•ORAL MUCOUS MEMBRANE
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiand...
 CONTENTS


1. INTRODUCTION



2.DEVELOPMENT



3.FUNCTION





4.TISSUE COMPONENTS OF ORAL
MUCOSA
5.DIVISION OF ORA...


PROSTHODONTIC CONSIDERATIONS



6.BEHAVOIUR OF ORAL MUCOSA UNDER STRESS





7.INFLAMATION AND ORAL MUCOSA .
8.INFLU...
 INTRODUCTION







The oral cavity is in many respects a very interesting
part of the human body .
Many different ki...
 DEVELOPMENT









Primitive oral cavity develops from the fusion of the
embryonic stomodeum with foregut after t...
 FUNCTIONS OF THE ORAL MUCOSA

•
•
•

•

•

1.PROTECTION.
Protects the deeper tissues and organs.
Adapts to withstand ...
 COMPONENT TISSUE



A. ORAL EPITHELIUM



B.LAMINA PROPRIA



C.SUBMUCOSA

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 DIVISION OF ORAL MUCOSA

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 EPITHELIUM






Epithelium of the oral
mucosa is stratified
squamous epithelium.
It may be ;
1.Keratinized
2.Non ker...
 KERATINIZED EPITHELIUM

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 NON KERATINIZED EPITHELIUM

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 CELLS OF NON KERATINOCYTES









MELANOCYTES; Synthesize
melanin pigment granules & transfer
to surrounding kerat...
 SMOKERS MELANOSIS








Smoking tobacco imparts smokers melanosis.
Deposition of melanin in basal layer of mucos...
 JUNCTION OF THE
EPITHELIUM, & LAMINA
PROPRIA.






The region where connective tissue of the lamina
propria meets th...








The interface consists
of CT ridges ,conical
papillae projecting into
the epithelium.
The surface area of the
...


It is also called as BASAL LAMINA.



Two zones ;

Lamina Lucida






45 nm wide.

Lamina densa.

Towards epithe...




Basal lamina attached by
hemidesmosomes.
The tonofilaments , desmosomes ,
hemidesmosomes together
represents the mec...
 FUNCTIONS






Provides mechanical bond .
Semipermeable, acts as a barrier.
Respond to tissue injury.
MUCOSAL BLIST...
 LAMINA PROPRIA
The connective tissue supporting the oral
epithelium
is termed lamina propria.

Two layers ;






...
 CELLS FOUND IN LAMINA
PROPRIA










Fibroblast - secretion of fibers &ground substance
Histiocytes - precur...
 SUBMUCOSA
.






Consists of connective
tissue of various thickness .
It attaches the mucous
membrane to the
underly...
 DIVISION OF THE ORAL MUCOSA


















KERATINZED AREAS
MASTICATORY MUCOSA.
GINGIVA
HARD PALATE
VER...
 REGIONAL VARIATIONS;
MAXILLARY EDENTULOUS
FOUNDATION










CREST OF THE RESIDUAL
RIDGE
Firmly attached to the ...
 SLOPES OF RESIDUAL RIDGE






Non keratinized or Para keratinized.
Tissues are loosely attached to periosteum.
Thi...
 ALVEOLAR MUCOSA












EPITHELIUM ; thin
nonkeratinized
LAMINA PROPRIA;
Short papillae
CT contains many el...
 REGIONS OF HARD PALATE

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 HARD PALATE

.EPITHELIUM; thick
orthokeratinized
 LAMINA PROPRIA ; long papillae, thick
collagenous tissue especially u...
 CLINICAL SIGNIFICANCE






Tissues should be recorded in resting
position .
If the tissues displace during impressio...
 MID PALATINE SUTURE







Extends from the incisive papilla to posterior
region of hard palate .
Sub mucosa is very...
 CLINICAL SIGNIFICANCE






Little or no pressure should be applied to this region
.
This area is highly sensitive ....





