Oral Histology, Embryology and Genetics
Spring 2008
Course Syllabus
Oral Mucosa
Mucous Membrane: Moist lining of the gastrointestinal tract, nasal passages and
other body cavities that communicate with the exterior
In the oral cavity the lining is called as oral mucous membrane or oral mucosa
Functions of the Oral Mucosa
1. Protection: Barrier for mechanical trauma and microbiological insults
2. Sensation: Temperature (heat and cold), touch, pain, taste buds, thirst;
reflexes such as swallowing, etching, gagging and salivating
3. Secretion: Salivary secretion
4. Thermal regulation: Important in dogs not in humans
Organization of the Oral Mucosa
3 types according to FUNCTION:
1. Masticatory Mucosa: 25% of total mucosa. Gingiva (free, attached
and interdental) and hard palate. Primary mucosa to be in contact with food
during mastication. MASTiCATORY MUCOSA IS USUALLY KERATINIZED.
2. Lining Mucosa: 60% of total mucosa. Covers the floor of mouth, ventral
(underside) tongue, alveolar mucosa, cheeks, lips and soft palate.
Does not function in mastication and therefore has minimal attrition.
Non-keratinized; soft and pliable.
3. Specialized Mucosa: 15% of total mucosa. Covers dorsal tongue and
composed of cornified epithelial papillae.
Masticatory Mucosa
Masticatory Mucosa
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Lining Mucosa
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Specialized Mucosa
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General Features of Oral Mucosa
1. Separated from the skin by vermillion zone of the lips which is more deeply
colored than rest of the oral mucosa
2. Factors affecting color of the oral mucosa:
a. Concentration and state of dilation of the blood vessels in
underlying connective tissue
b. Thickness of the epithelium
c. Degree of keratinization
d. Amount of melanin pigmentation
Clinically, color of oral mucosa is very important. For example, inflamed oral
tissues appear red rather than the normal pale pink
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How is the oral mucosa different from skin?
1. Color
2. Moist surface
3. Absence of adnexal skin structures such as hair follicles, sweat glands
and sebaceous glands (exception in Fordyces disease)
4. Fordyces disease: Sebaceous glands in oral cavity predominantly in upper
lip, buccal mucosa and alveolar mucosa
5. Presence of minor salivary glands in oral mucosa
6. Texture of surface: Oral mucosa is smoother than the skin (few exceptions
like dorsal tongue due to papillae; hard palate rugae; gingiva stippling)
7. Firmness: Oral mucosa varies in its firmness. For example buccal mucosa
and lips are loose and pliable whereas the gingiva and hard palate are firm
so critical clinically while giving injections
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Skin
Oral Mucosa-Cheek
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Fordyces Spots
Pale yellow spots
Normal variation
Lips, buccal mucosa, alveolar
mucosa and tonsillar pillar
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Structure of Oral Mucosa
1. Overlying oral epithelium
2. Underlying connective tissue (lamina propria and submucosa)
In skin called epidermis and dermis
Rete ridges/pegs
Connective tissue papilla
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A: Epithelium
B: Connective tissue
C: Salivary gland
A: Startum basale
B: Startum spinosum
C: Startum superficiale
The oral epithelium is keratinized or non-keratinized stratified squamous epithelium
The interface between epithelium and connective tissue is comprised of a
structureless layer called basement membrane
This interface is irregular and is composed of downward projections of epithelium
called rete ridges or rete pegs, and upward projection of connective tissue termed
as connective tissue papillae
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Junction between oral epithelium and lamina propria is more obvious than that between
lamina propria and submucosa
No muscularis mucosae layer seen in oral mucosa
Loose fat and glandular tissue with blood vessels and nerves seen underneath oral mucosa
from underneath bone or muscle layer - this layer is termed SUBMUCOSA provides flexibility
In gingiva and hard palate, no submucosa is seen and the lamina propria is directly
attached to the periosteum of the underlying bone which provides firm, inelastic attachment
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this is called ORAL MUCOPERIOSTEUM
Connective tissue in oral cavity is comprised of salivary glands, sebaceous glands
(Fordyces disease) and lymphoid tissue (tonsillar tissue)
Salivary glands
Sebaceous glands
Lymphoid tissue (tonsil)
High Power view of sebaceous glands
www.usc.edu/hsc/dental/opfs/QL/09tn.html
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Oral Epithelium
Progenitor population: Divide and provide new cells (Proliferation)
Maturing population: Undergo differentiation (maturation)
Estimated time necessary to replace all the cells in the epithelium: turnover time
Skin: 52 to 75 days
Gut: 4 to 14 days
Gingiva: 41 to 57 days
Cheek: 25 days
Nonkeratinized epithelium turns over faster than keratininzed epithelium
Clinical correlation: Oral ulcers during cancer chemotherapeutic treatment
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Types of Oral Epithelium
Orthokeratinized stratified Parakeratinized stratified
squamous epithelium
squamous epithelium
Nonkeratinized stratified
squamous epithelium
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Components of Oral Epithelium
Lining Mucosa:
Stratum Basale: Basal cell layer comprised of cuboidal cells. Progenitor
cells that divide and provide new cells by mitotic division that migrate to the
surface to replace cells that are shed.
