ANATOMY AND PHYSIOLOGY OF ORAL CAVITY

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 INDEX
Sr. no. Topic Page no.
1 Anatomy of oral cavity 3
2 Vestibule 4
3 Lips 4
4 Cheeks 4
5 Oral cavity proper 5
6 Gums 5
7 Teeth 6
8 Hard palate 8
9 Soft palate 9
10 Physiology of oral cavity 12
11 Functions of mouth 11
12 Salivary gland 11
13 Properties and composition of saliva 14
14 Functions of saliva 14
15 Bibliography 16

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 Anatomy of Oral Cavity
APPLIED ANATOMY
 The oral cavity extends from the lips to the oropharyngeal isthmus, i.e. up to the level of anterior pillar of tonsils. It is
divided into the following sites :

1. Lips. They form anterior boundary of the oral vestibule.

2. Buccal or cheek mucosa. It lines the inner surface of cheeks and lips, and extends up to pterygomandibular

raphe. Anteriorly, it extends to the meeting line of lips.

3. Gums (gingivae). They surround the teeth and cover the upper and lower alveolar ridges.

4. Retromolar trigone. It is a triangular area of mucosa cov-ering anterior surface of the ascending ramus of man- dible. Its base
is posterior to the last molar while its apex is adjacent to the tuberosity of maxilla.

5. Hard palate. It forms roof of the oral cavity

6. Oral tongue. Only anterior two-thirds of tongue are included in the oral cavity. Posterior one-third or base of tongue is
situated behind the circumvallate papillae and forms part of the oropharynx. Oral tongue is divided into tip, lateral borders,
dorsum and the undersurface.

7. Floor of mouth. It is a crescent-shaped area between the gingivae and undersurface of tongue. Anterior por- tion of the floor
is best seen when patient raises the tip of tongue to touch the hard palate. Frenulum and sub- lingual papillae with openings of
submandibular ducts can be easily seen. Lateral portion of floor of mouth is best seen by displacing the lateral surface of
tongue in medial direction with the help of a tongue depressor.

Divisions

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  The oral or mouth cavity is divided into an outer, smaller portion, the vestibule, and an inner larger part, the oral cavity
proper.

VESTIBULE

 The vestibule of the mouth is a narrow space bounded externally by the lips and cheeks, and internally by

the teeth and gums .

 It communicates:

a. With the exterior through the oral fissure.

b. With the mouth open, it communicates freely with the oral cavity proper. Even when the teeth are occluded a small

communication remains behind the third molar tooth.

 The parotid duct opens on the inner surface of the cheek opposite the crown of the upper second molar tooth .
Numerous labial and buccal glands (mucous) situated in the submucosa of the lips and cheeks open into the vestibule.
Four or five molar glands (mucous), situated on the buccopharyngeal fascia, also open into the vestibule.
 Except for the teeth, the entire vestibule is lined by mucous membrane. The mucous membrane forms median folds
that pass from the lips to the gums, and are called the frenula of the lips.

Lips
 The lips are fleshy folds lined externally by skin and internally by mucous membrane. The mucocutaneous junction lines
the ‘edge’ of the lip, part of the mucosal surface is also normally seen.
 Each lip is composed of:

a. Skin

b. Superficial fascia

c. The orbicularis oris muscle

d. The submucosa, containing mucous labial glands and blood vessels

e. Mucous membrane.

 The lips bound the oral fissure. They meet laterally at the angles of the mouth. The inner surface of each lip is
supported by a frenulum which ties it to the gum. Philtrum is a median vertical groove on the outer surface of the
upper lip.
 Lymphatics of the central part of the lower lip drain to the submental nodes; the lymphatics from the rest of the lower
lip pass to the submandibular nodes.

