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Masticatory Mucosa

ORAL MUCOSA
Presented by

Firm & immobile mucosa; pink in color; keratinized& functions during mastication.

Gingiva Covering of hard palate

Hanaa Aly
Professor of Oral Biology Faculty of Dentistry Alexandria UniversityProf. Hanaa Aly

Gingiva: is that part of oral mucosa that surrounds the neck of teeth and cover alveolar process. Morphologically it is divided into 3 areas or zones: 1- free or marginal gingiva 2- attached gingiva 3- interdental papilla

Prof. Hanaa Aly

Ten Cates 2008 p350

1-boundaries of Free gingiva ( marginal gingiva):

coronally by gingival margin, apically by free gingival groove inner margin by gingival sulcus outer surface by vestibular and oral cavities

2-boundaries of Attached gingiva:

Between free gingiva and alveolar mucosa Separated from alveolar mucosa by mucogingival junction Wider in anterior (5-6mm) than posterior (3mm)

3- boundaries of Interdental papilla

wedge shaped, occupies the space between to adjacent teeth apical to contact area

Prof. Hanaa Aly

What is the mucogingival junction ?

Prof. Hanaa Aly

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Stippling of Attached gingiva (orange (orange-peel appearance):

Portions at the epithelium appear to be elevated , & between the elevations there are shallow depressions .CT papilla project into the elevations Characteristic of normal gingiva Functional adaptation to mechanical impacts Absence of stippling means edema

Gingival sulcus shallow groove between the tooth & normal gingiva Its depth = 0.5 - 3 mm Contains gingival fluid in which desquamated epithelial cells & neutrophils exist

Interdental grooves:
Slight vertical folds of the gingiva extends e vertically toward interdental papilla and correspond to depressions between the roots of adjacent teeth

age and sex:

(a) Males tend to have more heavily stippled gingiva than females. (b) In younger females the connective tissue is finely textured than in males. (c) Females' cells contain a large chromatin particle adjacent to the nuclear membrane ( Barr's body).

Prof. Hanaa Aly

Prof. Hanaa Aly

The interdental gingiva: It is the continuation of the attached and free gingiva in the interdental spaces between the teeth. It is attached to the crest of the alveolar bone and supported by it. Facially and lingually the interdental gingiva is triangular, the base of the triangle extends from the margin of the gingiva at the center of one tooth to the center of the next. The interdental papilla is the free part of the interdental gingiva reaching up to the contact area

Prof. Hanaa Aly

Interdental Col interproximal to vestibular & oral cavity surfaces of IDP

3 dimension of IDP: Anterior teeth (pyramidal) Posterior teeth (tent shape)

Prof. Hanaa Aly

a valleyvalley-like depression (concave area) between the buccal & lingual raised margins of IDP Lies directly below the contact points of posterior teeth(broad contact areas) Gingival epith is thin nonkeratinized+ numerous epith ridges +signs of inflammation By age the col flatten because the vestibular & interdental peaks descend

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Histology of the Gingiva:

surface epithelium: Is a stratified squamous epithelium containing nonkeratinocytes. The epithelium: is of three types.

Turnover time
The turnover time of the gingival epithelium varies from 41-57 days. Definition :

Orthokeratinized epithelium: the stratum corneum consists of flat tightly

packed scales showing no nuclei. This type constitutes 15%.

Parakeratinized epithelium: the stratum corneum retain pyknotic nuclei

This type constitutes 75%.

It is the time necessary for the epithelial cell to divide and migrate through the entire epithelium to be desquamated at the surface.

Nonkeratinized epithelium: This type accounts for about 10%.

gingival sulcus, the epithelium of the col

and the junctional epithelium

Prof. Hanaa Aly Prof. Hanaa Aly

study table 12-6 Ten Cates 2008, p347 masticatory mucosa

Microscopic appearance of the gingiva Dense collagenous lamina propria (Gingival Ligament):
1-Dentogingival fibers (cementum to lamina propria of gingiva) 2-Alveologingival fibers (bone to lamina propria of gingiva) 3-Circular fibers 4-Dentoperiosteal (cementum to periosteum)

Blood supply of gingiva

1-Interdental Alveolar Arterioles penetrate ID septa 2-Supraperiosteal Arterioles facial & lingual surfaces of alveolar bone 3-PDL vessels extend to gingiva & anastomose with capillaries in sulcus

Lymph vessels of the gingiva

rich network ; along bld vs to submandibular & submental lymph nodes

Nerve supply of the gingiva 5-Transseptal fibers:Interproximally between 2 teeth No submucosa (Mucoperiosteum)
gingiva is well innervated Nerve endings: free, Meissner,Krause & Ruffini corpuscles

Any one of these nerve endings responds to most of the sensation modalities, heat , cold, touch and pain i.e. they are polymodal

Prof. Hanaa Aly

Prof. Hanaa Aly

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Dentogingival junction
A unique anatomic feature . It is the junction between epith & enamel ( the principal seal between oral cavity & underlying tissues) Derived from reduced enamel epithelium & regenerate from adjacent oral epith Components : 1-gingival epithelium (orthokeratinized or paraparakeratinized str sq epith) 2-sulcular epithelium (nonkeratinized str sq epith) 3-junctional epitheliu (immature flat cells oriented parallel to tooth surface lying on basal cells) tapered(3 tapered( 3-4 layers apically to 15 15-30 layers coronally) it has outer basal lamina attaches epith to CT; inner basal lamina adheres to tooth surface differ from outer basal lamina that type IV & VII collagens are not present:it contain amelotin