 PALATINE RUGAE

Irregularly shaped rolls of soft tissue in the anterior part of
hard palate.
It is a secondary s...
 SOFT PALATE






EPITHELIUM;
thin
Non keratinized, taste buds
LAMINA PROPRIA;
thick
numerous papillae, elastic fiber...
 BLOOD & NERVE SUPPLY OF PALATE

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 BLOOD & NERVE SUPPLY OF PALATE




Tonsillar branch – glossopharengeal
nerve
MOTOR SUPPLY ;Pharyngeal plexus.
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 STOMATITIS NICOTINA PALATI









Response of oral mucosa to
prolong smoking.
Middle , elderly men.
Initially- ...
 BUCCAL- LABIAL MUCOSA
EPITHELIUM; thick
Non keratinized.
 LAMINA PROPRIA;
 Long slender papillae, dense fibrous
CT con...



FORDYCE’S SPOTS

Fordyce’s spots are ectopic
sebaceous glands present in the
buccal and labial mucosa.

www.indianden...
 LINEA ALBA





A raised white wavy line
of variable length and
prominence located at the
level of occlusion.
Thin ker...
VESTIBULAR SPACES








It is bound facially by mucosa of lips , cheek &
orally by mucosa of residual ridge .
Vest...
 FRENUM








It is fold of mucous
membrane
Labial frenum is fan
shaped
Buccal frenum is
associated with muscles
Re...
 VIBRATING LINE






It is an imaginary line
drawn across the soft
palate.
Sub mucosa contains
glandular tissue .
Lam...
 MUCOUS MEMBRANE OF HAMULAR
NOTCH




Space between the posterior part of the
maxillary tuberosity & pterygoid hamuls
I...








MANDIBULAR EDENTULOUS
FOUNDATION
SUPPORTING STRUCTURES

CREST OF THE RESIDUAL
RIDGE
It is similar to maxilla...
 BUCCAL SHELF







Partially keratinized.
Loosely attached.
Thick submucosal layer.
Bone – compact bone
That why i...
 VESTIBULAR SPACES






Similar to the maxilla.
Epithelium is thin .
Non-keratinized .
Submucosa- loose areolar tiss...
 MOLAR REGION





Here the sub mucosa is attached to the
mylohyoid muscle .
Length and form of the lingual flange of t...
 RETROMOLAR PAD







Epithelium is thin .
Non-keratinized .
Submucosa – glands , loose
areolar tissue , blood vess...
FLOOR OF THE ORAL CAVITY
EPITHELIUM; very thin
Non keratinized .
 LAMINA PROPRIA ;Short papillae.
Elastic fibers.
Extensi...


FLOOR OF THE MOUTH

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





Extension of the dentures
posterior lingual flanges
usually will allow for a stable
denture.
This objective will ...
 LIPS
VERMILION ZONE


EPITHELIUM; thin ,
orthokeratinized.



LAMINA PROPRIA; narrow
papillae.





Capillary loops ...
 INTERMIDIATE ZONE









EPITHELIUM; thin
Para keratinized
LAMINA PROPRIA; long
,irregular papillae, elastic
fiber...
 BLOOD & NERVE SUPPLY










BLOOD;
UPPER LIP; SUPERIOR LABIAL ARTERY
LOWER LIP; INFERIOR LABIAL ARTERY
MENTAL...
 GINGIVA.











EPITHELIUM; Ortho-keratinized
Para-keratinized ,stippling .
LAMINA PROPRIA ;long narrow
papill...
 GINGIVA
A. ALVEOLAR MUCOSA
D. ATTACHED GINGIVA

B. GINGIVA C. MUCOGINGIVAL JUNCTION
E. FREE GINGIVA

F. INTERDENTAL GING...
 TYPES OF EPITHELIUM IN GINGIVA


3 TYPES;



1.Outer epithelium



2. Sulcular epithelium



3.Junctional epithelium...
 INTERDENTAL GINGIVA











COL

Non keratinized
Depression between
buccal & lingual papilla
Connects both the...
•BLOOD SUPPLY















UPPER GINGIVA

ANTERIOR;ANTERIOR SUPERIOR ALVEOLAR ARTEY
PALATAL; GREATER PALATINE ...
•NERVE SUPPLY









UPPER GINGIVA;

ANTERIOR, POSTERIOR, MIDDLE SUPERIOR
ALVEOLAR BRANCH OF MAXILLARY NERVE

LOWE...
 TONGUE
DORSAL SURFACE OF TONGUE











EPITHELIUM; thick
Keratinized &nonkeratinized
Lingual papillae's are...













