DEVELOPMENT OF THE HEAD & NECK

1. Pharyngeal Arches
a. Each arch (pharyngeal membrane) has:
i. Ectoderm (clefts)
ii. Endoderm (pouches)
iii. Mesenchymefrom neural crest cells
b. Each arch consists of cartilage, arteryhas its own blood
supply (arches), and cranial nerve
c. Neural crest cells form:
i. Bones of face/skull
1. mandible, maxilla, alveolar bone
ii. Hyoid cartilage
iii. Cartilage, bone, dentin, teeth, dermis etc.
d. Neural crest cells arise from:
i. Rhombomeresderived from Hoxb5 genes, which
are regulated by Sonic HH and retinoic acid and can
have implications for the potential regrowth of teeth
2. Pharyngeal Arches at 5 weeks
a. Stomadeum is presentis the opening into the pharynx
(future oral cavity)
b. Surrounded by 1st arch
c. Ectoderm surrounds the stomadeum near the tonsillar
fossa

First Arch Summary

G e r m L a y e r s P r e s e n te d

1 st A rch

S u r fa c e E c to d er m
(c lefts)

E p i th e l i u m o f b u c c a l c a v i t y a n d e a r , en a m e l,
s a liv a ry g la n d s , a n te rio r 2 /3 o f to n g u e e p ith e liu m .

N eu r a l E c to d er m

C N V

R h o m b om er es

R 1 & R 2.

S k eleto n

2 M a x illa ry a n d 2 m a n d ib u la r p ro m in e n c e s , a n d
fro n to n a s a l p ro m in e n c e .

M u sc les

M a s tic a to ry

E n d o d er m o f p o u ch es

E u s ta c h ia n (a u d ito ry ) tu b e , m id d le e a r

E c to m esen c h y m e

D e n tin

Second Arch Summary

G e r m L a y e r s P r e s e n te d

2n d A rch

S u r fa c e E c to d er m
(c le fts)

E p ith e lia l p o rtio n o f e x te rn a l a u d ito ry m e a tu s a n d

c e rv ic a l s in u s .

N eu r a l E c to d er m

C N V II

R h o m b o m er es

R 4

M u sc les

A ll m u sc les o f fa c ia l ex p r essio n

E n d o d er m o f f o o r

T h y ro id (fro m a d iv e rtic u lu m o f th e fo ra m e n c e c u m
[b e tw e e n tu b e rc u lu m im p a r a n d h y p o b r a c h ia l
e m in e n c e ] w ith 1 st a r c h ) . M ig r a te s d o w n f ro m
p h a ry n x to ju n c tio n o f tra c h e a a n d la ry n x .

E n d o d er m o f P o u ch

C r y p ts o f p a la tin e to n sil in to n silla r fo ssa

S k eleto n

Third Arch Summary

G e r m L a y e r s P r e s e n te d

3rd A rch

S u r fa c e E c to d er m
(c lefts)

E p ith e liu m a ro u n d e a r, c o rtic a l th y m u s .

N eu r a l E c to d e r m

C N IX .

R h om b om er es

R 6 & R 7.

S k eleto n
M u sc les
E n d o d er m o f f o o r
E n d o d er m o f p o u ch es

in fe rio r p a ra th y ro id s , m e d u lla ry th y m u s

Fourth Arch Summary

3.

G e r m L a y e r s P r e s e n te d

4 th & 5 th ( 6 t h ) A r c h e s

S u r fa c e E c to d er m
(c lefts)

E p ith e liu m a ro u n d e a r.

N eu r a l E c to d er m

C N X a n d m a y b e so m e C N X I.

R h o m b om er es

R 8.

S k eleto n

L a ry n g e a l c a rtila g e s .

M u sc les

P h a ry n g e a l & la ry n g e a l m u s c le s .

E n d o d er m o f f o o r

R o o t o f to n g u e , e p ig lo ttis & p h a ry n x .

E n d o d er m o f p o u ch es

S u p e rio r p a ra th y ro id s ,
th y ro id p a ra fo llic u la r c e lls (n e u ra l c re s t)

Pituitary
a.Fusion of:

Develo
pment
of the

i. Rathkes pouchinvagination of ectoderm

1.Gives rise to pars intermedia, distalis, and
tuberalis
ii. Infundibulumdiverticulum from forebrain
1.Gives rise to infundibular stalk and pars
nervosa

DEVELOPMENT OF THE FACE

1. Neural Crest Cells
a. Migrate to pharyngeal arches and form:
i. Maxilla, mandible, frontonasal prominence, hyoid
cartilage, bone, dentin, dermis, etc.
2. Face Development
a. Week 5:
i. 5 facial prominences: 2 mandible, 2 maxilla,
frontonasal
ii. 2 nasal placodesectoderm induced by ventral
forebrain to invaginate inwards to form nasal pits
iii. Lateral and medial nasal prominences surround nasal
pits
b. Next 2 Weeks:
i. Upper LipMaxillary prominences and medial nasal
prominences increase in size and move toward
midline where they fuse
ii. Maxillary prominence and lateral nasal prominence
separated by nasolacrimal groove
iii. Nasolacrimal groove invaginates to form
nasolacrimal duct and the lacrimal sac
iv. Lower LipMandibular prominences merge in the
midline
v. CheeksDevelop from maxillary prominences
(neural crest)
vi. Nose
1. Frontal prominence=bridge
2. Medial nasal prominences=crest and tip

3. Lateral Nasal Prominences=alae

3. Palateintermaxillary segment (primary) and palatine shelves
(secondary)
a.Primary palate (Intermaxillary Segment)formed
by 2 medial nasal prominences
i. Gives rise to:
1. Labial componentphiltrum of upper lip
2. Upper jaw4 incisor teeth
3. Palatalprimary palate
ii. Fuses with nasal septum from frontal prominence
b.Secondary palateformed from 2 outgrowths of
the maxillary processes and the palatine shelves.
i. 2 pieces of secondary palate fuse together after first
fusing to primary palate, creating a junction called
the incisive foramen
c. Nasal Septum fuses with primary and secondary palate to
separate the nasal and oral cavity
4. TongueDevelops at the junction of the stomadeum and the
pharynx

5. Nasal Cavitiesseparated from oral cavity by oronasal

membrane, which breaks down to form the primitive choanae
a. As secondary palate forms, the definitive choanae forms,
covered by the soft palate.
6. Teeth
a. Maxillary incisorsnasomedial prominences
b. Maxillary caninesmaxillary prominence
c. Maxillary premolarsmaxillary prominence
d. Maxillary molarsmaxillary prominence
e. Mandibular incisorsmandibular prominence-1st arch
f. Mandibular caninesmandibular prominence
g. Mandibular premolarsmandibular prominence
h. Mandibular molarsmandibular prominence