Cheeks (Buccae)
 The cheeks are fleshy flaps, forming a large part of each side of the face. They are continuous in front with the lips, and
the junction is indicated by the nasolabial sulcus (furrow) which extends from the side of the nose to the angle of the
mouth.
 Each cheek is composed of:

a. Skin

b. Superficial fascia containing some facial muscles, the parotid duct, mucous molar glands, vessels and nerves.

c. The buccinator covered by buccopharyngeal fascia and pierced by the parotid duct.
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 d. Submucosa, with mucous buccal glands.

e. Mucous membrane.

 The buccal pad of fat is best developed in infants. It lies on the buccinator partly deep to the masseter and partly in
front of it.
 The lymphatics of the cheek drain chiefly into the submandibular and preauricular nodes, and partly also to the buccal
and mandibular nodes.

ORAL CAVITY PROPER

 It is bounded anterolaterally by the teeth, the gums and the alveolar arches of the jaws. The roof is formed by the hard
palate and the soft palate. The floor is occupied by the tongue posteriorly, and presents the sublingual region
anteriorly, below the tip of the tongue. Posteriorly, the cavity communicates with the pharynx through the
oropharyngeal isthmus (isthmus of fauces) which is bounded superiorly by the soft palate, inferiorly by the tongue, and
on each side by the palatoglossal arches.
 The sublingual region presents the following features:
a. In the median plane, there is a fold of mucosa passing from the inferior aspect of the tongue to the floor of the mouth.

This is the frenulum of the tongue.

b. On each side of the frenulum, there is a sublingual papilla. On the summit of this papilla, there is the opening of
submandibular duct.
c. Running laterally and backwards from the sublingual papilla, there is the sublingual fold which overlies the sublingual
gland. A few sublingual ducts open on the edge of this fold.
 Lymphatics from the anterior part of the floor of the mouth pass to the submental nodes. Those from the hard palate
and soft palate pass to the retropharyngeal and upper deep cervical nodes. The gums and the rest of the floor drain
into the submandibular nodes.

Gums (Gingivae)
 The gums are the soft tissues which envelop the alveolar processes of the upper and lower jaws and surround the
necks of the teeth. These are composed of dense fibrous tissue covered by stratified squamous epithelium.
 Each gum has two parts:

a. The free part surrounds the neck of the tooth like a collar.

b. The attached part is firmly fixed to the alveolar arch of the jaw. The fibrous tissue of the gum is continuous with the

periosteum lining the alveoli (periodontal membrane).

 Lymphatics of the upper gums pass to the submandibular nodes. The anterior part of the lower gums drains into the
submental nodes, whereas the posterior part drains into the submandibular nodes.

TEETH
 The teeth form part of the masticatory apparatus and are fixed to the jaws. In man, the teeth are replaced only once
(diphyodont) in contrast with non-mammallian vertebrates where teeth are constantly replaced throughout life
(polyphyodont). The teeth of the first set (dentition) are known as milk, or deciduous teeth, and the second set, as
permanent teeth.
 The deciduous teeth are 20 in number.In each half of each jaw,there are two incisors, one canine, and two molars.

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  The permanent teeth are 32 in number, and consist of two incisors, one canine, two premolars, and three molars in
each half of each jaw.

Parts of a tooth
Each tooth has three parts:

1 A crown, projecting above or below the gum.

2 A root, embedded in the jaw beneath the gum.

3 A neck, between the crown and root and surrounded by the gum.

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Structure
Structurally, each tooth is composed of:

1 The pulp in the centre.

:2 The dentine surrounding the pulp.

3 The enamel covering the projecting part of dentine, or crown.

4 The cementum surrounding the embedded part of the dentine.

5 The periodontal membrane.

 The pulp is loose fibrous tissue containing vessels, nerves and lymphatics, all of which enter the pulp

cavity through the apical foramen. The pulp is covered by a layer of tall columnar cells, known as odontoblasts

which are capable of replacing dentine any time in life.