Stratum Spinosum (or intermedium): Cells are oval and represent bulk
of the epithelium.
Stratum Superficiale: Cells are flat and contain small oval nuclei that are
continuously shed.
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Histology of Lip
Skin: keratinized stratified squamous
epithelium with adnexal skin structures
Oral Mucosa: Moist-surface, covered by
nonkeratinized stratified squamous epithelium
associated with small round seromucous
glands of the lamina propria. In the
submucosa fibers of orbicularis oris muscle is
noted.
Vermillion zone: Very thin keratinized
epithelium that contains no adnexal skin
structures (can contain sebaceous glands)
A: Skin
B: Vermillion zone
C: Oral (labial) mucosa
D: Minor salivary glands
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What gives the vermillion zone the red color?
1. Epithelium is thin
2. Epithelium contains eleidin, which is
transparent
3. Blood vessels are present near the surface
Eleidin is a semi-fluid clear substance present
in the stratum lucidum of the skin epithelium
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Skin of the Lip
A: Sweat glands
B: Sebaceous glands
C: Hair follicles
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Vermillion Zone and Labial Mucosa
A: Vermillion zone
B: Labial mucosa
C: Orbicularis oris muscle
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Soft palate
A: Hard Palate
B; Soft palate
C: Nasal cavity
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1. Nonkeratinized
2. Highly vascularized so more pink
than hard palate
2. Lamina propria and submucosa
present (unlike hard palate when
only lamina propria is noted
mucoperiosteum)
3. Submucosa contains salivary
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glands and muscle soft palate
Cheeks (Buccal Mucosa)
Similar to lips and soft palate
Nonkeratinized stratified squamous epithelium, lamina propria and submucosa
Submucosa of cheeks contain fat cells along with lobules of minor salivary
glands and muscle fibers
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Ventral surface of tongue
Floor of mouth
Nonkeratinized stratified squamous Nonkeratinized stratified squamous
epithelium, lamina propria and submucosa
epithelium, lamina propria and
submucosa
Epithelium is loosely attached to
lamina propria
Extremely dense muscle fibers
interlacing connective tissue fibers
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No muscle
in submucosa
Masticatory Mucosa
Epithelium that covers gingiva and hard palate
Mucosa is thicker than nonkeratinized because of the keratin layer
Stratum basale
Startum spinosum
Same as nonkeratinized epithelium
Stratum granulosum: Cells contain keratohyaline granules
Stratum corneum: Contains thin, flat and nonnucleated cells which are filled with
keratin. In contrast to the hard keratin seen in nails and hair, keratin overlying
normal masticatory oral mucosa is soft. Keratin is tough, nonliving material that
is resistant to friction and impervious to bacterial invasion
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Miller SE. Histology for Pathologists. 3rd edition. LWW. 2007
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Types of Keratinized Epithelium
Miller SE. Histology for Pathologists. 3rd edition. LWW. 2007
The superficial cells are dead but retain the nucleus in parakeratinized epithelium
but the nuclei are lost in orthokeratinized epithelium
The rete pegs are long and slender in keratinized epithelium
Mucoperiosteum
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Gingiva and Epithelial Attachment
Free or marginal gingiva
Attached gingiva attaces with the neck
of the tooth by means of junctional epithelium
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Histology of Gingiva
Thick (250 m), either orthokeratinized or parakeratinized stratified
squamous epithelium with a stippled surface
A: Rete pegs
B: Conective tissue papilla
C: Parakeratin
D: Spinous layer
In healthy attached gingiva stippling is seen which appears as small pits in the epithelium and
are due to deep rete pegs. The lamina propria is composed of long narrow papillae which are not
highly vascular. No distinct submucosa is noted as the overlying mucosa is directly attached
to the underlying periosteum and cementum by collagen fibers
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Free Gingiva: Keratinized; NOT STIPPLED; bound on inner margin by the
gingival sulcus, which separates it from the tooth; bound on its outer margin by
the oral cavity; and apically by the free gingival groove.