TOOTH DEVELOPMENT
1.Teethdevelop from ectoderm and ectomesenchyme (neural
crest)
2.Intermaxillary segment/nasomedial prominences4 maxillary
incisors
a.Rest of teeth are from either the mandibular or maxillary
prominences.
3.Early tooth development
a.Primary epithelial bandforms as a result of mitosis and
the change in orientation of the cells
i. Causes an indentation/invagination, which is the
dental lamina w/ 20 tooth buds
b.Ectomesenchymecondenses and becomes the dental
papilla
c. FirstEctoderm epithelium directs tooth development
i. Any type of neural crest cell that associates with
maxillary or mandibular epithelium will result in a
tooth, meaning you need the appropriate epithelium
to form a tooth.

d.SecondNeural crest cells take over the direction of

tooth development
4.Tooth Development Pathway
a.1st arch ectoderm influences ectomesenchyme
i. Requires FGF8inactivation leads to arrest of tooth
development
b.Ectomesenchyme upregulates SHH and downregulates
BMP 2&4.
i. SHHinactivation leads to arrest of tooth
development.
ii. BMPoverexpression leads to arrest of tooth
development
st
c. 1 arch ectoderm influences tooth bud formation, which
results in the formation of the dental organ.
d.The dental organ further influences the ectomesenchyme
by upregulating Lhx-6&7, and Pax9
e.WNT-7B is required in non-tooth areas to prevent
formation of teeth. Overexpression of WNT leads to
supernumerary teeth.
5.Models of Crown Shape Determination
a.Clone Model
i. Different areas of ectomesenchyme are programmed
to form different teeth by the epithelium, and coax
the dental lamina to form a tooth bud
b.Odontogenic homeobox code Model
i. Each area of ectomesenchyme has components for
the type of teeth it will eventually form.
ii. Different genes cause different types to form

6.Stages of Tooth Development

a.Bud Stage
i. Cell proliferation of tooth bud (invagination of dental
lamina) and ectomesenchyme (forming dental
papilla)
ii. The tooth bud influences the ectomesenchyme to
condense

Slide 1
Image 1

Slide 1
Image 2

Tongue

MS
DL

OC

OC

Tooth Development - Bud Stage - Medium magnification

Tooth Development - Bud Stage - Overview

The tongue is in the middle of the developing head with the developing oral
cavity (OC) lateral to it. On the next slide you will see condensations of
mesenchyme

Adjacent to the oral cavity is a thickening of the epithelium, called the dental
lamina (DL), which is associated with a condensation of mesenchymal
cells (MC). This collection of early developing and condensing cells is the
tooth bud or tooth primordium.

Slide 2
Image 2

Slide 2
Image 1

EO
SR

TB
DP
Tooth Development - Bud Stage - High magnification

Tooth Development - Bud Stage - Low magnification

Look at the oral epithelium lateral to the developing tongue and you will see
an invagination into the tooth bud (TB).

Condensation of mesenchyme continues as the oral epithelium invaginates

into it. The invaginating tissue will further differentiate into what will
become the enamel organ (EO) that will have 3 layers: an outer and inner
enamel epithelium and a stellate reticulum (SR; starting to show stellate
cells in the center). The mesenchyme will become the dental papilla (DP).

b.Cap StageBeginning of Histodifferentiation

i. The enamel/dental organ invaginates to make a
cap over the aggregating ectomesenchyme (dental
papilla).
1.The stellate reticulum forms within the dental
organ due to accumulation of GAGs (hydrophilic)
and the drawing in of water
a.The inner and outer enamel epithelium also
differentiate
i. Basement membranes are present
between the outer layer and the dental
follicle and between the inner layer and
the dental papilla
2.Ectomesenchymal cells surrounding the dental
organ and the dental papilla make up the dental
follicle

Slide 2
Image 3

EO

Tooth Development - Cap

Stage - High magnification
This developing tooth in the cap
stage shows the enamel organ
(EO) that has 3 layers: an outer
enamel epithelium (OEE; starting
to pinch off the surface
epithelium), an inner enamel
epithelium (IEE; composed of
darker and taller columnar cells)
and a stellate reticulum (SR;
starting to show stellate cells in
the center). Between the inner
enamel epithelium and the
stellate reticulum are cells
starting to differentiate into the
stratum intermedium. The
mesenchyme will become the
dental papilla (DP).

SR

OEE
IEE

DP

c. Bell StageMorphodifferentiation
i. Tooth assumes its final shape
ii. The dental lamina breaks up so the tooth is no longer
connected to the oral ectoderm, which may cause
cysts
Slide 3
Image 1
Tooth Development Bell Stage - Low
magnification

Slide 3
Image 2
OEE

SR
DS

Under this magnification one

can see the outer enamel
epithelium (OEE) covering
the stellate reticulum (SR).
The darker inner enamel
epithelium (IEE) partially
surrounds the dental papilla
(DP).

HRS
Tooth Development - (Late) Bell Stage - Low magnification

DP
IEE

Under this magnification one can see the dental sac or follicle (DS)
surrounding the tooth and even enamel (E) at the crown. The roots are
developing from inward growth of Hertwig s epithelial root sheath (HRS).

Slide 3
Image 4

Slide 3
Image 5

E
D

D
PSA

Tooth Development - Late Bell Stage - High magnification

Near the base of the crown are cells that are developing enamel and dentin.
On the lower left side are columnar cells (presecretory ameloblasts; PSA).
To the right of them is pink staining dentin (D) formed from odontoblasts
(O).

DE

O
Tooth Development - Late Bell Stage - High magnification
The clear area at the crown represents decalcified enamel (DE) adjacent to
the very basophilic enamel (E) remaining behind. The ameloblasts (A) are
in the cell layer outside of the enamel. The innermost layer of cells are
odontoblasts (O) forming the lighter purple stained dentin (D).

d.Crown StageSuccessional lamina

i. Successional lamina arises from the dental lamina
and gives rise to incisors, canines, and premolars
ii. Dental lamina gives rise to molars
Slide 3
Image 7

OE

Tooth Development - Late Bell

Stage - Low mag.
Extending from the outer enamel
epithelium (OEE) is a thin strand of
epithelial cells forming the lateral
dental lamina (LDL). This joins the
original dental lamina (ODL) that is
connected to the oral epithelium
(OE). Extending down from the
junction of the lateral and original
dental laminae is the successional
lamina (SL) that will serve to
become the permanent tooth
primordium.