FILLIFORM PAPILLAE

keratinized
Anterior tongue
Smallest & numerous
Hair like extensions
FOLIATE PA...


FUNGIFORM PAPILLAE

Non keratinization
Anterolateral
Taste buds
Round & reddish.


CIRCUMVALLATE PAPILLAE

Keratinized...
 TASTE BUDS



Chemoreceptor organs
Barrel shaped
seen in –fungiform papillae
circumvallate papillae
soft palate ….

ww...
VENTRAL SURFACE OF THE
TONGUE


•







EPITHELIUM; Thin, non
keratinized .
LAMINA PROPRIA ;Thin ,
Numerous short...
 LINGUAL VERUCOSITES
( PHLEBECTASIA )










Common in elder individuals.
Purplish blue nodular area.
Due to d...
 BLOOD & NERVE SUPPLY OF TONGUE
BLOOD SUPPLY;









Ant 23rd -- deep lingual artery
Post 13rd --dorsal lingual...
EFFECT OF AGING ON THE ORAL MUCOSA









HISTOLOGY

Epithelial thinning
Decreased keratinization
Less prominent ...


These changes in the histology of oral mucosa are more
marked in women especially post menopausal.



Vascular changes...


Wound healing and regeneration of tissue may be delayed
with age. Oral mucosal immunity is also believed to undergo
som...
 AGING IN GINGIVA






With the aging there is decreased
keratinization and stippling
Though gingival recession incre...


There is stiffening of the walls of the
blood vessels and decrease in their
diameter due to arthrosclerosis.



Decrea...
 BEHAVIOUR OF ORAL MUCOSA
UNDER STRESS








Oral mucosa under compression behaves in a
viscoelastic fashion.
Loads...
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

Function & Parafunction



PRESSURE

FORCE

TIME





controlled by
Tissue damage caused by
1 correct clinical
occl...
 SOFT TISSUE CHANGES IN ORAL MUCOSA














SOFT TISSUE HYPERPLASIA
FIBROUS HYPERPLASIA
EPULIS FISSURAT...
 SOFT TISSUE HYPERPLSIA










Rolls of hyperplastic tissues under denture
base
Due to bone resorbtion, with les...
 PAPILLARY HYPERPLASIA







Granular type of inflammation seen in palatal region.
numerous papillary projections gi...
 DENTURE STOMATITIS










Chronic inflammation of the denture bearing
area.
CAUSES;
Para functional habit.
il...
 DENTURE STOMATITIS











SYMPTOMS;
Redness of the tissue.
Pain.
Burning sensation
Rx;
Discontinue denture ...
 CONTACT STOMATITIS







Certain individuals react to materials & drugs
differently than others do.
In oral cavity ...
 CANDIDIASIS












Usually seen in,
Unclean mouth.
Debilitated patients
Systemic disease such as diabete...
 ANGULAR CHELITIS.







SIGNS;
Bilateral lesion that develops at the angle of the
lips.
Deep fissure or crack may ...
LOCAL DISEASES AFFECTING ORAL
CAVITY










WHITE LESIONS;
Leukoplakia.
Lichenplanus.
Hyperkeratosis.
MALIGNAN...
 LEUCOPLAKIA

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 LICHEN PLANUS

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 ERYTHROPLAKIA

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 CARCINOMA

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 NUTRITIONAL DEFICIENCY

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 SUMMARY







The oral mucosa consists of stratified
squamous epithelium followed by Lamina
propria & Submucosa.
Th...
 CONCLUSION




The dentures must function in harmony with the
remaining tissues that both support and
surround them .
...
 REFERENCES












1.A.R.Tencate -Oral Histology
,Development ,Structure and Function -- 6th
Edition
2.Anne M ...







