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GOOD-MORNING

GOOD-MORNING. Oral mucosa. Presented by : DEEPTI AWASTHI P G STUDENT DEPT. OF PEDODONTICS. Contents :. Introduction Functions Classification Development Organization Clinical features Components Epithelium

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GOOD-MORNING

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  1. GOOD-MORNING

  2. Oral mucosa Presented by : DEEPTI AWASTHI P G STUDENT DEPT. OF PEDODONTICS

  3. Contents : • Introduction • Functions • Classification • Development • Organization • Clinical features • Components Epithelium Lamina propria

  4. Subdivisions of oral mucosa Keratinized mucosa Lining mucosa Specialized mucosa • Gingival sulcus • Junctions in the oral mucosa Mucocutaneous Mucogingival Dentogingival • Turn over time • Age changes • Conclusion • References

  5. INTRODUCTION

  6. FUNCTIONS

  7. CLASSIFICATION

  8. DEVELOPMENT • By fusion of stomatodeum with foregut, at about 26 days of gestation. • Ectodermal origin - • Endodermal origin - • 5th to 6th wk – • 10th to 14th wk – • 13th to 20th wk – • The surface layer of epithelium shows parakeratosis & ortho keratinization does not occur until teeth erupt postnatally.

  9. Ectomesenchyme : • Initially, consist of widely spaced stellate cells in an amorphous matrix. • 6th to 8th wk – reticular fibres • 8th to 12th wk – capillary buds & collagen fibres • 17th to 20th wk – elastic fibres in lining mucosa.

  10. organization • Specialized

  11. Boundaries : Distinguishing features of oral mucosa from skin : • Moist surface • Absence of appendages • Minor salivary glands • Sebaceous glands – fordyce spots • Surface is smoother • Linea alba -

  12. Component • 1 Epithelium • 2 Connective tissue • ORAL EPITHELIUM • Epithelial proliferation • The progenitor cells are situated in the basal layers retain the proliferative potential of the tissue. Clinical importance - cancer chemotherapeutic drugs

  13. Epithelial maturation KERATINIZED NON-KERATINIZED

  14. KERATINIZED EPITHELIUM Str. Basale Str. Spinosum Str.Granulosm Str. corneum

  15. NON KERATINOCYTES • Melanocytes 2 types of pigmentation – Exogenous Endogenous • Lack desmosomes & tonofilaments • Possess long dendritic process. • in gingiva, buccalmucosa,hard palate & tongue. • NEVUS- • MELANOMA-

  16. Langerhan’s – • antigen presenting cell • Ultrastructurally- small rod or flask- shaped granule is seen - birbeck granule • Merkel cells- • in the basal layer • not dendritic • are sensory & respond to touch • Lymphocytes-

  17. Basement membrane • Interface between the epithelium & connective tissue. • Ultrastructurally, known as basal lamina. • Basal lamina is made up of – • Lamina lucida • Lamina densa • Lamina densa- type IV collagen with heparansulphate in chicken wire configuration. • Anchoring fibrils – type VII collagen, form loops & are inserted into the lamina densa. • Type I & II collagen run through these loops. • Clinical importance :

  18. Lamina propria The connective tissue supporting the oral epitheliums . divided in 2 layers : • Papillary –superficial • Reticular- deeper • Consist of cells, blood vessels , neural elements & fibres. • Attaches directly to periosteum of alveolar bone- gingiva & part of hard palate Submucous layer is present in- cheeks, lips &part of palate.

  19. CELLS Fibroblast Macrophages Mast cell Pmn s Lmphocytes Plasma cell Endothelial cell FIBRES primarily type I & III with type IV & VII as part of basal lamina type V – in inflamed tissue

  20. Sub divisions of oral mucosa • KERATINIZED NON-KERATINZED Masticatory mucosa Lining mucosa Gingiva Specialized mucosa Hard palate Vermilion border of lip

  21. gingiva • Extends from DGJ to alveolar mucosa. • Gingiva is • Parakeratinized- 75% • Orthokeratinized- 15% • Non-keratinized-10% • Divided into Free gingiva Attached gingiva Interdental papilla

  22. Clinical features • COLOR • CONTOUR • SIZE SHAPE

  23. CONSISTENCY SURFACE TEXTURE

  24. GINGIVAL FIBRES • Dento gingival • Alveolo gingival • Circular • Dentoperiosteal FUNCTIONS : Accessory fibres that extend interproximally between adjacent teeth are referred to as trans septalfibres. unique feature in children -

  25. Blood supply • Supra periosteal arterioles • Vessels of PDL. • arterioles which emerge from the crest of the interdental septa. Nerve supply nerves in the pdl & from labial , buccal& palatine nerves.

  26. col • In a 3-D view ,the interdental papilla of posterior teeth - tent shaped. • in anterior teeth – pyramidal shaped. • Non- keratinized • Vulnerable to perio- dontal disease.