ODL
LDL

SL

OEE

e.Root Formation
i. Cervical loop gives rise to Hertwigs root sheath
ii. Inner epithelial cells of the root sheath induce
odontoblasts to form from the denal papilla, which
forms the dentin of the root

iii. The root sheath stretches during growth and

fragments, forming the rests of Malassez
Slide 3
Image 6

HRS

Tooth Development - Late Bell Stage - High magnification

The root develops from Hertwig s epithelial root sheath (HRS). It is in the
area where the inner and outer enamel epithelia meet. Dentin from
odontoblasts and cementum from developing cementoblasts will form the
root.

7.Important Tooth Structures/Definitions

a.Enamel OrganThe organ overlying the dental papilla
i. Forms enamel/crown
b.Dental PapillaThe area under the dental organ
i. Forms dentin and pulp
c. Dental FollicleThe area surrounding the enamel organ
and dental papilla
i. Forms cementum, periodontal ligament, & alveolar
bone
d.Enamel Knotclusters of non-dividing epithelial cells
within the enamel organ
e.Enamel Nicheproduced as a result of cutting curved
cellsfd1

ENAMEL
1.Composition
a.Inorganic Material
i. Calcium phosphate hydroxyapatite (96%)
b.Organic Material
i. Water (3%)
ii. Tyrosine rich amelogenin
1.Hydrophobic, regulate crystal growth
iii. Nonamelogenins
1.Ameloblastin
a.Promotes mineral formation
2.Enamelin
a.Crystal nucleation and growth
3.Tuftelin
a.Function unclear

2.Structure
a.Enamel rodbasic unit of enamel, long crystals that run
parallel to long axis of rod
i. As they mature, they get larger, and lose water and
organic material. They get pushed together.
b.Interrod enamelareas where rods are not surrounded by
rod sheath and crystals run in various directions
i. Ions can be incorporatedF, Mg, Sr, Pb
c. Rod Sheatharea between rod and interrod (surrounds
rod)
i. Most organic material is here
3.AmelogenesisREQUIRES DENTIN (forms first)!
a.Reciprocal induction
i. Inner enamel epithelium induces dental papilla to
become odontoblasts (make dentin)
ii. Dentin induces inner enamel epithelium to become
ameloblasts
b.Phases/Stages of Amelogenesis
i. Morphogenetic stagecells commit to ameloblast
lineage
1.Cells of internal dental lamina have centrally
located
A

SI
A

Proceeding upward from the cervical loop, the cells of the

internal dental epithelium become ameloblasts (A). These
columnar shaped cells are in the Morphogenetic Stage of
enamel development. The nuclei of these cells become
located closer to the stratum intermedium (SI).).

At the late bell stage, the morphogenetic stage of enamel

development is identified. The ameloblasts (A) are
columnar in shape with a centrally placed nucleus.

nuclei

ii. Histodifferentiation stage

1.Nuclei shift toward stratum intermedium, which
is in between the inner enamel epithelium and
the stellate reticulum
2.Prominent Golgi and RER
3.Terminal webs hold cells together as enamel is
produced by ameloblasts

SI
O

iii.
Moving toward the apex, the columnar ameloblasts (A) can
be seen with their nuclei continuing to move toward the
stratum intermedium (SI). Deep to the ameloblasts,
odontoblasts (O) can be seen just beginning to differentiate.

Presecret
ory Phase

1.Cells differentiate and become protein secreting

2.Rods not formed, but immediate mineralization
iv. Secretory Phase: 30% mineralized enamel
1.Ameloblasts make and organize enamel
a.Small dotsameloblastin
b.Large dotsamelogenin
2.Extensive Golgi and RER
3.Tomes Processes
a.Proximal Processforms interrod enamel
i. Initially, theres only a proximal process
and enamel is structureless
b.Distal Processforms rods
i. As ameloblasts move away from dentin,
distal process forms and secretes rods

while the cell junctions (proximal)

secrete interrod enamel
ii. Sits into a pit and forms rods

SA
D

T
SA

SE

After dentin formation starts the ameloblasts (A) enter the

E
secretory phase and begin secreting enamel (E).
In the rat incisor, it is possible to identify the later stages
Odontoblasts (O) continue to form dentin (D). As enamel
of enamel formation. Here the late secretory
is formed the ameloblasts move away from the dentin and
ameloblasts (SA)are seen above both structureless
as they do the later secretory ameloblasts (SA) are seen with
(SE) and structured enamel (E).
projections called Tomes processes (T).

v. Maturation Phase: addition of mineral and removal of

water and organic materials
1.Ameloblasts get smaller and absorb/remove
water but still some enamel secretion
2.2 Types of Ameloblasts
a.Ruffle endedTight junctions are tight
i. Add inorganic material
ii. Undergo modulation and become
smooth ended
b.Smooth Endedtight junctions are leaky
i. Remove water and organic material
3.Apoptosis occurs (50% of ameloblasts die)
4.Basement membrane present

A
E

After the secretory stage there is a brief transition

stage of amelogenesis. Here the ameloblasts
(A) become shorter and and have fewer
organelles and less volume.

vi. Protective stage

1.Basal lamina is
secreted
2.
Hemidesmosomes
are formed with
ameloblasts

The next stage of enamel formation is the

maturation phase. Ameloblasts (A) are seen
above enamel (E). A ruffled border is found in
some ameloblasts in this phase (arrow).

A
E

The final stage of enamel formation is the protective

phase. Ameloblasts (A) are seen above enamel (E).
The space between ameloblasts and the enamel is
where calcified enamel was removed during tissue
preparation.

4.Mineralization Stages
a.Stage 1formation of
partially mineralized enamel in secretory stage
b.Stage 2mineralization from surface to deeper layers
c. Stage 3mineralization from inner later to surface
d.Stage 4heavy mineralization of outer layer
5.Organization of Enamel
a.Rods run perpendicular to dentin
b.Stria of Retziusincremental growth lines that represent
weekly changes in enamel formation
i. Neonatal line is an enlarged stria, representing
change in nutrition from umbilical to breast milk

DEJ

c.

At low power under

transmitted light dentin
(D), enamel (E), and the
dento-enamel junction
(DEJ) is seen. Running
in a curve from the DEJ
to the surface are the
incremental lines of
Retzius (R).