Attached Gingiva: Keratinized; STIPPLED; separated from the alveolar mucosa
by the mucogingival junction (groove). Attached to the tooth by junctional epithelium.
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In A note the difference in
keratinization, thickness of
epithelium and ridge pattern.
In B stained with an elastic
stain, note the presence of
elastic fibers in lamina propria
in alveolar mucosa. Not
much difference in the
epithelium is seen between
the two types of mucosa.
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Dentogingival Junction and Junctional Epithelium
Dentogingival junction is the
region where the oral mucosa
meets the surface of the tooth
Very important because it is a
weak area in the oral mucosa
which is otherwise continuous
Bacteria on the surface of the
tooth produce toxins that can
incite inflammation and damage
if it enters into the mucosal tissues
Gingival sulcus in healthy individuals is ~ 0.5 to 3 mm (mild inflammation is present1.8 mm average)
Depth greater that 3mm is considered pathologic; and the sulcus represents
periodontal pocket
Floor of the sulcus and the epithelium cervical to it is called junctional epithelium
which is in contact with the tooth surface (enamel and sometimes cementum)
Wall of the gingival sulcus is lined by nonkeratinizing stratified squamous epithelium that is
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derived from and continuous with the rest of the oral mucosa oral sulcular epithelium
Junctional Epithelium
The epithelium that is attached to the tooth (enamel or sometimes cementum) surface
continuous with sulcular epithelium
Derived from reduced enamel epithelium of the tooth germ
Junctional epithelium consists of flat cells aligned parallel to the tooth surface
increasing in thickness from the apex to the crown
Attached to enamel by internal basal lamina and to the connective tissue by external
basal lamina. Hemidesmosomes are present in both basal laminas.
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Epithelial cell turnover in gingiva
Similar to all other epithelia, the deeper
cells adjacent to the connective tissue
undergo cell division to replenish those
lost at the surface
High rate of cell division
Migrate about 2 to 3 cell layers from the
tooth surface and then join a main migratory
route in a coronal direction, parallel to tooth
surface, to be desquamated into the
gingival sulcus.
Key point: Junctional epithelium readily
regenerates from the sulcular epithelium
or oral epithelium if it is damaged or surgically
excised
Connective tissue normally contains plenty of neutrophils which is different
than the normal oral mucosa
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Col
Col (or depression): This is how the gingiva looks in the interdental area. Similar
to an outline of a depression or col with buccal and lingual peaks. Col epithelium
is identical to junctional epithelium and has the same origin (from dental epithelium)
and is also replaced continually by cell division.
Not sure if there is any significance that the col is more vulnerable to inflammation,
but the incidence of gingivitis is greater interdentally.
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How does Gingiva develop?
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A quick note on..
Blood supply to the gingiva: Derived from periosteal vessels in the periosteum
of the alveolar process
Blood supply to the dentogingival junction: Continuation of interalveolar arteries
Nerve supply to the gingiva: terminal branches of periodontal nerve fibers and by
branches of the infraorbital and palatine, or lingual, mental, and buccal nerves
PLEASE REVIEW TABLE 12-4 AND 12-5 IN THE TEXT BOOK
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Histology of Hard Palate
Thick orthokeratinized (or parakeratinized in areas) epithelium showing ridges (rugae)
Lamina propria shows long papillae with thick dense connective tissue
Submucosa is mucoperiosteum with dense collagenous connective tissue attaching
directly to periosteum. Contains fat and salivary glands
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Specialized Mucosa Dorsal Tongue
Types of papilla: 4 types
A: Foliate
C: Circumvallate
D: Filiform
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1. Filiform papilla: Makes up majority of the papillae and covers the anterior part
of the tongue. They appear as slender, threadlike keratinized projections
(~ 2 to 3 mm) of the surface epithelial cells. These papillae facilitate mastication
(by compressing and breaking food when tongue is apposed to the hard palate)
and movement of the food on the surface of the tongue. The papillae is directed
towards the throat and assist in movement of food towards that direction.
