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HISTOLOGY OF ORAL MUCOUS

MEMBRANE AND GINGIVA

Vinay Pavan Kumar .K


1st year MDS
AECS Maaruti College of Dental Sciences
Functions Classification

Definition Structure

HISTOLOGY OF ORAL MUCOUS


MEMBRANE AND GINGIVA

Prosthetic
Organization
consideration

Histology of
Biological width
gingiva
INTRODUCTION

The oral cavity is in many respects a very


interesting part of the human body .

Many different kind of tissue from the hardest


teeth to the softest, the salivary glands are
found therein.

The oral cavity is lined with an uninterrupted


mucosa which is continuous with the skin near
vermillion border of the lips and with the
pharyngeal mucosa in the region of soft palate
Functions of oral mucosa

Protection :
Barrier for mechanical trauma and
microbiological insults
Sensation :
Temperature (heat and cold), touch, pain,
Reflexes such as swallowing, gagging and
salivation
Absorption :
Nitrates are absorbed sublingually
Secretion:
Salivary secretion creates a moist oral
cavity helps in speech, swallowing,
mastication and in the perception of taste.
Thermal regulation:
Important in dogs not in humans
Excretion:
excretion of certain metabolites
Esthetics :
Lips and gingiva enhance facial esthetics
Classification of oral mucosa
Based upon primary function served
1. Masticatory Mucosa (25%)
2. Lining Mucosa (Covers 60% of total area)
3. Specialised Mucosa (15%)

Based upon keratinisation


1. Keratinised
Orthokeratinized

Parakeratinized
2. Non-keratinised.
Based upon Location

1. Buccal Mucosa.

2. Lingual Mucosa.

3. Palatal Mucosa.

4. Labial Mucosa.

5. Alveolar Mucosa.

Structure of Oral Mucosa

Epithelium

Lamina Propria.

Submucosa
Epithelium
Epithelium of the oral mucosa is stratified squamous
epithelium.

It may be

1.Keratinized
2.Non keratinized

Keratinized layer
ortho keratinized
Para keratinized
Oral epithelium

Consists of two populations of cells:


Progenitor population
Maturing population

Progenitor cells function is to divide and


provide new cells

Maturing cells continually undergo a


process of differentiation or maturation to
form a protective layer
Progenitor Cells

Stem cells Amplifying Cells

Slow dividing Rapidly dividing


Maintain basal cell layer Form other cell layers.
Turn over time
The time taken for a proginetor cell to pass through
the entire epithelial thickness and reach the surface

Skin : 52 75 days

Gut : 4 14 days

Gingiva : 41 57 days

Cheek : 25 days

Junctional Epithelium : 5 - 6 days


Keratinized oral mucous membrane
Keratinised Epithelium
(light microscopy)
Keratinised Epithelium
(Electron Microscopy)
Stratum Basale
Basal layer made of cell that synthesize DNA &
undergo mitosis.

Basal cells show ribosomes & elements of rough


endoplasmic reticulum indicative of protein
synthesizing activity.
Structureless zone seen under
light microscope is basement
membrane.
1 4 microns wide.

Under electron microscope,


Basal lamina
lamina lucida light zone
lamina densa dark
zone
Basal cells are attached to basal lamina by
hemidesmosomes.

Epithelial cell-cell contact is made through


desmosomes - macula adherens. These are
anchored intracellularly by tonofibrils.
i) Serrated- heavily packed with tonofilaments
which are adaptations for attachment.

ii) Non-serrated stem cells slowly dividing


cells which serve to protect genetic information of
the tissue.
Stratum spinosum or prickle cell
layer:
It is a layer of relatively large irregular polyhedral
cells.
Show first sign of maturation.

Nuclei stains less intense the intercellular spaces of


the prickle layer are large and distended, with more
prominent desmosomes
Stratum granulosum

Flatter & wider & nuclei show signs of degeneration &


pyknosis.
Active in protein synthesis.

Involucrin - soluble precursor protein of the


cornified envelope appears first in the spinosum.