E
R
E

HunterSchrager
Bands
optical
pattern
resulting
from
changes in

rod direction
i. Alternating light and dark bands
d.Gnarled enamelthe cuspal region of the crown where
enamel rods twist and are irregular

GE

DEJ
Identify the dento - enamel junction (DEJ). The lines that represent the dentinal
tubules (arrow) can be seen. In the enamel find the regions where the enamel rods
appear to be running in many different directions. This is termed gnarled enamel
(GE) and is found in the cusps.

e.Enam

el tuftsabrupt changes in enamel rods at DEJ

f. Enamel lamellaerun from enamel surface and are filled
with enamel protein or organic debris

This higher magnification of the

transverse ground section is taken at
the dento-enamel junction (DEJ).
The scalloped profile of the junction
is evident. In this section enamel
tufts (T) and enamel lamellae (L)
can be seen. The enamel tufts are
regions where the enamel protein is
high due to the less mineralized state
of the region. The incremental lines
of Retzius (R) are also quite
apparent running parallel to the
surface of the enamel.

L
R
T
DEJ

g.Enamel spindlesnewly formed odontoblast processes

that get caught between enamel formed by ameloblasts

At the tip of the cusp identify the dentin

(D) and the enamel (E). In this
region find the enamel spindles
(arrow) which are the continuations
of the odontoblastic processes into
the enamel.

DENTIN

1. Composition
a. Inorganic (70%)hydroxyapatite crystals
b. Organic (20%)Type I collagen and proteins form
scaffold for the mineral deposits
c. Water (10%)
2. Types
a. Predentinunmineralized, like osteoid (newly laid down)
b. Mantle Dentinthin dentin, just below the DEJ
c. Primarycircumpulpal and mantle dentin
i. Bulk of dentin is primary, and is well organized into
tubules
d. Secondarydeposited after root formation
e. Tertiaryreparative dentin, formed in reaction to stimulus
i. Has no organization

3. Organization
a. Dentin is organized into tubules, that are surrounded by
peritubular dentin
i. The odontoblast processes sit inside the tubules,
which is what leaves the space as they move down.
b. In between the tubule/peritubule complex is intertubular
dentin

c. Cannaliculi are
also present in
between tubules

4. Dentinogenesis
a. Odontoblasts (from neural crest/neuralectoderm)form
dentin
i. Inner enamel epithelium induces dental
papillary cells to differentiate into
odontoblasts
b. Dentinogenesis begins in the cuspal region (coronal
dentin)
c. Continues later in the root, induced by Hertwigs
root sheath.
i. Deciduous teethdentin at root finished forming 18
mo. after eruption
ii. Permanent teethdentin at root finished forming 2-3
years after eruption
iii. No dentinal tubules in cementum, unlike coronal
dentin, which have tubules that project into enamel
(spindles).
d. Presecretory odontoblastscells are larger, with more
organelles and polarized nucleus (away from inner
enamel epithelium)
e. Secretory odontoblaststall columnar cells

i. Secrete Type I collagen and ground substance

(like fibroblasts) to make predentin

f. Mineralizationoccurs in small, round areas called

calcospherites, which coalesce to form a solid mass
i. Interglobular dentinuncalcified regions of dentin

5.Definitions
a.Enamel spindleOdontoblastic process that becomes
embedded in enamel, and gets longer as the
odontoblasts lay down dentin and move towards the pulp

b. Von

Korffs fibersType I
collagen secreted by

odontoblasts in predentin
c. Tomes granular layerspecial arrangements of collagen
and proteins at the CEJ
d. Lines of von Ebnerincremental growth lines
e. Lines of Owenlarger, more pronounced incremental line
that indicates change in nutrition status after birth

CLINICAL CORRELATION ON INTEGUMENT

1. Skin and Mucosa
a. Skin Layers
i. St. Basale
ii. St. Spinosum
1. Cells adhering via
a. Hemidesmosomesintegrins

i. Attach cells to the basal layer

b. Desmosomescadherins
i. Attach cells to neighboring cells with
the help of desmogleins, which attach
tonofiliaments
iii. St. Granulosa
iv. St. Lucidum
v. St. Corneum
b. Mucosalose keratinization
2. Types of Skin Cancersthey usually present as abnormalities
in the dermis, as the cells have broken through the basal
lamina protective barrier separating the epidermis from the
dermis.
a. Basal cell
b. Squamous cell
i. Can occur in the mouth, especially is tobacco user
c. Melanomamelanocytes
i. A (asymmetry) B (border) C (color) D (diameter) E
(evolving)
3. Other Skin Conditions
a. Psoriasisa pruritic (itchy) condition causing patches of
flaky, red, blistering skin all over the body including the
mouth
i. Skin is red due to an overgrowth of blood vessels
ii. Dentritic cells affected
b. Pemphigusautoimmune disease to desmosomes
i. Pemphigus foliaceusmild form (skin only)
1. Caused by the knockout of Dsg1 (IgG antibodies)
a. Dsg1 present in high quantity in the stratum
corneum, resulting in detachment of St.
corneum, causing light pink, superficial
lesions/blisters
b. Very little Dsg1 in the mouth, so lesions are
only present in skin
ii. Pemphigus vulgarismore severe (skin and mouth)
1. Caused by knockout of Dsg3 (IgG antibodies)

a. Dsg3 present in high quantity in the stratum

basale, resulting in a complete separation of
the upper layers from the basal layer,
causing angry, deep red blisters
b. High quantity of Dsg3 in the mouth, so
lesions are present in the oral mucosa
c. Can have both Dsg3 and Dsg1 knocked out,
resulting in lesions in both the skin and
mouth
iii. In both types, the basal layer is still attached
because they are attached to the basal lamina via
hemidesmosomes, which dont have Dsg1 or Dsg3
and are unaffected.
iv. Nikolskys Signa test to diagnose pemphigus (and
other issues)
1. Is either positive or negative
a. Positive results are those with loose skin
that slips free from underlying layers when
rubbed
b. Doctor uses the eraser of a pencil and twists
it against the skin. If positive, a blister will
form there in minutes.
v. Generally has a good prognosis with topical steroids
vi. Risk factors are Myesthenia Gravis, Cancer, sun
exposure, and travel to Brazil (mosquito bite
initiates).
c. Bollous Pemphigoidauto immune disease of
hemidesmosomes)
i. Causes disruption of adhesion between the St. basale
and the basal lamina, resulting in complete
detachment of the epidermis from the dermis
causing angry red blisters.