NO TASTE BUDS.
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Hairy Tongue
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2. Fungiform papilla:
papilla (Fungus-like) These are interspersed between the filiform papilla.
More numerous near the tip of the tongue. Smooth, round structures that appear
red because of their highly vascular connective tissue core, seen through a thin,
nonkeratinized stratified squamous epithelium. Taste buds are usually seen within
the epithelium.
Filiform papilla
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3. Foliate Papilla:
Papilla (Leaf-like). Present on the lateral margins of the posterior tongue.
Consist of 4 to 11 parallel ridges that alternate with deep grooves in the mucosa,
and a few taste buds are present in the epithelium. They contain serous glands
underlying the taste buds which cleanse the grooves.
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4. Circumvallate papilla:
papilla (Walled papilla). 10 to 14 in number these are seen along
the V-shaped sulcus between the base and the body of the tongue. Large, ~ 3 mm
in diameter with a deep surrounding groove. Ducts of von Ebner glands (serous
salivary glands) open into the grooves. Taste buds are seen lining the walls of
the papillae.
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Taste Buds:
Buds Unique sense organs that contain the chemical sense for taste.
Microscopically visible barrel-shaped bodies found in the oral epithelium.
Usually associated with papillae of the tongue (circumvallate, foliate and
fungiform). Also seen in soft palate, epiglottis, larynx, and pharynx.
Referred to as NEUROEPITHELIAL STRUCTURES. But most correctly referred
as epithelial cells closely associated with clib-shaped sensory nerve endings. These
nerves arise from the chorda tympani in anterior tongue and glossopharyngeal in
posterior tongue and come to lie among the taste cells. Each taste bud has ~ 10 to
14 cells. Majority are taste cells with elongated microvilli that project into the
taste pore. (Epiglottis and larynx Vagus nerve)
Type 1 dark cell (60% of cells)
Type 2, light cells (30%)
Type 3 (7%) and Type 4 (basal cells ~ 3%)
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Taste Buds in the Human Adult
Location
Number
Tongue
Soft palate
Epiglottis
Larynx/pharynx
Oropharynx
10,000
2,500
900
600
250
4 taste sensations: Sweet, salty, sour and bitter
Sweet and salt: ant tongue
Sour: lateral tongue
Bitter: region of circumvallate papilla
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Epithelial maturation
Keratinization
Gingiva
Hard palate
Some areas of dorsal tongue
Nonkeratinization
No granular cell layer
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Basal cells interface with a membrane separating the epithelium and lamina propria.
The membrane is called basal lamina. Basal cells attached to basal lamina by
hemidesmosomes.
Epithelial cell-cell contact is made through desmosomes (in oral cavity appears
discoid and called macula adherens). These are anchored intracellularly by
tonofibrils.
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Nonkeratinocytes in oral epithelium
Constitute about 10% of epithelial cell population. Three major cells which are all
clear cells with a halo around their nuclei.
1. Langerhans cells: found on stratum spinosum (suprabasal) and function in
antigen trapping and processing. Dendritic cells. No desmosomes or tonofilaments.
2. Merkel cell: Located in basal cell layer (mostly in gingiva). Function as touch
receptors. Nondendritic. Sparse desmosomes and tonofilaments.
3. Melanocytes: Found in basal cells. Melanin-producing cells (mostly in gingiva).
Dendritic. Presence of melanin granules (melanosome).
4. Lymphocytes and leukocytes: Inflammatory cells that are not clear cells.
Associated with inflammatory response in oral mucosa
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Lamina Propria
Superficial papillary layer (associated with
rete ridges) and deeper reticular layer
(between papillary layer and deeper
structures)
Reticular refers to the netlike arrangement of
collagen fibers (nothing to do with
reticulin fibers)
Papillary layer has thin and loose collagen
fibers with many capillary loops
Reticular layer has collagen fibers arranged in
thick bundles that are parellel to surface
Lamina propria also contains various cells,
blood vessels, nerves and fibers
(collagen and elastic) embedded in an
amorphous ground substance
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Cell Types in the Lamina Propria of Oral Mucosa
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