7.Hubert E Schroeder -Oral Structural
Biology --3rd Edition
8.John J Sharry -Complete denture
prosthodontics ...
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Oral mucous membrane /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Oral mucous membrane /certified fixed orthodontic courses by Indian dental academy

  1. 1. •ORAL MUCOUS MEMBRANE INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2.  CONTENTS  1. INTRODUCTION  2.DEVELOPMENT  3.FUNCTION   4.TISSUE COMPONENTS OF ORAL MUCOSA 5.DIVISION OF ORAL MUCOSA www.indiandentalacademy.com
  3. 3.  PROSTHODONTIC CONSIDERATIONS  6.BEHAVOIUR OF ORAL MUCOSA UNDER STRESS   7.INFLAMATION AND ORAL MUCOSA . 8.INFLUENCE OF LOCAL AND SYSTEMIC DISEASE ON ORAL MUCOSA.  9.SUMMARY & CONCLUSION  10.REFERENCES. www.indiandentalacademy.com
  4. 4.  INTRODUCTION    The oral cavity is in many respects a very interesting part of the human body . Many different kind of tissue from the hardest teeth to the softest, the salivary glands are found therein. The oral cavity is lined with an uninterrupted mucosa which is continuous with the skin near vermillion border of the lips and with the pharyngeal mucosa in the region of soft palate. www.indiandentalacademy.com
  5. 5.  DEVELOPMENT      Primitive oral cavity develops from the fusion of the embryonic stomodeum with foregut after the rupture of buccopharyngeal membrane.(26 days) Oral cavity is lined by both ectoderm and endoderm. Structures developed from brachial arch Ectoderm ---tongue Endoderm---Palate ,cheeks ,Gingiva www.indiandentalacademy.com
  6. 6.  FUNCTIONS OF THE ORAL MUCOSA  • • •  •  • 1.PROTECTION. Protects the deeper tissues and organs. Adapts to withstand mechanical forces. Barrier in preventing microorganism. 2.SENSATION. Receptors responsible for the taste , thirst, temperature. 3.SECRETION. Major &minor salivary gland secretions –secrete protective substance. www.indiandentalacademy.com
  7. 7.  COMPONENT TISSUE  A. ORAL EPITHELIUM  B.LAMINA PROPRIA  C.SUBMUCOSA www.indiandentalacademy.com
  8. 8.  DIVISION OF ORAL MUCOSA www.indiandentalacademy.com
  9. 9.  EPITHELIUM    Epithelium of the oral mucosa is stratified squamous epithelium. It may be ; 1.Keratinized 2.Non keratinized Keratinized layer ortho keratinized Para keratinized www.indiandentalacademy.com
  10. 10.  KERATINIZED EPITHELIUM www.indiandentalacademy.com
  11. 11.  NON KERATINIZED EPITHELIUM www.indiandentalacademy.com
  12. 12.  CELLS OF NON KERATINOCYTES     MELANOCYTES; Synthesize melanin pigment granules & transfer to surrounding keratinocytes LANGERHANS CELL ; Antigen trapping & processing. MERKEL CELL ; Tactile sensory cell. LYMPHOCYTES ; Associated with inflammatory response in oral mucosa. www.indiandentalacademy.com
  13. 13.  SMOKERS MELANOSIS       Smoking tobacco imparts smokers melanosis. Deposition of melanin in basal layer of mucosa. Affects elderly person –heavy smokers. Appears as a diffuse brown patch. Mandibular ant. Gingiva & buccal mucosa commonly affected. Labial mucosa ,palate, tongue, floor of the mouth , lips . www.indiandentalacademy.com
  14. 14.  JUNCTION OF THE EPITHELIUM, & LAMINA PROPRIA.    The region where connective tissue of the lamina propria meets the overlying epithelium. Metabolic exchange between epithelium & CT takes place Epithelium has no blood vessels. www.indiandentalacademy.com
  15. 15.     The interface consists of CT ridges ,conical papillae projecting into the epithelium. The surface area of the interface is flat & provide better attachment It helps in dissipating the force applied on the epithelium to greater area of CT. MASTICATORY MUCOSA has greater number of papillae per unit area . www.indiandentalacademy.com
