ORAL MUCOSA

It is a mucous membrane epithelium of the mouth.

Divided into 3 types: Lining mucosa covers the floor of the mouth, the

cheeks, lips and soft palate Masticatory mucosa covers the hard palate and alveolar ridges Specialized mucosa covers the surface of tongue

 The mucosa has lamina propria, the connective tissue

just below the epithelium Lamina propria is composed of papillary and reticular layers In the papillary layer, the connective tissue extends into pockets in the epithelium. This increases the surface of the epithelium for contact with vascular supply and nerves

 The reticular layer contains the deeper plexus of

vessels and nerves Below the lamina propria is the submucosa

Lining mucosa
Its soft, pliable and nonkeratinized
Covers the lips, cheeks, soft palate, floor of mouth and

ventral surface of the tongue Mucosa is composed of thin layer of epithelium and lamina propria From bottom to top the epithelium has this layers: stratum basale, stratum intermedium or spinosum and stratum superficiale

 Stratum basale cells are cuboidal

Stratum intermedium cells are oval and somewhat

flattened Stratum superficiale cells are flanned with small oval nuclei
The lining is similar to that of the pharynx

 Associated with small, round seromucous glands of

the lamina propria Submucosa has fibers of M. Orbicularis oris The mucosa is distinguished by a red border known as vermillion border Vermillion border is the junction between the oral mucosa and the skin of the lips, becoming modified into keratinized epithelium

Why is the vermilion border red in colour?

The epithelium is thin
The epithelium contains eleidin, which is transparent The blood vessels are near the surface of the papillary

layer, revealing the red blood cell colour

 The skin of the lip has hair follicles and associated

sebaceous glands, erector pili muscles and sweat glands Sometimes the sebaceous glands may be seen at the angle of the mouth without associated hair follicles. The glands are termed Fordyces spots

Soft palate
Mucosa is more pink than that of the hard palate.
Why pink? Because the lamina propria contains many

small blood vessels The submucosa contains muscles of the soft palate and minor salivary (mucous) glands

Cheeks
Cheeks The submucosa contains fat cells and seromucous glands located within and between the muscle fibers Ventral surface of the tongue In the submucosa, muscle fibers are located under the surface of the tongue

 The entire are exhibits dense, interlaced muscle and

connective tissue fibers Limits of the submucosa are not distinct because the submucosa continues with the deep muscles of the tongue along with the CT fibers The mucosa is well vascularized and is used for drug delivery in patients who suffer from cardiovascular and other systemic disease

Floor of the mouth The epithelium appear loosely attached to the lamina propria in contrast to the adjacent undersurface of the tongue mucosa which is firmly attached The area contains minor salivary glands and right and left major mucous glands, sublingual glands

Masticatory mucosa
Its a thick keratinized epithelium that renders the

epithelium resistance to attrition Covers gingiva and hard palate Layers of the epithelium from bottom to top: stratum basale, stratum intermedium, stratum granulosum and stratum corneum Stratum basal cells are cuboidal/columnar with irregularly oval nuclei and numerous mitotic figures

Cont.
The layer exhibit numerous mitotic figures as they

undergo constant cell division The cells gradually migrate to the surface of the mucosa Basal cells are attached to the basal lamina (membrane that separate epithelium and connective tissue) by a minute disks termed hemidesmosomes

 These thickenings of the cell membrane are supported

by filaments from within the cells, Also by anchoring fibrils that attach the basal lamina and the epithelial cells to the collagen fibers of the lamina propria

 Stratum spinosum several cells thick, cells are oval

polygonal in shape Stratum granulosum contain many keratohyalin granules Stratum corneum cells are thin, flattened and nonnucleated. The cells contain soft keratin Keratin is tough, nonliving material resistant to friction and impervious to bacterial invasion

 The cells continually get lost and replaced by cells of

the underlying layers = desquamation

Gingiva and epithelial attachment

Gingiva surrounds the necks of the teeth and extends

apically to the mucogingival junction. Divided into 3 zones: 1. Free or marginal zone encloses the tooth and defines the gingival sulcus 2. Attached gingiva portion of the epithelium attached to the neck of the tooth by means of junctional epithelium 3. Interdental zone area between the two adjacent teeth beneath their contact point

 Free gingival groove is an indistinct groove that

separates the free and attached gingivae Attached gingiva is separated from the alveolar mucosa by mucogingival junction Attached gingivae is stippled and the free gingiva has a smooth surface