THE PULP COMPLEX

1. Zones of the Pulp
a. Odontoblast Layer
i. Odontoblasts
produce Type I
collagen
b. Cell free zone
i. Nerve plexus of
Raschkow
c. Cell Rich zone
i. Fibroblastsmake
pulp matrix
ii. Ectomesenchymal
cellsgive rise to

odontoblasts/fibroblasts
d. Core zone
i. Blood supply
Arterioles enter the pulp from the apical and
accessory foramen
1. Main capillary bed is near the odontoblast layer
2. Shunts are present throughout the pulp

ii. Nerves
Sensory and
Sympathetic nerve
bundles also enter
through the apical and
accessory foramen and
regulate the
vasculature.
Myelinated and
Unmyelinated Nerves
(surrounded by Schwann)
o Myelinateddetect pressure and vibration
o Unmyelinateddetect pain
1. Major nerve plexus of Raschkow present in cell
free zone
2. Nerve growth factor is present in dentinal
tubules, meaning that stimulation of dentin may
cause pain sensation. All sensations within the
dentin/pulp complex cause pain.
iii. Lymphatics
Begin in coronal region and exit through the apical
foramen
1. Macrophagefrom monocytes
2. Lymphocytesmostly T cells
3. Dendritic cellsAntigen presenting cells that can
project processes into dentinal tubules
2. Collagen of the Pulp
a. Types I and III (TMJ=Type II)
i. Greatest concentration of collagen is in the most
apical portion of the pulp
3. Pain in the Dentin/Pulp Complex
a. All sensations cause pain (ex. Heat, air, cold, water, etc.)
due to presence of nerves in the dentinal tubules
b. Theories of Painnone are proven
i. Dentin is directly innervated
ii. Odontoblasts act as receptors for neurons
1. No synapses have ever been found

iii. Fluid movement through tubules stimulates receptors

in pulp
1. Fluid movement influences the pulp and is
sensed by nerve endings
4. Age-Related Changes to Pulp
a. Decrease in volume of chamber due to continued dentin
production
b. Reduction of vasculature
c. Cell density reduced with increase of fibrous bundles
d. Loss of axons and pulp sensitivity
e. Calcifications/Pulp Stones
5. Age-Related Changes to Dentin
a. Gradual reduction in diameter of dentinal tubule
b. Closure of dentinal tubule, resulting in sclerotic dentin
c. Increased brittleness
d. Dead tracts found near the root apex due to the death of
odontoblasts

THE PERIODONTIUM
1. Parts
a. Gingivasupport teeth
b. Alveolar Processesbone that supports teeth
c. Periodontal ligamentfibers that connect
cementum/roots to bone
i. Inserts into cementum (Sharpeys fibers) between
cementocytes
ii. Made of Type XII collagen
d. Cementumcovers root of teeth
e. Composition
1. Matrix (50%)
a. Mostly collagen Type I, III, XII (also V, VI, XIV)
b. Proteins
2. Mineral (50%)
a. Hydroxyapatite
2. Types of Cementum
a. Primary

i. Aceullar extrinsic fiber cementum

1. No cementocytes embedded
2. Provides tooth attachment
3. Found at cervical crown
4. Cementoblasts align along predentin and initially
produce collagen that intermingles with dentin
collagen
a. PDL fibers sit between cementoblasts and
insert into the primary cementum, resulting
in Sharpeys fibers that get trapped in the
mineralized cementum

Image 1

IL
PC
TGL
Dentin

Cementum - low & high magnifications

Cellular detail is lost in this section of ground tooth. However in the upper one-third of
the root one can find acellular or primary cementum (PC). Deep to the cementum is a
portion of the dentin called Tomes granular layer (TGL). Running parallel to the
surface in the cementum are incremental lines (IL) indicating differences in growth
periods. Not shown well on this slide, but perhaps on your section, are embedded
collagen fibers running perpendicular to the surface. These are Sharpey s fibers,
which help to stabilize the root to the surrounding periodontal tissues.

b. Secondary
low
i. Cellular intrinsic
Image3
fiber cementum
Cementum - low & high
magnifications
1. Has
On the right side of the
upper image is alveolar
cementocytes
bone (ALV) and on the
left side is the tooth.
in lacunae
Between them are the
embedded in
collagen fibers of the
periodontal ligament
mineralized
(PDL). The thin
basophilic area on the
cementum
surface of the tooth is
the cementum (C) with
2. Adaptive role
embedded Sharpey s
fibers.
to tooth wear,
movement,
high
repair
3. Found at the apical root
4. Formed after tooth is in occlusion

ALV

PDL

PDL
C

TGL

Image2

SC

Cementum - high magnification

On the apical one-third of the root you will see cellular or secondary cementum
(SC). The cementocytes (C) are embedded in lacunae and their cellular
processes resemble spider legs emanating from them. Since this is a thick
ground section you will need to use the fine focus of the microscope to
visualize their three dimensional structure. Tomes granular layer (TGL) is
seen in the dentin.

3. Cementogenesisnot clear which cells actually produce

cementum

a. Initiated at Hertwigs Root Sheath (HERS)

b. After odontoblasts produce predentin, it comes in contact
with ectomesenchymal cells from dental follicle
c. 2 Theories about what happens next
i. Dental follicle cells receive signal from HERS or
dentin and differentiate into cementoblasts
ii. HERS cells differentiate into Cementoblasts
iii. BMP and Runx2 may cause differentiation
d. During these processes, some cementoblasts undergo
apoptosis, forming the cell rests of Malassez, which are
present in the PDL and contribute to
maintenance/regeneration of the PDL
4. CEJ
a. Types of junctions
i. Overlap of Cementum and Enamel
ii. Gap between Cementum and Enamel
iii. Perfect meeting/opposition of Cementum and Enamel
5. Alveloar Process aka Lamina Dura aka Alveolar Bone Proper
a. Made up of spongy bone which sits between cortical bone
and the lamina dura (closest to PDL)
b. Derived from ectomesenchyme
c. Bundle bonedirectly lines the socket where teeth sit
i. Collagen fibers of the PDL insert/attach via Sharpeys
fibers
d. Tooth movement causes constant remodeling (resorption
and deposition) of bone

Image6
Human adult tooth, decalcified.
The tooth is seen at the
alveolar crest (AC). The
alveolar bone facing the
vestibule or lingual aspect of
the mouth is compact bone
called cortical plates (CP);
the bone facing the root is
alveolar bone proper (aka
known as lamina dura or
cribiform plate) (LD) is also
compact bone. Between these
inner and outer plates is
spongy bone (SB).
Connecting the lamina dura
and the root of the tooth is the
periodontal ligament (PDL).