  16. 16.  It is also called as BASAL LAMINA.  Two zones ; Lamina Lucida      45 nm wide. Lamina densa. Towards epithelium . Quite clear. Glycoprotein. Bullous phemphigoid antigen. 50 nm thick . Towards tissue. Granular. Type 4 collagen Proteoglycon. . www.indiandentalacademy.com
  17. 17.   Basal lamina attached by hemidesmosomes. The tonofilaments , desmosomes , hemidesmosomes together represents the mechanical linkage www.indiandentalacademy.com
  18. 18.  FUNCTIONS     Provides mechanical bond . Semipermeable, acts as a barrier. Respond to tissue injury. MUCOSAL BLISTER; Separation of the epithelium from the connective tissue at Lamina lucida www.indiandentalacademy.com
  19. 19.  LAMINA PROPRIA The connective tissue supporting the oral epithelium is termed lamina propria.  Two layers ;       1.PAPILLARY LAYER. Close to epithelial ridges. Arranged loosely. 2.RETICULAR LAYER parallel to epithelium fibers are very thick. form network It consists of cells , blood vessels , neural elements & fibers embedded in amorphous ground substance www.indiandentalacademy.com
  20. 20.  CELLS FOUND IN LAMINA PROPRIA          Fibroblast - secretion of fibers &ground substance Histiocytes - precursor of macrophage Macrophages - phagocytosis Mast cell - inflammatory mediator (kinins), vasoactive agent (histamine) Polymorphonuclear leucocytes - phagocytosis Lymphocytes - cell mediated immune response Plasma cells - synthesis immunoglobulin Endothelial cells - lining of blood & lymphatic channels www.indiandentalacademy.com
  21. 21.  SUBMUCOSA .    Consists of connective tissue of various thickness . It attaches the mucous membrane to the underlying structures. It may be a loose or a firm attachment - to glands, blood vessels , nerves, and adipose tissues www.indiandentalacademy.com
  22. 22.  DIVISION OF THE ORAL MUCOSA               KERATINZED AREAS MASTICATORY MUCOSA. GINGIVA HARD PALATE VERMILION BORDER OF LIP NON KERATINIZED AREAS LINING OR REFLECTING MUCOSA LIP CHEEK VESTIBULAR FORNIX ALVEOLAR MUCOSA FLOOR OF THE MOUTH SOFT PALATE SPECIALIZED MUCOSA DORSUM OF THE TONGUE www.indiandentalacademy.com
  23. 23.  REGIONAL VARIATIONS; MAXILLARY EDENTULOUS FOUNDATION       CREST OF THE RESIDUAL RIDGE Firmly attached to the bone. Keratinized epithelium Dense collagen fibers Sub mucosa – fat or glandular cells Although the sub mucosa is thin it is thick to provide adequate resiliency for primary support of denture . www.indiandentalacademy.com
  24. 24.  SLOPES OF RESIDUAL RIDGE      Non keratinized or Para keratinized. Tissues are loosely attached to periosteum. This marks the end of residual attached mucous membrane. These tissues will not withstand the masticatory and other stress. Less stresses should be placed on the movable tissue during impression making. www.indiandentalacademy.com
  25. 25.  ALVEOLAR MUCOSA          EPITHELIUM ; thin nonkeratinized LAMINA PROPRIA; Short papillae CT contains many elastic fibers . Capillary loops close to the surface. Vessels –run superficial to the periosteum. SUB MUCOSA Loose CT Thick elastic fibers connects periosteum –alveolar process www.indiandentalacademy.com
  26. 26.  REGIONS OF HARD PALATE www.indiandentalacademy.com
  27. 27.  HARD PALATE .EPITHELIUM; thick orthokeratinized  LAMINA PROPRIA ; long papillae, thick collagenous tissue especially under rugae Moderate vascular supply with short capillary loops.  SUBMUCOSA; Dense collagenous CT attaching mucosa to periosteum . Fat & minor salivary gland – CT –overlying neurovascular bundle.  www.indiandentalacademy.com