Protein synthesis rate progressively gets


diminished as cell approaches stratum corneum.

In the upper part cells of stratum granulosum,


shows granules called ODLAND BODIES.
Keratinosome or odland bodies or
membrane containing granules
Modified lysosomes

0.25m in length.

Rich in phospholipids.

Structure - layers of parallel lamellae, probably


originating from golgi apparatus.

Lamellar granules discharge their contents -


permeability barrier.
Stratum corneum
Made up of keratinised squamae, which are
larger & flatter than the granular cells.

Nuclei & other organelles disappear.


Cell surfaces in this layer are more regular &
more closely adapted to adjacent cell surfaces.

The filaggrin a non fibrous inter-filamentous


matrix protien helps in this close adaptation.
Types of keratinized epithelium
Parakeratinized Epithelium :The superficial cells
are dead but retain the nucleus
Orthokeratinized Epithelium : The nuclei are lost
in epithelium
Non keratinized epithelium
Nonkeratinized epithelial cells in the superfacial
layers do not have keratin filaments in the cytoplasm

The surface cells also have nuclei

This epithelium is associated with lining of the oral


cavity
Difference
Keratinized Nonkeratinized

Layers - basal, spinosum, Layers-basal,intermediate,


granular, cornified layer. surface layer.

Do not produce a cornified


Produce a cornified surface layer.
surface layer.
Intercellular spaces not
Prickly appearance. obvious-no prickly
appearance.
No nuclei-orthokeratinised Stratum superficiale
Pyknotic nuclei- contains nucleated cells
parakeratinised

Filaggrin present. Lack filaggrin,but contain


involucrin.

Numerous Less developed and


tonofilaments,keratohyaline dispersed tonofilments,lack
granules present. keratohyaline granules.
Lamina Propria
Two Layers
Papillary layer
Close to epithelial ridges.
Arranged loosely.

Reticular layer
Parallel to epithelium.
Fibers are very thick.

Consists of cells , blood vessels, neural elements &


fibers embedded in amorphous ground substance.
Cells found in lamina propria
Fibroblast
Histiocytes
Macrophages
Mast cell
Polymorph nuclear leucocytes
Lymphocytes
Plasma cells
Endothelial cells
Submucosa

It attaches the mucous


membrane to the
underlying structures
muscle or bone

loose or a firm attachment


and consists of glands,
blood vessels, nerves, &
adipose tissues.
connective tissue of
various thickness
Nonkeratinocytes

Langerhans cells:Dendritic cells.

Merkel cell: touch receptors

Melanocytes: melanin systhesis

Inflammatory cells
Organization of the Oral Mucosa
3 types according to function:

Masticatory Mucosa:25% of total mucosa.

Lining Mucosa:60% of total mucosa

Specialized Mucosa:15% of total mucosa.


Lining mucosa
Covers the floor of mouth, ventral (underside)
tongue, alveolar mucosa, cheeks, lips and soft
palate.

Lip
Lip is covered by lining mucosa
Vermilion border
Junction between the skin and mucous membrane
of the lip
Floor of the mouth
Loosely attached to the underlying structures

Submucosa adipose tissue


Ventral surface of the tongue
The mucous membrane is tightly bound to the
muscle bundles of the tongue smooth and relatively
thin
Cheek
Submucosa contains fat cells and small mixed
salivary glands
Mucosa of the Tongue - Specialised
mucosa
Anatomical division
It is divided into two parts by a V-shaped groove
known as sulcus terminalis.

Anterior 2/3rd or papillary portion or body of the


tongue contains lingual papillae.

