1. STRUCTURE OF THE ORAL
MUCOSA IN CHILDREN
BY, VAISHNV RAJESH
PILAKKADAN MOHAMMED ADIL
2. ORAL MUCOSA
The oral mucosa is the mucous membrane lining or “skin” inside of the mouth,
including cheeks and lips.
People with oral mucosal diseases may
develop painful mouth sores or ulcers on this lining.
It comprises stratified squamous epithelium,
termed ‘oral epithelium’ and an underlying
connective tissue termed lamina proparia.
3. STRUCTURE OF ORAL MUCOSA AT
NEONATAL PERIOD
Neonate oral epithelium is heavily colonizes,
but microbial load declines during weaning.
Color of newborn’s oral mucosa is red.
They are thin.
They have huge amount of vessels.
They have only two layers of epithelium .
Tender to injury.
They have extremely high regeneration.
Strong against all infections.
4. Neutrophils are present in the oral epithelium prenatally and are additionally but
transiently recruited postnatally in a microbiota- and IL-17-dependent manner.
γδT cells are the major IL-17-producing T cells in the neonatal oral epithelium.
5. The neonatal oral epithelium becomes less permeable during postnatal
maturation in a microbiota-dependent manner.
Upregulation of saliva secretion after birth reduces oral microbiota while the
microbiota induces expression of salivary antimicrobial components.
The neonatal epithelium has a slower turnover rate and distinct transcriptomic
signature compared to the adult epithelium.
Differential expression of microbial recognition receptors and antimicrobial
molecules in the neonate and adult epithelium.
6. CHARACTERISTICS
The sagittal maxillomandibular relationship presents changes during the
development of occlusion.
Forward maxillary positioning in relation to the mandible is the most remarkable
aspect at birth and yields a pseudo-appearance of micrognathia.
Concerning the vertical maxillomandibular
relationship, there is anterior open bite,
regarded as physiological before onset m
of tooth eruption.
7. The lip contour is characteristically triangular, with base on the lower lip and
vertex on the upper lip.
After birth, the frequent feedings lead to formation of the sucking callus.
The attachment of the lip frenum is variable, ranging from a few millimeters
above the alveolar ridge margin.
The palatal rugae are very evident in the newborn.
8. FUNCTION
The presence of neutrophils in the neonatal oral epithelium is likely to
provide protection when the epithelium is temporally vulnerable due to its
increased permeability and exposure to high microbial load.
9. STRUCTURE OF ORAL MUCOSA AT
INFANCY P
Oral microbial colonization of an infant’s mouth begins shortly after birth.
The infants mouth consist only of gum pads in the pre-dentate stage, i.e.,
till about 6-7 months of age.
As the teeth begin to erupt into the oral cavity (as the infant enters dentate
stage), the colonization changes as the teeth present additional hard
tissues surfaces for colonization.
10. SPECIFIC CHARACTERISTICS
The alveolar ridges of infants exhibit gum pads.
Infants also present some frequent changes according to their stage of
development, such as natal and neonatal teeth.
Some infants also present gingival cyst. These are remnants of embryonic
epithelial structures and may be classified as Epstein pearls, Bohn nodules or
dental lamina cys
11. FUNCTION
Effective oral motor function is fundamental to a newborn human infant’s
successful transition from intra to extra-uterine phases of life.
The development of this function begins prenatally.
Throughout the first 12 months after birth oral motor function progressively
develops to atch other biologically driven developmental processes.
Sucking, chewing and tongue activity prepare food for swallowing.
Within the pharynx both liquid and solid foods are swallowed and guided into
the esophagus while air moves toward the larynx and trachea.
This process requires a sequence of well-coordinated neuromuscular actions.
12. HISTOLOGY
The epithelium of the vestibule of the oral cavity originates from the cutaneous
ectoderm, and the epithelium lining the oral cavity itself is of endodermal origin.
The mucous membrane of the oral cavity is divided into lining, or covering (the
mucous membrane of the lips, cheeks), chewing (the mucous membrane of the
hard palate and gums) and specialized, which covers the upper and lateral
surfaces of the tongue.
In turn, the epithelium of the lining mucosa is non-keratinizing, the epithelium of
the lining mucous membrane is non-keratinizing, the epithelium of the masticatory
mucosa is multilayered flat keratinizing, and the epithelium of the specialized
membrane of the tongue forms the epithelial-connective tissue papillae.
13. Oral fossa of a human embryo of 4 weeks. Staining with hematoxylin and eosin.
It was revealed that at the 3rd week the wall of the oral fossa of the
embryo is covered with a single-layer epithelium. The floor of the oral
fossa is covered with a two-layer low-prismatic epithelium, and the roof is
covered with ciliated epithelium.
14. The oral cavity of a human embryo of 5 weeks. Staining with hematoxylin and eosin.
15. The oral cavity of a human embryo of 5 weeks. Staining with hematoxylin and eosin.
16. EARLY CHILDHOOD
Conditions affecting the oral mucosa and associated soft
tissues can be classified as follows: infections, ulcer
vesiculobullous lesions, white lesions, cysts, and tumours.
Infections
Viruses, bacteria, fungi, or protozoa may cause infections of
the oral bb mucosa.
17. Aphthous ulcers were the commonest inflammatory lesions
observed. Our cases included severe and chronic presentations,
both idiopathic as linked to identifiable systemic diseases, always
requiring prolonged oral treatment.
More rarely, we observed cases of relapsing mucous erythema
multiforme, lichen planus and autoimmune bullous diseases,
including a very rare case of mucous membrane pemphigoid and
other inflammatory pseudotumor of the tongue
19. We found 4 cases of cheilitis granulomatosa (Melkersson-
Rosenthal syndrome, exceptional in childhood), all were very
chronic and resistant to treatment.
Mucoceles were the commonest non inflammatory lesions, these
occurred most often in the lower lip and less frequently in the
ventral tongue (glands of Blandin-Nuhn) and in the floor of the
mouth (ranula). Several studies on pediatric mucocele appeared
after our publication. Other interesting benign mucosal tumors
observed included verrucous nevus and granular cell tumor.
20. Bacterial infection on the
lips of an
immunocompromised
child
Oral candidiasis in an
immunocompromised child
undergoing chemotherapy
for acute lymphoblastic
leukaemia
Ulceration of the lower lip
produced by biting while
still anaesthetized from an
inferior block.
21. In total, 10,128 children (0-12 years old) were enrolled. Clinical
diagnostic criteria proposed by the World Health Organization were
followed. The frequency of children presenting oral mucosal lesions
was 28.9%, and no differences related to gender were observed. The
most frequent lesions recorded were oral candidiasis (28.4%),
geographic tongue and other tongue lesions (18.5%),
22. Traumatic lesions (17.8%), recurrent aphthous
ulcerations (14.8%), herpes simplex virus type 1
infections (9.3%), and erythema multiforme (0.9%).
Children suffering from chronic diseases had a
higher frequency of oral lesions compared with
healthy children (chi-square: P < .01).
25. Ankyloglossia is characterized by an
abnormally short lingual
frenum, resulting in complete or
partial attachment of tongue to the
floor of mouth.
It may lead to decreased mobility of
the tongue.
Treatment:-frenectomy
26. CONCLUSION
Mucosal alterations in children are relatively
common, and several oral disorders are
associated with underlying medical
conditions.