  28. 28.  CLINICAL SIGNIFICANCE    Tissues should be recorded in resting position . If the tissues displace during impression procedures, they tend to return to normal Such dentures cause soreness of mouth. www.indiandentalacademy.com
  29. 29.  MID PALATINE SUTURE     Extends from the incisive papilla to posterior region of hard palate . Sub mucosa is very thin . Mucosal layer is practically in contact with underlying bone . Tissue covering the suture is non resilient www.indiandentalacademy.com
  30. 30.  CLINICAL SIGNIFICANCE     Little or no pressure should be applied to this region . This area is highly sensitive . Excessive pressure in this area causes pain . Relief should be given in this area www.indiandentalacademy.com
  31. 31.     PALATINE RUGAE Irregularly shaped rolls of soft tissue in the anterior part of hard palate. It is a secondary stress bearing area It resists forward movement of denture. www.indiandentalacademy.com
  32. 32.  SOFT PALATE    EPITHELIUM; thin Non keratinized, taste buds LAMINA PROPRIA; thick numerous papillae, elastic fibers Highly vascular- developed capillary network. SUB MUCOSA; diffuse tissue containing minor salivary glands www.indiandentalacademy.com
  33. 33.  BLOOD & NERVE SUPPLY OF PALATE www.indiandentalacademy.com
  34. 34.  BLOOD & NERVE SUPPLY OF PALATE   Tonsillar branch – glossopharengeal nerve MOTOR SUPPLY ;Pharyngeal plexus. www.indiandentalacademy.com
  35. 35.  STOMATITIS NICOTINA PALATI        Response of oral mucosa to prolong smoking. Middle , elderly men. Initially- diffuse erythematous. Palate becomes grayish white ,sec to hyperkeratosis. Multiple discrete keratotic papules with depressed red center. opening of the glands dilate & inflame. Papules enlarge if irritation persist. www.indiandentalacademy.com
  36. 36.  BUCCAL- LABIAL MUCOSA EPITHELIUM; thick Non keratinized.  LAMINA PROPRIA;  Long slender papillae, dense fibrous CT containing collagen & elastic fibers .  Rich vascular supply. Anastomosing capillary loops into papillae.  SUBMUCOSA; firmly attached to the under lying muscles by collagen & elastin Fat, minor salivary gland .  www.indiandentalacademy.com
  37. 37.   FORDYCE’S SPOTS Fordyce’s spots are ectopic sebaceous glands present in the buccal and labial mucosa. www.indiandentalacademy.com
  38. 38.  LINEA ALBA   A raised white wavy line of variable length and prominence located at the level of occlusion. Thin keratin layer. www.indiandentalacademy.com
  39. 39. VESTIBULAR SPACES      It is bound facially by mucosa of lips , cheek & orally by mucosa of residual ridge . Vestibule is divided medially by labial frenum & laterally by buccal frenum. Epithelium is thin & nonkeratinized. Submucosa is thick , Large amount of loose areolar tissue. www.indiandentalacademy.com
  40. 40.  FRENUM     It is fold of mucous membrane Labial frenum is fan shaped Buccal frenum is associated with muscles Relief should be provided in denture www.indiandentalacademy.com
  41. 41.  VIBRATING LINE    It is an imaginary line drawn across the soft palate. Sub mucosa contains glandular tissue . Lamina propria has elastic fibers. www.indiandentalacademy.com
  42. 42.  MUCOUS MEMBRANE OF HAMULAR NOTCH   Space between the posterior part of the maxillary tuberosity & pterygoid hamuls It is thick and is made of loose areolar tissue. www.indiandentalacademy.com