Dentogingival junction connective tissue component:

How CT determine the epithelial expression? TWO factors: 1-Lamina propria provide instructive influences Deep CT possesses only permissive factors

Epithelial attachment Mode of attachment of junctional epithelium:

means of attachment on tooth(E or C) consist of inner basal lamina+hemidesmosomes

Ultrastructure of junctional epith:fewer tonofilaments& desmosomes, wide intercellular spaces,presence

of neutrophils, st basament membrane Basal cells undergo cell division high rate(4 rate(4-6 days) ;migratory route of cells is coronally parallel to tooth surface then desquamate into gingival sulcus

2-Inflammation ? What is the importance of that junctional epith is in contact with deep CT? 1-to remain undifferentiated 2-to form epithelial attachment Low level of Inflammation in CT lead to Passive eruption

Prof. Hanaa Aly

Prof. Hanaa Aly

Prof. Hanaa Aly

Orbans Oral Histology & Embrology p308 p308& &309

Avery 3rd ed Oral Development and Histology p252-253

Masticatory mucosa

Passive Eruption (shift of DGJ)

Apical migration of the junctional epithelium on the tooth surface

What are the four stages of passive eruption?

Where is the bottom of the sulcus &apical end in each stage?

At what age the first & second persist? Clinical crown? p 309 Anatomical crown ? p 309

MUCOPERIOSTEUM : -Gingival region -Palatine raphe (median median) -rugae (traction bands ?) SUBMUCOSA : -Anterolateral area fatty fatty zone zone -Posterolateral are glandular glandular zone zone Incisive papilla:Covered by keratinized mucosa Dense CT may contain - nasopalatine duct remnants - cartilage - epithelial pearls Why there are areas of submucosa in hard palate?p347 Ten Cates 2008 table 12-6

Prof. Hanaa Aly

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Lining mucosa (table 12-6 p347 Ten Cates 2008)

FIRMLY ATTACHED: Soft palate Labial & buccal mucosa Ventral (inferior) surface of tongue

Ten Cates Oral Histology 2008 p 347 table 12-6 &p350

Mucocutaneous junction(vermilion zone)junction bet skin & labial mucosa
No appenndages Few sebaceous glands (crack in cold weather) Thin keratinized epith Protein in epithelial cells (eleidin) more transparent Numerous long CT papillae containing capillary loops (blood close to surface give red coloration)

LOOSELY ATTACHED:
What is the structure of each? Where is the thinner & thickest epith? Where is elastic fibers found? Floor of mouth (more permeable to drugs) Vestibular fornex Alveolar mucos

Intermediate zone (suckling pad)

Bet vermilion zone & labial mucosa Infants Thickened Covered by parakeratinized epith Elastic fibers

Prof. Hanaa Aly

Prof. Hanaa Aly

Ten Cates 2008 p 320& 321

CLINICAL FEATURES

Specialized mucosa(dorsal surface of tongue)

KERATINIZED Anesthessia painful? Biopsy no suture? Need suture? Tongue papillae: Filiform papillae (masticatory function) Funiform papillae (flexibility:taste ) Circumvallate papillae (taste); (von Ebner glands) Folliate papillae (taste) NONNON -KERATINIZED Not painful ? Anterior 2/3(covered by papillae) Posterior 1/3(covered by lymphoid nodules;lingual tonsils)

Fordyces spots: sebaceous glands appear pale yellow spots Present in: upper lip; buccal mucosa; occassionally in alveolar mucosa & dorsum of tongue Linea alba: slight whitish ridge occurs along buccal mucosa in occlussal plane Keratinized Rough restoration or cheek biting

Mention their distribution on tongue surface? What is the structure of each under microscope?

Prof. Hanaa Aly

Ten Cates 2008 p349-350

Prof. Hanaa Aly

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Ten CatesTaste 2008buds p344-346

found in soft palate; pharynx; fungiform; circumvallate; folliate papillae

Barrel shaped 30-80 spindle shaped cells Basal lamina bet cells & CT Taste pore 2 types of cells: Type I(dark; numerous vesicles; adjacent to nerves;junctional complexes) Type II (supporting cells;large pale nucleus)
Prof. Hanaa Aly

The posterior third of the tongue

irregularly studded with round or oval prominences, lingual follicles. one or more lymph nodules, lingual tonsil + the palatine tonsils +pharyngeal tonsils (adenoids) completes Waldeyer's ring of lymphoid tissue guarding the entrance of the gastrointestinal and the respiratory tracts.

Prof. Hanaa Aly

(Ten Cates 2008 p355-356)

AGE CHANGES OF ORAL MUCOSA

Epithelium : thinner ; flattening of epith ridges; more fragile Fewer Langerhans cells & immunity decline Lamina Propria :decrease in cellularity ;increase in collagen (coarser) Fordyces spots (sebaceous glands) increase Minor salivary glands : atrophy Tongue :reduced # of filiform ; foliate more prominent(smooth, glossy) Nodular varicose veins (cavier tongue) Recession of gingiva & decrease in height of IDP

Textbooks
Ten Cates Oral Histology 7th ed ch 12 Oral Mucosa 2008 Avery Oral Development and Histology 3rd ed ch 14 p252-253 ch 15 p263-267 Orbans Oral Histology and Embryology 10th ed ch 9 p305,308,310& 314

Passive eruption Clinical consideration In Lining mucosa fluid disperse

Prof. Hanaa Aly

Prof. Hanaa Aly

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GOOD LUCK Prof. Hanaa Aly