Posterior 1/3rd is lymphatic portion or base of the


tongue contains lingual tonsil.
The different papillae found on the dorsal surface of
the tongue are:
1. Filliform papillae
2. Fungiform papillae
3. Circumvallate papillae
4. Foliate papillae
1. Filliform papillae

Pointed extensions of the


keratinized epithelial cells

Most numerous papillae of the


tongue
Scanning electron micrograph of
Filliform papillae(arrow)

Not associated with taste buds


2. Fungiform papillae

Fewer than the filliform papillae and are scattered


over the dorsal surface of the tongue

Rounded elevations above the surface of the tongue

Have taste buds on their superior surfaces

Not keratinized
3. Circumvallate papillae

Located at the junction of the anterior two thirds (body)


and posterior one thirds (base) of the tongue

There are eight to twelve in number

Lined with taste buds and also openings of serous


glands

The secretion from the serous glands washes away


food for renewal of taste
4. Foliate papillae

Located in the furrows along the posterior sides of


the tongue

Lined with taste buds

Not prominent in human beings


Taste Buds
They are small ovoid barrel shaped organs

40 micron thick and 80 micron high

Their outer surface is covered by flat cells


which surround a small opening called the Taste
Pore
Areolar mucosa
The areolar mucosa is a reddish-pink
tissue with blue vascular areas.

The epithelium is extremely thin non-


keratinized mucosa with a lamina propria
Hard Palate
Covered by masticatory mucosa
lateral regions of the posterior part contains
palatine glands
Gingiva

Covers the alveolar process of jaws and


surrounds the cervical portion of teeth.
It develops from the union of oral epithelium and
reduced enamel epithelium
Gingiva can be classified as
Free gingiva,
Attached gingiva and
Interdental papilla
Free gingiva (marginal gingiva)

Part of the oral mucosa


that surrounds the necks
of the teeth and forms the
free margin of the gingival
tissue

differentiated apically by
the free gingival groove
Attached gingiva
Between the free gingival groove and the
alveolar mucosa

The junction of the attached gingiva and the


alveolar mucosa is called mucogingival junction

In healthy mouth attached gingiva shows


stippling
Interdental papilla
Appear in-between teeth apical to the contact
points
Valley like depression in the interdental papilla
called Col.
Gingival sulcus

Space or potential space between the tooth


surface and the free gingiva.

It is lined with sulcular epithelium

Extends from free gingival margin to the


junctional epithelium.
Junctional epithelium
Forms the seal of the gingival epithelium and the
tooth

Floor of the gingival sulcus and extends apically


to the enamel of the tooth

Disturbances of epithelial attachment results in


deepening of the sulcus which is a sign of
gingival/periodontal disease
Sulcular epithelium

It is nonkeratinized.

No rete pegs in sulcular epithelium.

Sulcular epithelium is continuous With gingival


epithelium & the attachment epithelium
Gingiva contains dense fibers of
collagen:

Dentogingival : extends from the


cervical cementum into the lamina
propria of the gingiva.

Circular: small group of fibers


that circle the tooth & interlace
with other fibers.
Dentoperiosteal: fibers
can be followed from the
cementum into periosteum
of the alveolar crest & of
the buccal & palatal or
lingual surface of the
alveolar bone.

Alveologingival: fibers
arise from the alveolar
crest & extends into lamina
propria.
Biologic Width
Biologic width
The dimension of space that the healthy gingival
tissues occupy above the alveolar bone is the
biologic width.

Connective Tissue attachment + junctional


epithelium constitutes Biologic width
1.07mm +0.97mm= 2.04 mm

Any restoration should be atleast 3mm above


the alveolar crest to prevent the violation of the
biologic width.
Passive Eruption
Effect Of Aging On The Oral
Mucosa

Epithelial thinning
Decreased keratinization
Less prominent rete pegs
Decreased cellular proliferation
Loss of submucosal elastin and fat
Increased fibrotic connective tissue with
degenerative alteration in the collagen.
Prosthetic considerations
Behaviour of oral mucosa under
stress
Under compression behaves in a viscoelastic fashion.

Loaded epithelium demonstrates decrease in the


depth of epithelial ridges & connective tissue papillae

Care to be taken during impression procedures by


applying minimal pressures.
Tissue response
A. Recently made dentures:
Inflammation .
Soft tissue distortion.
Impingement of gingival margin.
Accumulation of dental plaque.