 The dentine is a calcified material containing spiral tubules radiating from the pulp cavity. Each tubule is occupied by
a protoplasmic process from one of the odontoblasts. The calcium and organic matter are in the same proportion as
in bone.
 The enamel is the hardest substance in the body. It is made up of crystalline prisms lying roughly at right angles to the
surface of the tooth.
 The cementum resembles bone in structure, but like enamel and dentine, there is neither any blood supply nor any
nerve supply. Over the neck, the cementum commonly overlaps the cervical end of enamel; or, less commonly, it may
just meet the enamel. Rarely, it stops short of the enamel (10%) leaving the cervical dentine covered only by gum.
 The periodontal membrane (ligament) holds the root in its socket. This membrane acts as a periosteum to both the
cementum as well as the bony socket.

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Form and Function (Crowns and Roots)
 The shape of a tooth is adapted to its function. The incisors are cutting teeth, with chisel-like crowns. The upper and
lower incisors overlap each other like the blades of a pair of scissors. The canines are holding and tearing teeth, with
conical and rugged crowns. These are better developed in carnivores. Each premolar has two cusps and is, therefore,
also called a bicuspid tooth. The molars are grinding teeth, with square crowns, bearing four or five cusps on their
crowns.
 The incisors, canines and premolars have single roots, with the exception of the first upper premolar which has a bifid
root. The upper molars have three roots, of which two are lateral and one is medial. The lower molars have only two
roots—an anterior and a posterior.

Eruption of Teeth
 The deciduous teeth begin to erupt at about the sixth month, and all get erupted by the end of the second year or soon
after. The teeth of the lower jaw erupt slightly earlier than those of the upper jaw. The approximate ages of eruption of
deciduous and permanent teeth are given in Blood supply of teeth—both upper and lower are supplied by branches of
maxillary artery.

Nerve Supply of Teeth

 The pulp and periodontal membrane have the same nerve supply which is as follows:
 The upper teeth are supplied by the posterior superior alveolar, middle superior alveolar, and the anterior superior
alveolar nerves (maxillary nerve).
 The lower teeth are supplied by the inferior alveolar nerve (mandibular nerve)

HARD PALATE
 It is a partition between the nasal and oral cavities. Its anterior two-thirds are formed by the palatine processes of
the maxillae; and its posterior one-third by the horizontal plates of the palatine bones .
 The anterolateral margins of the palate are continuous with the alveolar arches and gums.
 The posterior margin gives attachment to the soft palate.
 The superior surface forms the floor of the nose.
 The inferior surface forms the roof of the oral cavity.

Vessels and Nerves

 Arteries: Greater palatine branch of maxillary artery.
 Veins: Drain into the pterygoid plexus of veins.
 Nerves: Greater palatine and nasopalatine branches of the pterygopalatine ganglion suspended by the maxillary nerve.
 Lymphatics: The lymphatics drain mostly to the upper deep cervical nodes and partly to the retropharyngeal nodes.

SOFT PALATE
 It is a movable, muscular fold, suspended from the posterior border of the hard palate.
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  It separates the nasopharynx from the oropharynx, the crossroads between the food and air passages.
 The soft palate has two surfaces—anterior and posterior; and two borders—superior and inferior.
 The anterior (oral) surface is concave and is marked by a median raphe.
 The posterior surface is convex, and is continuous superiorly with the floor of the nasal cavity.
 The superior border is attached to the posterior border of the hard palate, blending on each side with the pharynx .
 The inferior border is free and bounds the pharyngeal isthmus. From its middle, there hangs a conical projection, called
the uvula .
 From each side of the base of the uvula (Latin small grape), two curved folds of mucous membrane extend laterally and
downwards. The anterior fold is called the palatoglossal arch or anterior pillar of fauces.
 It contains the palatoglossus muscle and reaches the side of the tongue at the junction of its oral and pharyngeal parts.
This fold forms the lateral boundary of the oropharyngeal isthmus or isthmus of fauces. The posterior fold is called the
palatopharyngeal arch or posterior pillar of fauces. It contains the palatopharyngeus muscle. It forms the posterior
boundary of the tonsillar fossa, and merges inferiorly with the lateral wall of the pharynx.

Structure
The soft palate is a fold of mucous membrane containing the following parts.