Gingiva

Root

AC

PDL
LD

CP
SB

Image5
F

CP

LD
SB

CP

Two slides show the adult s tooth (left)

or child s tooth (right) in the tooth
socket formed by alveolar bone.
Alveolar bone may have lamina dura
(LD) separated from the cortical
plate (CP) by spongy bone (SB) or
they may be fused (F).

6. PDLmade of Type I, III,

and XII collagen
LD
a. Development
SB
i. Derived from
ectomesenchyme (neural crest)
1. Gives rise to fibroblasts, which produce collagen
of PDL
ii. Early on the PDL fibers are unorganized
iii. Later becomes organized
1. Alveolar crest fibers

2. Horizontal
fibers
3. Oblique fibers
4. Apical fibers
5. Interradicular
fibers
b. Has significant nerve
supply
i. Free nerve endings
pain
ii. Ruffini endings
pressure
c. Blood supply is
extensive

Image7

Fiber groups of thePDL include:

1- Alveolar crest - cementum to alveolar
crest
2 - Horizontal - top 1/3rd of cementum to
alveolar bone
3 - Oblique fibers - bottom 2/3rds of
cementum to alveolar bone
4 - Apical - apex to fundic crypt

Image8
5

1
2
3

interradicular
crest
4
Two decalcified molar teeth of a rat.
Fiber groups of the PDL include:
1- Alveolar crest - cementum to alveolar crest
2 - Horizontal - top 1/3rd of cementum to alveolar bone
3 - Oblique fibers - bottom 2/3rds of cementum to alveolar bone
4 - Apical - apex to fundic crypt
5 - Interradicular - cementum to interradicular crest

7. Important Definitions
a. Sharpeys (extrinsic acellular) fibersCollagen fibers of
the PDL that become embedded in the ingoranic
cementum matrix
b. Cementoidnewly laid unmineralized cementum made
up of collagen fibers which intermingle with dentin
collagen
c. Cell rests of Malassezremnants of the epithelial sheath
(Hertwig) that are part of the PDL and maintain/regernate
it.
SALIVARY GLANDS
1. Salivary GlandsTubuloalveolar exocrine glands
a. Glands form from epithelium and differentiate to be
ducts or secretory cells

b. They are surrounded by CT, which invaginates to form

lobules
i. Acini are in the lobules in bunches
ii. Product moves from the acini, to an intercalated
duct (simple cuboidal), to a striated duct (simple
columnar), to an intralobular duct, to an
interlobular duct, to a lobar duct, and out to the
main duct
1. Striated ductshave basal infoldings w/Na+
ion pumps, which help produce a hypoosmotic saliva
c. Tubulesare mucous producing
i. Have myoepithelial cells at the base, which are
filled with actin filaments and contract to move
secretions through the ducts
ii. Can have serous demi-lunes, which will produce a
serous secretion that mixes with the mucous
secreting tubule
d. Alveolus/AcinusSerous secreting
i. Have myoepithelial cells as well
2. Types of Glands
a. Parotidserous acini
i. Stains intensely because acini are making lots of
proteins
ii. Produce a watery saliva w/ amylase, lysozyme,
IgA, and lactoferrin
ID
cap

L
n

SD
SG

Parotid, serous endpieces & ducts,-high mag.

Serous glands are composed of pyramidal cells (circle) surrounding a small
lumen (L). Round nuclei (n) are basally located and rough endoplasmic
reticulum adds to the basophilia; refractile secretory granules (SG) are
located apically. Small intercalated ducts (ID) lined by simple cuboidal cells
drain to larger striated ducts lined by simple columnar cells (SD).

Secretory enpieces (circled) with

acinar cells (A) drain directly into
intercalated ducts (ID) which
have a simple, low cuboidal
epithelium. The intercalated duct
transports saliva to the striated
duct (SD) which is lined by pink,
simple columnar cells having
many basal infoldings and
mitochondria (which push the
nuclei toward the center or apex
of the cell). Close to the
basement membrane of the
striated duct are many
fenestrated capillaries (cap).
Salivary glands have many
antibody-secreting plasma cells
(pc) in the connective tissue just
outside the acini.

SD

A
PC
ID

b. Submandibularmixed, mostly serous (w/demilunes)

Submandibular gland
MC
SD

This a predominantly serous gland which in places has mucous secretory endpieces
with serous demilunes (SD). The gland has both blue, pure serous acini and pale,
mucous endpieces (MC).

c.

Sublingualmixed,
mostly mucous due to mucin (pale staining cells)

Sublingual gland
Sublingual gland
This gland has serous and (SC) mucous
cells (MC) but it is primarily mucous.
Nuclei in mucous cells are often flat
and pressed to the cells base. In
some endpieces a few serous cells
form a serous demilune (SDL).
Intercalated ducts (ID) drain to
striated ducts (SD).

ID
SD
SDL

SC MC

STR

An intercalated duct (ID)

can be seen draining
onto a striated duct
(SD). Under higher
magnification, basal
striations (STR) can
be seen in the striated
duct cells in sharp
contrast to the pale
staining mucous cells
(MC).

MC

ID

d. Minor glandslabial, palatal, buccal, lingual

i. Mixture of serous and mucous

3. Innervation (unmyelinated w/ Schwann cells)

a. Parasympathetic (most common)evokes fluid
secretion during eating, etc.

SD

i.

Fluid and electrolyte secretion

1. Acetylcholine (parasympathetic) binds to
cholinergic receptor
2. Sets off a cascade, leading to excretion of
fluids/electrolytes

b. Sympathetic (more intermittent)do not mobilize fluid

secretion due to fight or flight response
i. Protein secretion
1. Norepinephrine (sympathetic) binds to B
adrenergic receptor, setting off a cascade
and ultimately releasing proteins

ORAL MUCOSA
1. Masticatory Mucosa/Oral Mucoperiosteum (hard palate, gums)
a. Epitheliumstratified squamous wet

b. Lamina Proprialots of CT fibers that hold the mucosa

tightly bound against the bone along with vessels,
nerves, etc.
i. Has many papillary ridges, which increase area for a
secure attachment to the overlying epithelium
ii. Held to epithelium via hemidesmosomes, tonofibrils,
and carious other components that work in concert
to form tight connections
iii. Cells include fibroblasts (Type I, III), mast cells
(heparin), macrophages and other immune cells
(Plasma, neutrophils, lymphocytes)
c. Bone
2. Lining Mucosa (lips, posterior palate, cheek, etc.)
a. Epitheliumstratified squamous wet
b. Lamina Propriafine CT
i. Has papillary ridges to attach to epithelium and all
the same features as oral mucoperiosteum (see
above)
ii. Sometimes has skeletal muscle depending on
function of area
c. Submucosaloose CT, vessels, nerves, etc.
oral ss

skin

ts

Image 1
Oral
side

lp
bv

low

sg

med

sk

med

Lip, - Low & med. mag.