B. Dentures in use for > 1 year


Hyperkeratosis.
Scarring of tissue in border area.
Gross tissue distortion.
Soft tissue changes in oral mucosa
due to prostheses
soft tissue hyperplasia
fibrous hyperplasia.
epulis fissurata.
papillary hyperplasia.
inflammatory process under denture bases
denture stomatitis.
Candidiasis.
ulcerative lesions
angular chelitis.
Soft tissue hyperplasia
Rolls of hyperplastic tissues under denture
base
Due to bone resorption, with lesion filling the
space under denture base.
Develops slowly, painless.

Surgical removal.
New dentures.

Papillary hyperplasia

Granular type of inflammation


seen in palatal region.
Numerous papillary projections
give a warty appearance.
They show precancerous
tendencies.

Discontinue denture wearing.


Surgery.
New dentures
Epulis Fissuratum
It is a pathologic condition that
appears in the mouth as an
overgrowth of fibrous connective
tissue.

Also known as inflammatory


fibrous hyperplasia, denture
epulis and denture induced
fibrous hyperplasia.

It is mainly caused due to ill


fitting dentures
Denture stomatitis

Chronic inflammation
Ill fitting denture.
Nocturnal denture wearing.
Hypersensitivity.
Poor oral hygiene.
Infections Candida
albicans.
Candidiasis
Debilitated patients.
Systemic disease such as
diabetes.
Unhygienic conditions.

- Discard the existing


denture.
- Anti fungal therapy
- New dentures.
Angular chelitis
SIGNS
Bilateral lesion that develops at the angle of
the lips.
Deep fissure or crack may be seen.
Appear ulcerated.
Exudatve crust may be present.

Anti fungal therapy.


Denture bearing area

Points to be considered while fabrication of


denture:
Selective placement of forces by denture
base on supporting tissues.
Form and placement of denture borders to
accommodate normal function.
Selective placement of force can be achieved by
employing different impression techniques
depending on the patients oral condition
Minimal pressure technique/Mucostatic
technique .

Selective pressure technique.

Pressure / Muco-compressive technique.


Crest of the residual ridge
(maxillary)

Firmly attached to the bone.


Keratinized epithelium.
Dense collagen fibers .
Sub mucosa fat or glandular
cells.

Primary support for denture.


Palatine rugae
Irregularly shaped rolls of soft
tissue in the anterior part of
hard palate.

Clinical considerations
Secondary stress bearing area.
Resists forward movement of denture.
Tissue rebound phenomenon.
Maxillary major connector should end into
depressions between the rugae.
Mucous membrane of hamular notch
Space between the posterior part of
the maxillary tuberosity & pterygoid
hamulus.
It is thick and made of loose areolar
tissue.
Marks the distal end of
denture.
Buccal shelf area

Partially keratinized.

Loosely attached.

Bone compact bone.

Clinical implication

Impression should cover


the entire available area.
Slope of the residual ridge
(mandibular)

Keratinized epithelium .

When the soft tissue is


movable in the crest of the
ridge ,impression should be
recorded in its resting position.
F.P.D & oral mucosa
Sub gingival finish
esthetics.

old restoration extending into the


intracrevicular space.

Insufficient vertical length or height

Margins should be smooth with proper


fit.
Esthetics & oral mucosa

Case of Altered passive eruption(APE)


Implants and Biological width

It has been found that the biological


width need not be a vertical
dimension but can have a horizontal
component.
Platform switching provides this
horizontal distance and so preserves
the crestal bone.
CONCLUSION
References

Ten Cate A R, Oral histology development,structure


and function, 5th edition, India, Mosby, 1999, pp 345-
385.
Kumar G S, Orbans oral histology and embryology,
12th edition,India, Elsevier,2006, pp 210-257
Zarb G.A, Bolender C L, Prosthodontic treatment for
edentulous patients, 12th edition, India, Elsevier, 2004,
pp 84-86, 211-223,233-241
Avery J K, Oral development and histology, 3rd edition,
New York, Thieme, 2002, pp 243-252.