Histology for Pathologists. 3rd edition. LWW. 2007The superficial cells are dead but retain the nucleus in parakeratinized epitheliumbut the nuclei are lost in orthokeratinized epitheliumThe rete pegs are long and slender in keratinized epitheliumMucoperiosteum
34Gingiva and Epithelial Attachment Free or marginal gingivaAttached gingiva attaces with the neckof the tooth by means of junctional epithelium
35Histology of GingivaThick (250 µm), either orthokeratinized or parakeratinized stratifiedsquamous epithelium with a stippled surfaceA: Rete pegsB: Conective tissue papillaC: ParakeratinD: Spinous layerIn healthy attached gingiva “stippling” is seen which appears as small pits in the epithelium andare due to deep rete pegs. The lamina propria is composed of long narrow papillae which are nothighly vascular. No distinct submucosa is noted as the overlying mucosa is directly attachedto the underlying periosteum and cementum by collagen fibers
36Free Gingiva: Keratinized; NOT STIPPLED; bound on inner margin by the gingival sulcus, which separates it from the tooth; bound on its outer margin bythe oral cavity; and apically by the free gingival groove.Attached Gingiva: Keratinized; STIPPLED; separated from the alveolar mucosaby the mucogingival junction (groove). Attached to the tooth by junctional epithelium.
37In A note the difference in keratinization, thickness ofepithelium and ridge pattern.In B stained with an elasticstain, note the presence ofelastic fibers in lamina propriain alveolar mucosa. Notmuch difference in theepithelium is seen betweenthe two types of mucosa.
38Dentogingival Junction and Junctional Epithelium Dentogingival junction is theregion where the oral mucosameets the surface of the toothVery important because it is aweak area in the oral mucosawhich is otherwise continuousBacteria on the surface of thetooth produce toxins that canincite inflammation and damageif it enters into the mucosal tissuesGingival sulcus in healthy individuals is ~ 0.5 to 3 mm (mild inflammation is present-1.8 mm average)Depth greater that 3mm is considered pathologic; and the sulcus representsperiodontal pocketFloor of the sulcus and the epithelium cervical to it is called junctional epitheliumwhich is in contact with the tooth surface (enamel and sometimes cementum)Wall of the gingival sulcus is lined by nonkeratinizing stratified squamous epithelium that isderived from and continuous with the rest of the oral mucosa – oral sulcular epithelium
39Junctional Epithelium The epithelium that is attached to the tooth (enamel or sometimes cementum) surfacecontinuous with sulcular epitheliumDerived from reduced enamel epithelium of the tooth germJunctional epithelium consists of flat cells aligned parallel to the tooth surfaceincreasing in thickness from the apex to the crownAttached to enamel by internal basal lamina and to the connective tissue by externalbasal lamina. Hemidesmosomes are present in both basal laminas.
40Epithelial cell turnover in gingiva Similar to all other epithelia, the deepercells adjacent to the connective tissueundergo cell division to replenish thoselost at the surfaceHigh rate of cell divisionMigrate about 2 to 3 cell layers from thetooth surface and then join a main migratoryroute in a coronal direction, parallel to toothsurface, to be desquamated into thegingival sulcus.Key point: Junctional epithelium readilyregenerates from the sulcular epitheliumor oral epithelium if it is damaged or surgicallyexcisedConnective tissue normally contains plenty of neutrophils which is differentthan the normal oral mucosa
41ColCol (or depression): This is how the gingiva looks in the interdental area. Similarto an outline of a depression or col with buccal and lingual peaks. Col epitheliumis identical to junctional epithelium and has the same origin (from dental epithelium)and is also replaced continually by cell division.Not sure if there is any significance that the col is more vulnerable to inflammation,but the incidence of gingivitis is greater interdentally.
43A quick note on…..Blood supply to the gingiva: Derived from periosteal vessels in the periosteumof the alveolar processBlood supply to the dentogingival junction: Continuation of interalveolar arteriesNerve supply to the gingiva: terminal branches of periodontal nerve fibers and bybranches of the infraorbital and palatine, or lingual, mental, and buccal nervesPLEASE REVIEW TABLE 12-4 AND 12-5 IN THE TEXT BOOK
44Histology of Hard Palate Thick orthokeratinized (or parakeratinized in areas) epithelium showing ridges (rugae)Lamina propria shows long papillae with thick dense connective tissueSubmucosa is mucoperiosteum with dense collagenous connective tissue attachingdirectly to periosteum. Contains fat and salivary glands
46Filiform papilla: Makes up majority of the papillae and covers the anterior part of the tongue. They appear as slender, threadlike keratinized projections(~ 2 to 3 mm) of the surface epithelial cells. These papillae facilitate mastication(by compressing and breaking food when tongue is apposed to the hard palate)and movement of the food on the surface of the tongue. The papillae is directedtowards the throat and assist in movement of food towards that direction.NO TASTE BUDS.