  27. Hard palate • The mucous membrane is tightly fixed to the periosteum & is immovable. • ZONES – • Gingival region • Palatine raphe • Anterolateral • posterolateral

  28. Vermilion zone • The transitional zone between the skin of the lip & the mucous membrane of the lip • Red zone • Thicker but mildly keratinized. • Long papilla of lamina propria. A: Skin. B: Vermillion zone. C: Oral (labial) mucosa. D: Minor salivary glands.

  29. Lips & cheeks • Epithelium – • Lamina propria – • The strands of dense connective tissue limit the mobility & prevent lodging between the biting surface of teeth during mastication. • The cheek , lateral to the corner of the mouth - Fordyce’s spots. NON-KERATIN LAMINA PROPRIA SUBMUCOSA MUSCLE

  30. Alveolar mucosa • Thin & loosely attached to the periosteum by a submucus layer.

  31. Floor of the mouth • The mucus membrane is thin & loosely attached to the underlying structures to allow for the free mobility of the tongue. NON-KERATINIZED SALIVARY & MUCOUS GLANDS LAMINA PROPRIA

  32. Inferior surface of tongue

  33. Soft palate • Mucus membrane is highly vascularized & red. • Epithelium – Str. Sq. non keratinized • Lamina propria- layer of elastic fibres • Submucosa- loose & contains mucus glands.

  34. Dorsal lingual mucosa • Rough & irregular • V- shaped line divides into oral part – ant. 2/3 pharyngeal part – post. 1/3

  35. Filiform papilla

  36. Fungiform papillae

  37. Circumvallate papillae • On the lateral surface of the vallate papillae, epithelium contains numerous taste buds. • The duct of von-ebner’s gland open into the trough.

  38. Taste buds • Histologically , a barrel shaped structure. • Extends perpendicular from the BM to a little opening in the epithelium, the taste pore. • 3types of cells - • Type I –light • Type II – dark • Type III- intermediate

  39. Perception of taste • Tip – sweet • Lat. Border – salty & sour • Post. Region – bitter & sour • Special receptor localized to circumvallate papillae - to detect the taste of water.

  40. Gingival sulcus • Space between the inner aspect of gingiva & the tooth. • Extends from free marginal gingiva to the dentogingival junction. • Sulcular epithelium- non keratinized lacks epithelial ridges expresses CK4 Gingival Sulcus

  41. Junctions in the oral mucosa • Mucocutaneous junction between the skin & mucosa. appendages are absent , except few sebaceous glands. Epithelium is thin ,keratinized – red zone. Clinical imp. – in infants , this region is thick- suckling.

  42. Mucogingival junction between the gingiva & alveolar mucosa. • clinically, • Mucogingival groove- slight indentation • Bright pink of alveolar mucosa to paler pink of gingiva. • Histologically, • Attached gingiva – keratinized / parakeratinized • Lamina propria- numerous collagen bundles. • Stippling is seen. • Alveolar mucosa – non –keratinized • More elastic fibres.

  43. dentogingival junction • Junctional epithelium • Junction between the gingiva & the tooth. DEVELOPMENT OF J.E.

  44. str. sq. non keratinized epithelium • Basal lamina is seen • Outer- to connective tissue • Inner- to the tooth surface This inner basal lamina is unique as it binds to calcified surfaces rather than connective tissue It contains amelotin, a novel secreted protein.

  45. Cytokeratins present – k5, k14 & k 19 • Highest turnover rate – 5-6 days , therefore it regenerates readily. • Frequent presence of infilteratingneutrophils , leukocytes & mononuclear cells, contribute to permeability of tissue.

  46. Turn over time • Skin - 27 days • Hard palate - 24 days • Floor of mouth - 20 days • Buccal & labial mucosa - 14 days • Attached gingiva - 10 days • Taste buds - 10 days • J.E. - 5-6 days

  47. Age changes • Smooth & dry • Epithelium becomes thin. • Filiform papillae – reduced • Tongue – smooth • Nutritional deficiency – contributing factor • Lingual varices - ventral aspect of tongue • Ectopic sebaceous glands ( fordyce spots ) – common in elderly. FORDYCE SPOTS

  48. References • R.TenCate. Oral Histology, development, structure, and function. 5th Edition. • Orbans Oral histology and embryology. 10th Edition. • Essentials of Oral Histology and Embryology: A Clinical Approach. by James K.Avery, DeinelJ.Cheigo. • Illustrated Dental Embryology, Histology, and Anatomy by Mary Bath-Balogh, Margaret J. Fehrenbach, Pat Thomas. • ShobhaTandon Textbook of Pedodontics.1st Edition. • Human embryology, Inderbir Singh. • Carranza’s 10 th Ed. Periodontology

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