• The palatine aponeurosis which is the flattened tendon of the tensor veli palatini forms the fibrous basis of the palate. Near
the median plane, the aponeurosis splits to enclose the musculus uvulae.

• The levator veli palatini and the palatopharyngeus lie on the superior surface of the palatine aponeurosis.

• The palatoglossus lies on the inferior or anterior surface of the palatine aponeurosis.

• Numerous mucous glands, and some taste buds are present.

Soft palate comprises epithelium, connective tissue and muscles. Epithelium is from the ectoderm of maxillary process. The
muscles are derived from 1st, 4th and 6th branchial arches and accordingly are innervated by mandibular and vagoaccessory
complex.

Muscles of the Soft Palate

They are as follows:

1 Tensor palati (tensor veli palatini)

2 Levator palati (levator veli palatini)

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3 Musculus uvulae

4 Palatoglossus

5 Palatopharyngeus.

Nerve Supply
1. Motor nerves. All muscles of the soft palate except the tensor veli palatini are supplied by the pharyngeal plexus. The
fibres of this plexus are derived from the cranial part of the accessory nerve through the vagus. The tensor veli palatini
is supplied by the mandibular nerve.

2.General sensory nerves are derived from:

a. The middle and posterior lesser palatine nerves, which are branches of the maxillary nerve through the

pterygopalatine ganglion.

b. The glossopharyngeal nerve.

3. Special sensory or gustatory nerves carrying taste sensations from the oral surface are contained in the lesser palatine
nerves. The fibres travel through the greater petrosal nerve to the geniculate ganglion of the facial nerve and from there to the
nucleus of the tractus solitarius .

4 Secretomotor nerves are also contained in the lesser palatine nerves. They are derived from the superior salivatory nucleus
and travel through the greater petrosal nerve.

Movements and Functions of the Soft Palate

 The palate controls two gates—upper air way or the pharyngeal isthmus and the upper food way or oropharyngeal
isthmus. The upper air way crosses the upper food way .
 The soft palate can completely close them, or can regulate their sizes according to requirements. Through these
movements, the soft palate plays an important role in chewing, swallowing, speech, coughing, sneezing, etc. A few
specific roles are given below.

1 It isolates the mouth from the oropharynx during chewing, so that breathing is unaffected.

2 It separates the oropharynx from the nasopharynx by locking Passavant’s ridge during the second stage of swallowing, so that
food does not enter the nose.

3 By varying the degree of closure of the pharyngeal isthmus, the quality of voice can be modified and various consonants are
correctly pronounced.

4 During sneezing, the blast of air is appropriately divided and directed through the nasal and oral cavities without damaging
the narrow nose. Similarly during coughing, it directs air and sputum into the mouth and not into the nose.

Blood Supply
Arteries
1 Greater palatine branch of maxillary artery .

2 Ascending palatine branch of facial artery.

3 Palatine branch of ascending pharyngeal artery.

Veins
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They pass to the pterygoid and tonsillar plexuses of veins.

Lymphatics
Drain into the upper deep cervical and retropharyngeal lymph nodes.

LYMPHATIC DRAINAGE OF ORAL CAVITY

1. Lips. Lower: Medial portion of lower lip drains into sub- mental and lateral portion to submandibular nodes. Upper: Drain
into preauricular, infraparotid and subman- dibular nodes.

2. Buccal mucosa. Submental and submandibular nodes.

3. Upper and lower alveolar ridges. Buccal aspect of mucosa drains into submental and submandibular nodes. Lingual aspect of
upper alveolus drains into upper deep cervical and lateral retropharyngeal nodes.

Lingual aspect of lower alveolus drains into submandibu- lar nodes.

4. Hard palate. Upper deep cervical and lateral retropha- ryngeal nodes. Anterior part of palate drains into sub- mandibular
nodes.

5. Floor of mouth. Anterior portion of floor of mouth drains into submandibular nodes. Lymphatics from this area also cross the
midline. Posterior portion drains into upper deep cervical nodes.

