ORAL MUCOUS MEMBRANE

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 DEFINITION

• It is defined as a moist lining of oral cavity that

communicates with the exterior.

• Mucous membrane are also found lining other

body cavities such as sinuses, GIT, uterus etc.

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• The oral mucosa consists of two
layers: an epithelium (stratified
squamous epithelium) & an
underlying layer of connective tissue,
which is the lamina propria.

• Beneath selected areas of the oral

mucosa is a loose connective tissue,
the submucosa.

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CLASSIFICATION OF ORAL
MUCOSA

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DEVELOPMENT & STRUCTURE
OF ORAL EPITHELIUM

• The cells vary from cuboidal or low

columnar at the connective tissue
interface to flat squamous at the
surface.

• Most of the mucosal surface of the oral

cavity is lined by a nonkeratinized
epithelium, except for the gingiva, hard
palate & dorsal surface of the tongue
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where the epithelium is keratinized.
• Four layers in nonkeratinized epithelium
are:
- The stratum basale,
- The stratum spinosum,
- The stratum intermedium,
- The stratum superficiale.

Four layers in keratinized epithelium are:

- The stratum basale,
- The stratum spinosum,
- The stratum granulosum,
- The stratum corneum.
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 STRATUM BASALE

• Cells are cuboidal or low columnar.

• Cells form a single layer resting on the

basal lamina at the interface of the
epithelium & lamina propria.

• The epithelia of the oral mucosa are in a

constant state of renewal, & the basal
cells show the most mitotic activity.
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 STRATUM SPINOSUM

• Is several cells thick.

• Mitotic figures can be occasionally seen.

• The stratum basale & first layers of the

stratum spinosum are referred to as the
stratum germinativum as this zone
gives rise to new epithelial cells.

• The cells are shaped like a polyhedron,

with short cytoplasmic processes. 12
• Under the light microscope, the normal
appearance of these cells is accentuated
by shrinkage artifacts produced during
routine fixation, staining & mounting. Due to
this, its known as prickle cell layer.

• Abundance of intracytoplasmic fibrils

(tonofibrils) that project toward & attach to
the desmosomes.

• Membrane coating granules fuse with the

cytoplasmic membrane of the cell &
exteriorize their contents into the intercellular
spaces. 13
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 STRATUM GRANULOSUM
• The cells are flat & stacked in a layer three to
five cells thick.

• Consists of dense, relatively large (0.5 to 1

um) keratohyaline granules in their
cytoplasm.

• These are closely associated with

ribosomes.

• Help to form the matrix for the numerous

keratin fibers found in the superficial layers.
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 STRATUM CORNEUM

• The cells are very flat, devoid of nuclei, &

full of keratin filaments surrounded by a
matrix.

• There is abrupt change between the

stratum corneum & stratum granulosum.

• These surface cells are continually being

sloughed & are replaced by the continual
migration of cells from the underlying layers.
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ULTRASTRUCTURE OF STRATUM
CORNEUM

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SCANNING ELECTRON MICROGRAPH
OF SURFACE VIEW OF EPITHELIAL
CELLS.

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 TURNOVER OF ORAL EPITHELIUM
• High rate of turnover.

• Difficult to appreciate on a static diagram or

histologic slide.

• The dynamic nature of this epithelium is best

appreciated when cells are labeled
experimentally with radioactive thymidine,
which tags DNA at synthesis.

• The technique used to view the labeled DNA

is termed radioautography.
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TURNOVER OF EPITHELIAL CELLS
REVEALED BY 3H THYMIDINE
LABELING.

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• Sulcular epithelium takes 10 days
to renew, whereas the general
oral mucosa takes approximately
12 to 13 days.

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NONKERATINIZED EPITHELIUM

• The surface cells retain their nuclei.

• The cytoplasm does not contain

keratin filaments.

• The stratum corneum & granulosum

is absent.

• E.g. lining mucosa. 26

 PARAKERATINIZED
EPITHELIUM
• The surface cells have dark staining
pyknotic nuclei.

• The cytoplasm contains little if any

keratin filaments.

• E.g. gingiva.

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ILLUSTRATION OF THREE FUNCTIONAL
TYPES OF ORAL EPITHELIUM.

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JUNCTION OF EPITHELIUM &
CONNECTIVE TISSUE
• Connective tissue, with its inductive
properties, exerts control over the overlying
epithelium.

• The basement membrane is composed of

three parts:-
- Lamina lucida, which is less dense & is
toward the epithelial side;
- Lamina densa, middle of the three parts;
- Lamina reticularis, which is less dense
than the lamina densa & is located next to
the lamina propria. 29
• Type IV collagen & laminin, a
glycoprotein, are major components of the
lamina densa.

• Basal cells of the epithelium are not

attached to the connective tissue proper,
but rather form mechanical adhesions
with the basal lamina. These attachments
are hemidesmosomes.

• Fine collagen fibers attach to lamina on

the connective tissue side. These fibers
are anchoring fibers, composed of type
VII collagen. 30
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DIAGRAM OF HEMIDESMOSOMES

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 LAMINA PROPRIA
• Is the connective tissue layer immediately
below the epithelium.
• Can be divided into the papillary layer &
reticular layer.

• In the papillary layer, finger-like projections

of connective tissue extend into the deep
surface of the epithelium.
• An increase in the number & length of the
papillae is seen in areas where mechanical
adhesion between the epithelium & lamina
propria is required (masticatory mucosa).
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• In areas of lining mucosa, the reticular or
subpapillary layer predominates.

• The blood supply consists of a deep

plexus of large vessels in the submucosa,
which gives rise to a secondary plexus in
the papillary layer of the lamina propria.

• Capillary loops extend into the connective

tissue papillae.