The outer surface of the lip is covered by thin skin (ts). At the core of the lip is skeletal
muscle (sk). The inner aspect of the lip is lined by a thick non-keratinized stratified
squamous epithelium (ss). In the lamina propria (lp) underlying the wet epithelium
are many blood vessels (bv) & nerves; in the submucosal connective tissue deep to
the lamina propria lie minor salivary glands (sg). The cheek is similar to the lip.

3. Epithelium Types
a. Keratinizedtough, resists abrasion
i. St. Basaledivides and has tonofilaments
ii. Prickle cell layertonofibrils, membrane coating
granules, desmosomes
iii. Granular layerkeratohyaline granules, tonofibrils,
membrane coating granules
iv. St. corneum is highly keratinized and cells have no
nucleus/organelles
v. Found in hard palate, gingiva
b. Para-keratinized
i. St. corneum is highly keratinized but some cells still
have nuclei
c. Non-keratinizedthick but flexible
i. St. Basaledivides and has tonofilaments
ii. Prickle cell layertonofilaments, membrane coating
granules, desmosomes
iii. Intermediate layertonofilaments, glycogen
iv. St. corneum cells have nuclei
v. Found in lips, cheek, soft palate, floor of the mouth,
underside of tongue
1. Floor of mouth is thinnest stratified squamous
epithelium and is often used as a site for
administering drugs directly into the
bloodstream as they dissolve easily
4. Turnover Rate
a. Cheek15-25 days
b. Gingiva40-50 days
c. Influenced by cytokines, which are produces by
epithelium cells, fibroblasts, and inflammatory cells
i. Inflammation can either stimulate (slight) or slow
(severe) mitosis
5. Nerve supply
a. Better anteriorly to detect temperature and taste (buds
on tongue)

Muscle

Image7

LP

TONGUE/TASTE

BUDS

SS

Tongue- The epithelium of the ventral surface of the

tongue is smooth and thin. Its non-keratinized stratified
squamous epithelium (SS) (see nuclei (N) in its most
superficial layers) rests on a thin lamina propria which has
only low ct papillae.

2. Anterior 2/3
a. Filliform
keratinized

Low
Med

highly

C
G
SM

G
SM
Tongue - med & low mag.

The mucosa covering the tongue consists of epithelium (E) & underlying connective tissue.
Dorsal & ventral mucosae cover a core of skeletal muscle (SM) running in 3 planes. Embedded in the skeletal
muscle may be glands (G). The ventral surface of the tongue (not shown) is a thin smooth stratified
squamous epithelium (wet).
The anterior 2/3rds of the dorsal surface is covered by many papillae. Most numerous are conical, keratinized
filiform (f) papillae; non-keratinized mushroom-shaped fungiform papillae (not shown) are scattered. At the
junction of the anterior & posterior regions, i.e., the sulcus terminalis, lie 8 -12 large circumvallate papillae
(C). These cushion-shaped connective tissue structures are covered by a non-keratinized stratified
squamous epithelium in which there are many taste buds.

b. Fungiformnonkeratinized,
mushroom-like and
occasionally have taste
buds

fp
tb

high

Tongue, fungiform papilla with taste buds -

med

med & high mag

Taste buds (tb) appear on the apex of the fungiform papilla (fp). Taste buds
are barrel-shaped collections of about 20 epithelial cells within the surface
epithelium. Some cells are dividing (stem) cells, others are elongated
supporting cells for the actual taste cells. Taste cells are also elongated
cells whose microvilli extend into the taste pore which opens to the surface;
these cells are contacted by sensory nerves from below.

3. Posterior 1/3 (sulcus

terminalisjunction of anterior 2/3)
a. Circumvallatenon-keratinized w/ many taste buds
i. Have crypts, which is where the taste buds are
located

ii. Have von Ebners

glands, which are
serous secreting and
dump into the crypts

cv

cv
tb
low

tb
ve

high

4. Taste Buds
Tongue,
.
a. Function
i. Microvilli on taste
pores bind ligands
which turns on Gcoupled protein receptor pathways
ii. This activates channels allowing NaCl in, which
depolarizes the neuroepithelial cells and releases
neurotransmitters to the brain about taste (sweet,
sour, salty, umami, bitter).
PALATES
1. Hard Palatemasticatory mucosa
a. Stratified squamous epithelium w/ different composition
based on area. Gets more keratinized at the midline, and
keratinization decreases as you more laterally and
posteriorly.
i. Anterior Hard palatekeratinized
- low & high mags.
Each circumvallate papilla (cv) is large & surrounded by a moat-like invagination (m)
of epithelium, the walls of which contain many barrel shaped taste buds (tb). Ducts
of the serous glands of von Ebner (ve) empty secretions into the base of the moat.

Image9

Image8
Hard palate anterior
The masticatory mucosa (MM) in
the midline of the anterior part
of the hard palate has an
epithelium (E) which is (ortho)
keratinized. It is tightly bound
to the bony shelf of the palate
(BS) by a thin layer of dense ct
(CT) which, in the mid-line, has
no glands or fat.
The dorsal aspect of the palatine
shelf contains the glands of the
nasal cavity.

BS
K

CT
MM

Hard palate- anterior The superficial cells of this (ortho)keratinized stratified

squamous epithelium stain brightly pink (K) due to the keratin in them. Nuclei are
not present in these outermost cells.

ii. Anterolateralpara-keratinized

KE

Image11

Image10
SG
SG

M
LP

F
SM
Hard palate, anterolateral region
Somewhat lateral to the midline raphae the mucosa (M) has a more generous amount of ct in
the submucosa (SM) which includes fatty tissue (F). The junction between the
(ortho)keratinized epithelium (KE) and its underlying lamina propria (LP) shows deep
interdigitations.

KE

Hard palate, posterior region from theraphaelaterally - The parakeratinized

palatal epithelium (KE) covers the hard palate. Medially, towards the midline the
underlying connective tissue is sparse with occasional fat cells (F). Laterally, the
submucosa is filled with minor salivary glands (SG) a duct (D) of which is coursing
toward the surface.

iii.

Posterolateralnon-keratinized
Image12
Hard palate, posterior region
Parakeratinized palatal epithelium covers
the hard palate. The four major strata
of the epithelium are seen: basale (B),
spinosum (S), granulosum (G), and
corneum (C).