6. Tongue. Tip of tongue drains into submental and jugulo- omohyoid nodes, lateral portion drains into ipsilateral,
submandibular and deep cervical nodes. Central portion and base drain into deep cervical nodes of both sides.

Oral cavity is used for ingestion of food and fluids. It is continued posteriorly into the oropharynx, the middle part of the
muscular pharynx. In its upper part, opens the posterior part of the nasal cavity and the inlet of larynx opens into its lower part.
Roof of oral cavity is formed by the hard and the soft palates. Tongue is the biggest occupant of the oral cavity.

The cavity also contains 32 teeth in an adult.

PHYSIOLOGY OF ORAL CAVITY

FUNCTIONS OF MOUTH
Primary function of mouth is eating and it has few other important functions also.

Functions of mouth include:

1. Ingestion of food materials

2. Chewing the food and mixing it with saliva

3. Appreciation of taste of the food

4. Transfer of food (bolus) to the esophagus by swallowing

5. Role in speech

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6. Social functions such as smiling and other expressions.

 SALIVARY GLANDS
In humans, the saliva is secreted by three pairs of major (larger) salivary glands and some minor (small) salivary glands.

 MAJOR SALIVARY GLANDS

Major glands are:

1. Parotid glands

2. Submaxillary or submandibular glands

3. Sublingual glands.

1. Parotid Glands

Parotid glands are the largest of all salivary glands, situated at the side of the face just below and in front of the ear. Each gland
weighs about 20 to 30 g in adults. Secretions from these glands are emptied into the oral cavity by Stensen duct. This duct is
about 35 mm to 40 mm long and opens inside the cheek against the upper second molar tooth .

2. Submaxillary Glands

Submaxillary glands or submandibular glands are located in submaxillary triangle, medial to mandible. Each gland weighs about
8 to 10 g. Saliva from these glands is emptied into the oral cavity by Wharton duct, which is about 40 mm long. The duct opens
at the side of frenulum of tongue, by means of a small opening on the summit of papilla called caruncula sublingualis.

3. Sublingual Glands

Sublingual glands are the smallest salivary glands situated in the mucosa at the floor of the mouth. Each gland weighs about 2
to 3 g. Saliva from these glands is poured into 5 to 15 small ducts called ducts of Rivinus. These ducts open on small papillae
beneath the tongue. One of the ducts is larger and it is called Bartholin duct . It drains the anterior part of the gland and opens
on caruncula sublingualis near the opening of submaxillary duct.

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  MINOR SALIVARY GLANDS
1. Lingual Mucus Glands
Lingual mucus glands are situated in posterior one third of the tongue, behind circumvallate papillae and at the tip and
margins of tongue.

2. Lingual Serous Glands

Lingual serous glands are located near circumvallate papillae and filiform papillae.

3. Buccal Glands

Buccal glands or molar glands are present between the mucus membrane and buccinator muscle. Four to five of these are
larger and situated outside buccinator, around the terminal part of parotid duct.

4. Labial Glands

Labial glands are situated beneath the mucus membrane around the orifice of mouth.

5. Palatal glands

Palatal glands are found beneath the mucus membrane of the soft palate.

PROPERTIES AND COMPOSITION OF SALIVA

 PROPERTIES OF SALIVA
1. Volume: 1000 mL to 1500 mL of saliva is secreted per day and it is approximately about 1 mL/minute.
Contribution by each major salivary gland is:
i. Parotid glands : 25%
ii. Submaxillary glands : 70%
iii. Sublingual glands : 5%.

2. Reaction: Mixed saliva from all the glands is slightly acidic with pH of 6.35 to 6.85

3. Specific gravity : It ranges between 1.002 and 1.012

4. Tonicity : Saliva is hypotonic to plasma.

COMPOSITION OF SALIVA
Mixed saliva contains 99.5% water and 0.5% solids.

Composition of saliva is given in

FUNCTIONS OF SALIVA
Saliva is a very essential digestive juice. Since it has many functions, its absence leads to many inconveniences.