• The epithelium is avascular; therefore, its

metabolic needs must come via the vessels
of the lamina propria. 35
THE LAMINA PROPRIA CONSISTS OF THE
PAPILLARY LAYER & RETICULAR LAYER,
BELOW WHICH IS SUBMUCOSA.

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 SUBMUCOSA
• In most areas of the mouth, the submucosa is
absent or limited.

• Serves primarily as an attachment for the

lamina propria to the underlying bone
or skeletal muscle.

• Found in the cheeks, lips, & parts of palate, &

is a less dense component than the lamina
propria.

• Its functions are nutrition & defense.

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• It is the site containing adipose tissue &
minor salivary glands in the oral cavity.

• In the bony areas with no submucosa, fibers

of the lamina propria attach tightly to bone.

• The mucosa & lamina propria in these areas

is generally referred to as
mucoperiosteum.

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FULL THICKNESS OF CHEEK

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CROSS SECTION OF TONGUE

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 LINING MUCOSA

• Is smooth & shiny.

• Oral epithelium is less pigmented than

the epithelium of the skin & varies in
color from light pink to darker pink or
red.

• The hues are influenced by the

underlying capillary network in relation
to the free surface & by the amount of
melanin pigment in the epithelial cells.
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LINING MUCOSA OF FLOOR
OF MOUTH

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LIP WITH SKIN ON OUTER SURFACE &
LINING MUCOSA ON INNER SURFACE.

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 VERMILION BORDER
• It is the junction between the skin & mucous
membrane.

• The epithelium is thin.

• A protein eleidin is present, which is more

transparent than the protein keratin.

• Ectopic sebaceous glands are seen in the

vermillion border at the corners of the mouth or
more laterally in the cheeks opposite the molar
teeth. These are called fordyce’s spots.
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VERMILLION BORDER WITH
ITS COVERING OF CLEAR
ELEIDIN.

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 SOFT PALATE

• Is covered by lining mucosa, which is

more pink than the hard palate.

• A layer of elastic fibers separates

the lamina propria from the
underlying submucosa.

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MUSCLE IN SUBMUCOSA OF
VENTRAL SURFACE OF
TONGUE.

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 HARD PALATE
• In the anterior lateral regions of the hard
palate, the submucosa contains fatty tissue.

• The lateral regions of the posterior parts

contain the palatine glands, which extend
posteriorly into the soft palate.

• These glands are pure mucous glands

containing only mucous acini.

• The median raphae has no submucosa & there

is only dense fibrous attachment to the
underlying bone.
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DIAGRAM OF REGIONS OF
PALATE.

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• In the lateral regions of the palatine
mucosa, both fatty & glandular tissue
make up the submucosa.

• Rugae do not cross the midline but are

easily seen & palpated, & can be felt
with the tongue.

• The connective tissue fibers pass directly

from the papillary layer of the lamina
propria into the underlying bone. These
are termed traction bands & make
the rugae immovable structures.
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• In the lateral region of the palate
near the maxillary molar tooth, there
is no submucosal layer adjacent to
the teeth overlying the alveolar bone,
&

• The fibers of the lamina propria of

the palate & gingiva are continuous.
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DIAGRAM OF TONGUE, WITH
SPECIALIZED MUCOSA
SHOWN ON DORSUM OF
TONGUE

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 INTRA-EPITHELIAL NON-KERATINOCYTES

• These are known as clear cells because

they have a clear halo around their nuclei.

• These cells comprise four different types:

- Langerhans’ cells
- Merkel cells
- Melanocytes
- Lymphocytes.

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 LANGERHANS’ CELLS
• Are found in the stratum spinosum &,
occasionally in stratum basale.

• These cells have long, thin extensions of the

cytoplasmic membrane, called dendrites.

• They can be distinguished from keratinocytes

by the absence of desmosomes &
tonofilaments.

• Can be distinguished from the melanocytes by

the absence of premelanosomes. 61
• Contains the rod shaped or racquet shaped
birbeck’s granules, which allows for positive
identification at the ultrastructural level.

• Are antigen presenting cells.

• They engulf antigens from the external

environment & the intracellular lysosomes
split the antigens into peptide components.
These fragments are then transferred to T-
lymphocytes.

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 MERKEL CELLS
• Are situated in the basal layer of the gingival
epithelium.

• Possess occasional desmosomes &

tonofilaments.

• Are usually associated with an axon terminal.

• The merkel cell & associated axon terminal form
a complex that serves as a touch receptor.

• Are usually found in groups or clusters.

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 MELANOCYTES
• Are melanin producing cells located in the
basal layer of the gingival epithelium.

• These cells arise from the neural crest.

• Lack tonofibrils, desmosomes &

hemidesmosomes.
• Are highly dendritic in nature.

• The most characteristic feature of the

melanocyte is the melanosome granule found
within the cytoplasm.
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• A more heavily pigmented gingiva is
due to the production of melanin &
its subsequent uptake by the
epithelial cells.

• There is a great variability in the

location & distribution of melanin in
the oral cavity.
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 CLINICAL
CONSIDERATIONS
• The oral mucosa can change according to
various factors, including smoking, age &
disease.

• Over 7% of the total number of cancers

diagnosed in the United States are located
in the oral & oropharyngeal areas.

• The process of keratinization can be altered

in cancerous & precancerous lesions
such as leukoplakia.
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• Thinning of the epithelium occurs in
relation to prosthetic devices covering the
surface of the mucosa.

• Changes in salivary flow- due to age,

radiation or disease- disrupt the normal
maturation & differentiation of the epithelial
cell layers.

• The healing capacity of the oral mucosa is

greater than that of the skin. Orthognathic
surgery to move segments of the mandible
& maxilla can be performed using an
intraoral approach to take advantage of
these characteristics. 71
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