48Fungiform papilla: (Fungus-like) These are interspersed between the filiform papilla. More numerous near the tip of the tongue. Smooth, round structures that appearred because of their highly vascular connective tissue core, seen through a thin,nonkeratinized stratified squamous epithelium. Taste buds are usually seen withinthe epithelium.Filiform papilla
49Foliate Papilla: (Leaf-like) Foliate Papilla: (Leaf-like). Present on the lateral margins of the posterior tongue.Consist of 4 to 11 parallel ridges that alternate with deep grooves in the mucosa,and a few taste buds are present in the epithelium. They contain serous glandsunderlying the taste buds which cleanse the grooves.
50Circumvallate papilla: (Walled papilla) Circumvallate papilla: (Walled papilla). 10 to 14 in number these are seen alongthe V-shaped sulcus between the base and the body of the tongue. Large, ~ 3 mmin diameter with a deep surrounding groove. Ducts of von Ebner glands (seroussalivary glands) open into the grooves. Taste buds are seen lining the walls ofthe papillae.
52Taste Buds: Unique sense organs that contain the chemical sense for taste. Microscopically visible barrel-shaped bodies found in the oral epithelium.Usually associated with papillae of the tongue (circumvallate, foliate andfungiform). Also seen in soft palate, epiglottis, larynx, and pharynx.Referred to as NEUROEPITHELIAL STRUCTURES. But most correctly referredas epithelial cells closely associated with clib-shaped sensory nerve endings. Thesenerves arise from the chorda tympani in anterior tongue and glossopharyngeal inposterior tongue and come to lie among the taste cells. Each taste bud has ~ 10 to14 cells. Majority are taste cells with elongated microvilli that project into thetaste pore. (Epiglottis and larynx – Vagus nerve)Type 1 dark cell (60% of cells)Type 2, light cells (30%)Type 3 (7%) and Type 4 (basal cells ~ 3%)
53Taste Buds in the Human Adult Location Number Tongue 10,000Soft palate 2,500Epiglottis 900Larynx/pharynx 600Oropharynx 2504 taste sensations: Sweet, salty, sour and bitterSweet and salt: ant tongueSour: lateral tongueBitter: region of circumvallate papilla
54Epithelial maturation Keratinization NonkeratinizationGingivaHard palateSome areas of dorsal tongueNo granular cell layer
55Basal cells interface with a membrane separating the epithelium and lamina propria. The membrane is called basal lamina. Basal cells attached to basal lamina byhemidesmosomes.Epithelial cell-cell contact is made through desmosomes (in oral cavity appearsdiscoid and called macula adherens). These are anchored intracellularly bytonofibrils.
57Nonkeratinocytes in oral epithelium Constitute about 10% of epithelial cell population. Three major cells which are allclear cells with a halo around their nuclei.Langerhan’s cells: found on stratum spinosum (suprabasal) and function inantigen trapping and processing. Dendritic cells. No desmosomes or tonofilaments.Merkel cell: Located in basal cell layer (mostly in gingiva). Function as touchreceptors. Nondendritic. Sparse desmosomes and tonofilaments.Melanocytes: Found in basal cells. Melanin-producing cells (mostly in gingiva).Dendritic. Presence of melanin granules (melanosome).Lymphocytes and leukocytes: Inflammatory cells that are not clear cells.Associated with inflammatory response in oral mucosa
58Lamina PropriaSuperficial papillary layer (associated with rete ridges) and deeper reticular layer(between papillary layer and deeper structures)Reticular refers to the netlike arrangement of collagen fibers (nothing to do withreticulin fibers)Papillary layer has thin and loose collagen fibers with many capillary loopsReticular layer has collagen fibers arranged in thick bundles that are parellel to surfaceLamina propria also contains various cells, blood vessels, nerves and fibers(collagen and elastic) embedded in an amorphous ground substance