1. PREPARATION OF FOOD FOR SWALLOWING

When food is taken into the mouth, it is moistened and dissolved by saliva. The mucus membrane of mouth is also moistened
by saliva. It facilitates chewing. By the movement of tongue, the moistened and masticated food is rolled into a bolus. Mucin of
saliva lubricates the bolus and facilitates swallowing.

2. APPRECIATION OF TASTE

Taste is a chemical sensation. By its solvent action, saliva dissolves the solid food substances, so that the dissolved substances
can stimulate the taste buds. The stimulated taste buds recognize the taste.

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3. DIGESTIVE FUNCTION

Saliva has three digestive enzymes, namely salivary amylase, maltase and lingual lipase .

 Salivary Amylase

Salivary amylase is a carbohydrate-digesting (amylolytic) enzyme. It acts on cooked or boiled starch and converts it into dextrin
and maltose. Though starch digestion starts in the mouth, major part of it occurs in stomach because, food stays only for a
short time in the mouth. Optimum pH necessary for the activation of salivaryamylase is 6. Salivary amylase cannot act on
cellulose.

Maltase

Maltase is present only in traces in human saliva and it converts maltose into glucose.

Lingual Lipase

Lingual lipase is a lipid-digesting (lipolytic) enzyme. It is secreted from serous glands situated on the posterior aspect of tongue.
It digests milk fats ( Pre-emulsified fats). It hydrolyzes triglycerides into fatty acids and diacylglycerol .

„ 4. CLEANSING AND PROTECTIVE FUNCTIONS

i. Due to the constant secretion of saliva, the mouth and teeth are rinsed and kept free off food debris, shed epithelial cells and
foreign particles. In this way, saliva prevents bacterial growth by removing materials, which may serve as culture media for the
bacterial growth.

ii. Enzyme lysozyme of saliva kills some bacteria such as stathylococcus, streptococcus and brucella.

iii. Proline-rich proteins present in saliva posses antimicrobial property and neutralize the toxic substances such as tannins.
Tannins are present in many food substances including fruits.

iv. Lactoferrin of saliva also has antimicrobial property.

v. Proline-rich proteins and lactoferrin protect the teeth by stimulating enamel formation.

vi. Immunoglobulin IgA in saliva also has antibacterial and antiviral actions.

vii. Mucin present in the saliva protects the mouth by lubricating the mucus membrane of mouth.

5. ROLE IN SPEECH

By moistening and lubricating soft parts of mouth and lips, saliva helps in speech. If the mouth becomes dry, articulation and
pronunciation becomes difficult .

6. EXCRETORY FUNCTION

Many substances, both organic and inorganic, are excreted in saliva. It excretes substances like mercury, potassium iodide,
lead, and thiocyanate. Saliva also excretes some viruses such as those causing rabies and mumps. In some pathological
conditions, saliva excretes certain substances, which are not found in saliva under normal conditions. Example is glucose in
diabetes mellitus. In certain conditions, some of the normal constituents of saliva are excreted in large quantities. For example,
excess urea is excreted in saliva during nephritis and excess calcium is excreted during hyperparathyroidism.

7. REGULATION OF BODY TEMPERATURE

In dogs and cattle, excessive dripping of saliva during panting helps in the loss of heat and regulation of body temperature.
However, in human beings, sweat glands play a major role in temperature regulation and saliva does not play any role in this
function.

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8. REGULATION OF WATER BALANCE

When the body water content decreases, salivary secretion also decreases. This causes dryness of the mouth and induces
thirst. When water is taken, it quenches the thirst and restores the body water content.

REGULATION OF SALIVARY SECRETION

Salivary secretion is regulated only by nervous mechanism. Autonomic nervous system is involved in the regulation of salivary
secretion.

Bibliography
 Disease of ear,nose and throat & head and neck surgery by PL Dhingra
 Human anatomy by BD Chaurasia
 Essential of medical physiology by K Sembulingam
 Text book of salakya tantra by prof. Narayan j. Vidhwansa

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