Junctional epithelium
Provides attachment for the gingiva to the tooth in the

cervical area Forms the epithelium-lined floor of the sulcus The cells have fewer desmosomes, indicating a higher rate of turnover than occurs in the other gingival epithelial cells Turnover time is approximately 6 days Stratum basale cells also contain hemidesmosomes, the mechanism for attachment of cells to the salivary protein layer which covers the cervical area of enamel

 Disturbance of this attachment to the tooth by

infection, food impaction, calculus or other irritants results in a deepening of the gingival sulcus

 Gingiva located between the teeth and extending high

on the interproximal area of crowns on the labial and lingual surfaces is known as the interdental papilla In the interproximal area, between the lingual and vestibular papilla, is a concave zone of the gingiva that follows the contour of each crown. The junctional epithelium of the zone is known as the col The col is a thin nonkeratinized epithelium. Its more inclined in a peak between anterior teeth and more flattened or concave between the posterior teeth

 When the interproximal gingiva is inflammed or

hyperemic, the col is exaggerated and positioned higher on the neck of the tooth

Hard palate
The midline is known as median raphe
On each side of the median raphe are folds known as

rugae Anterior lateral palate has fatty tissue in the submucosa Posterior lateral area has mucous glandular tissue Traction bands are bundles of collagen fibers that insert into the papillary fibers of the lamina propria and extend into the bony palate

 Traction bands are found in lamina propria of the

rugae and between the lobules fatty tissue and glands Helps in anchoring the palatal mucosa to the underlying bone Hard palate assist in mastication

Specialized Mucosa
Covers the dorsum or superior surface of the anterior

2/3 of the tongue Has four types of papille 1. Filiform 2. Fungiform 3. Circumvallate 4. Foliate Filiform papillae Many, slender, threadlike keratinized extensions of the surface epithelial cells Projects 2-3 mm high from the surface of the tongue

 Covers the entire roughened surface of the tongue

Function: They facilitate mastication and movement

of the food on the surface of the tongue Fungiform Papillae Few in number, interspersed between the filiform however numerous near the tip of the tongue Pink or reddish, Mushroom-shaped with a cap usually larger than the stalk Taste buds occasionaly found on superior surface

Circumvallate papilla 10 14 in number, located along the V-shaped sulcus between the body and base of the tongue They are level with the surface of the tongue, each surrounded by a groove Large to 3mm in diameter Taste buds line the walls of the papillae Ducts of Von Ebners glands opens into the grooves Watery secretions washes out substances so that new taste can be perceived

Foliate papillae Vertical grooves or furrows located on the lateral posterior sides of the tongue 4 to 11 in number Also contains serous glands underlying the taste buds, which cleanse the trenches of the papillae

Taste buds
Sense organs containing the chemical sense of taste
Microscopically visible, barrel-shaped bodies found in

the oral epithelium Generally associated with papillae of the tongue(10000) Some distributed in the soft palate (2500), epiglottis (900), larynx and pharynx (600), oropharynx (250) Taste cells are epithelial cells that are closely associated with club-shaped sensory nerve endings Nerve arises from the chorda tympani

 Four types of taste sensation can be detected: sweet,

salty, sour and bitter There is regional selectivity of taste in the mouth; maybe inpart caused by the origin of the nerve supply Sweet on the tip of tongue Salty on the front sides of tongue Sour on the posterior sides of the tongue Bitter On the posterior centre of tongue and soft palate

 Nerves for taste buds of the anterior 2/3 pass to the

chorda tympani branch of facial nerve Those of posterior 1/3 pass to the glossopharyngeal nerve Those from the epiglottis and larynx pass to the vagus nerve

Levels of sensitivity of the oral region

Sensation Greatest sensitivity Moderate sensitivity

Pain Heat Cold Touch

Lips, larynx Anterior tongue base of tongue Lips Tip of tongue Lips, Base of tongue posterior palate ventral tongue Lips, tip of tongue Gingiva

EPITHELIAL NONKERATINOCYTE
Langerhans cells Found in stratum spinosum Responsible for processing of antigenic material The cell have processes but no desmosomes. Unique racket-shaped organelles Merkels cell located in basal layer of gingival epithelium. Associated with terminal axon Function as touch receptors

Melanocyte Melanin producing cells located in the basal layer of the gingival epithelium Lacks desmosomes, and tonofilaments and are dendritic Has melanin granules in the cytoplasm

Changes with aging

Thinning of epithelium
Less moist mucosa Ability to repair is reduced, length of healing time is

increased Apical migration of gingiva Cellular activity decreases, fibrosis increases