C
G

2. Soft Palateextension of hard palate (back of mouth to

pharynx) that has both a respiratory and oral epithelium
surface
a. Respiratory surface w/ respiratory epithelium
(pseudostratified ciliated columnar) and skeletal muscle

b. Oral surfacewet
stratified squamous w/
mucous glands and
lymphatic nodules

ss

sg

sm

Nasal cavity
NE

SM

Image14

ln

SM
SG
SM

oral cavity

Soft palate, uvula, - low mag.

This fleshy extension of the hard palate has a core of skeletal muscle (sm). Its upper surface
faces the respiratory passages (pseudostratified epithelium may not be present if the cut is too
far posteriorly) but since it presses against the nasopharynx in swallowing it has a wet stratified
squamous epithelium. The inferior surface faces the oral cavitand its mucosa has a wet
stratified squamous epithelium (ss). In the underlying connective tissue there are many
seromucous glands (sg) and lymphatic nodules (ln).

NK

Oral cavity
Soft palateAt low mag both the oral and nasal surfaces are seen. The oral mucosa is
surfaced by a non-keratinized stratified squamous epithelium (NK) while the nasal
epithelium (NE) is pseudostratified columnar. At the core of the soft palate is
skeletal muscle (SM). Between the muscle and the oral epithelium are many minor
salivary glands (SG).

Image15

skeletal muscle

SG
S
V

SG

E
LP

LOW

High
Soft palateAt low mag minor salivary glands (SG) can be distinguished from the

fatty ct (F) in the submucosa (S). The greater vascularity of the mucosa of the soft
palate (than the hard palate) is seen by the abundant vessels (V) in its lamina
propria. A layer of elastic fibers (E) separates the lamina propria (LP) from the
gland-containing submucosa.

GINGIVAmasticatory mucosa
1. Alveolar mucosanonkeratinized
a. Meets with attached gingiva at the mucogingival junction
2. Attached gingivapara-keratinized
3. Free gingivakeratinized
a. >3 mm sulcus means periodontal disease
b. Has junctional epithelium where the free gingiva attaches
to the enamel
i. Enamel is separated from epithelium by a basal
lamina
ii. Epithelium is separated from lamina propria by a
basal lamina

Image16

Image 17

FG

Enamel

Rat molar - The free and attached gingiva (FG, AG) are keratinized here. The
stratified squamous epithelium is (ortho)keratinized as noted by the intense
staining of the keratin (K) in the upper layers and the lack of nuclei in the
most superficial layers of the epithelium.

GS
GG
DG
AG

AG

RP

FG

PK

Gingiva - The free gingiva (FG) is seen between the gingival sulcus (GS) and the gingival
groove (GG). Below the gingival groove is the attached gingiva (AG) that is found over
the alveolar bone (not seen here). Note the long rete pegs (RP) found in the free and
attached gingiva. The junctional epithelium (JE) is attached to the enamel. Dentogingival
fibers (DG) connect the gingiva to the cementum (not seen).

Image 18
SS
Freegingiva - High
magnification
The interdigitations (rete ridges; RR)
of the gingival epithelium and the
connective tissue in the lamina
propria help withstand the abrasive
forces being applied. The
keratinocytes form the stratum
basale (SB) and stratum spinosum
(SS). In this image the
keratinocytes have formed
parakeratin (PK) on the surface.

JE

SS
SB

RR
RR

TOOTH ERUPTION
1. Stages of Tooth Eruption
a. Pre-eruptive stage
i. Tooth changes location during Bell Stage
b. Eruptive Stage
i. Upward movement of the tooth that begins with root
formation and ends when the tooth reaches the
occlusal plane
ii. There is an intraosseous and extraosseous phase as
the teeth move through the bone
c. Post-eruptive Stage
i. Normal growth of jaw up until age 20, with
readjustment between 14 and 18
1. Teeth move occlusally with root formation and
jaw growth

2. Occlusion causes PDL to become organized and

causes the alveolar bone to increase in density
2. Teeth movement
a. Teeth move in 2 ways in relation to the growing jaw
i. Total Bodily movement
1. Entire tooth shifts and involves bone
reabsorption and formation
ii. Eccentric growth
1. One part of the tooth grows (ex. Root elongates
but crown doesnt grow)

3. Mechanisms of Tooth Eruption

a. Little is actually known about tooth eruption, but there
are 4 factors to be considered
i. Root Formation
1. Occurs after amelogenesis is complete
2. Teeth without roots can erupt
ii. Bony remodelingCSF1 and RANKL are important
1. CSF-1 is needed. It stimulates monocytes to
enter during tooth eruption, which become
osteoclasts
a. Coronal region of the dental follicle
regulates osteoclasts and RANKL expression
increases (parathyroid hormone
upregulates RANKL)

Monocyte

2. Basal region of dental follicle

regulates osteoblast activity
and BMP expression
increases to create alveolar
bone
a. Controlled by Runx2
iii. Forces generated by the PDL
1. The PDL forms after root
formation starts and must
be remodeled as eruption occurs
2. It is thought that the PDL helps pull the tooth
through the bony socket
a. BUT with osteopetrosis, there is a PDL but
teeth dont erupt and teeth with no roots
and without a PDL do erupt, so we arent
really sure.

iv. Molecular changes in the dental follicle

1. The dental follicle is attached to the lamina
propria of the oral mucosa via the
gubernacular cord, which travels through the
gubernacular canal
a. The canal is widened by osteoclasts and
teeth travel up through it
2. Eruption may be dependent in part on the
presence of the dental follicle
a. Even without a tooth or with a replica, the
gubernacular cord develops and the tooth
will erupt, suggesting programmed bony
remodeling and a reliance on the dental
follicle

3. Dental follicle regulates:

a. Eruption pathway:
i. Bone, CT, and epithelium reabsorption
b. Moving tooth into eruption pathway:
i. Interradicular bone formation, root
growth, and PDL growth
4. Tooth wear
a. Occlusal
i. As teeth wear down they erupt further
b. Interproximal
i. Teeth have a tendency to move anteriorly (mesial
drift)
1. Involves continued bone remodeling. Bone
resorption on mesial and apposition on distal
2. Transeptal fibers play a role in the mesial drift
along with occlusal forces
5. Tooth exfoliation
a. Some of pulp cavity is lost when tooth is lost, but root and
dentin are reabsorbed by odontoclasts (from monocytes)
b. Caused by pressure from tooth underneath and increased
forces from mastication and jaw
c. Mandibular lost before maxillary and girls before boys