  43. 43.       MANDIBULAR EDENTULOUS FOUNDATION SUPPORTING STRUCTURES CREST OF THE RESIDUAL RIDGE It is similar to maxillary ridge. Keratinized epithelium . Sub mucosa is loosely attached. Nutrient canal openings. When the soft tissue is movable in the crest of the ridge ,impression should be recorded in its resting position. www.indiandentalacademy.com
  44. 44.  BUCCAL SHELF      Partially keratinized. Loosely attached. Thick submucosal layer. Bone – compact bone That why it is primary stress bearing area. www.indiandentalacademy.com
  45. 45.  VESTIBULAR SPACES     Similar to the maxilla. Epithelium is thin . Non-keratinized . Submucosa- loose areolar tissue ,elastin fibers. www.indiandentalacademy.com
  46. 46.  MOLAR REGION   Here the sub mucosa is attached to the mylohyoid muscle . Length and form of the lingual flange of the tray should reflect the physiologic activity of these structures . www.indiandentalacademy.com
  47. 47.  RETROMOLAR PAD      Epithelium is thin . Non-keratinized . Submucosa – glands , loose areolar tissue , blood vessels ….. CLINICAL SIGNIFICANCE Because of these structures impression should be recorded in resting position . www.indiandentalacademy.com
  48. 48. FLOOR OF THE ORAL CAVITY EPITHELIUM; very thin Non keratinized .  LAMINA PROPRIA ;Short papillae. Elastic fibers. Extensive vascular fibers. Short anastomosing capillary loops  SUBMUCOSA ;loose fibrous CT Fat, minor salivary glands .  BLOOD SUPPLY; Sublingual artery branch of lingual artery.  www.indiandentalacademy.com
  49. 49.  FLOOR OF THE MOUTH www.indiandentalacademy.com
  50. 50.    Extension of the dentures posterior lingual flanges usually will allow for a stable denture. This objective will not be fulfilled in this case, Unfavorable high attachment & mobile floor of the mouth. www.indiandentalacademy.com
  51. 51.  LIPS VERMILION ZONE  EPITHELIUM; thin , orthokeratinized.  LAMINA PROPRIA; narrow papillae.   Capillary loops close to surface layer SUBMUCOSA; mucosa firmly attached to the underlying muscles . www.indiandentalacademy.com
  52. 52.  INTERMIDIATE ZONE     EPITHELIUM; thin Para keratinized LAMINA PROPRIA; long ,irregular papillae, elastic fibers ,collagen fibers SUBMUCOSA; mucosa is firmly attached to muscle ,sebaceous gland ,minor salivary gland ,fat. www.indiandentalacademy.com
  53. 53.  BLOOD & NERVE SUPPLY         BLOOD; UPPER LIP; SUPERIOR LABIAL ARTERY LOWER LIP; INFERIOR LABIAL ARTERY MENTAL ARTEY branch of inferior alveolar artery. NERVE UPPER LIP ; INFRAORBITAL branch of max nerve . LOWER LIP; MENTAL branch of inferior alveolar . BUCCAL branch of mandibular nerve . www.indiandentalacademy.com
  54. 54.  GINGIVA.       EPITHELIUM; Ortho-keratinized Para-keratinized ,stippling . LAMINA PROPRIA ;long narrow papillae Dense collagenous CT . Not highly vascular, but long capillary loops with anastomoses are present . SUB MUCOSA ; no distinct layer . Mucosa is firmly attached by collagen fibers to cememtum & periosteum of alveolar process. www.indiandentalacademy.com
  55. 55.  GINGIVA A. ALVEOLAR MUCOSA D. ATTACHED GINGIVA B. GINGIVA C. MUCOGINGIVAL JUNCTION E. FREE GINGIVA F. INTERDENTAL GINGIVA www.indiandentalacademy.com
  56. 56.  TYPES OF EPITHELIUM IN GINGIVA  3 TYPES;  1.Outer epithelium  2. Sulcular epithelium  3.Junctional epithelium www.indiandentalacademy.com
  57. 57.  INTERDENTAL GINGIVA        COL Non keratinized Depression between buccal & lingual papilla Connects both the papilla Found below the contact point Anteriorly – pyramidal Posteriorly – tent shape. www.indiandentalacademy.com
  58. 58. •BLOOD SUPPLY           UPPER GINGIVA ANTERIOR;ANTERIOR SUPERIOR ALVEOLAR ARTEY PALATAL; GREATER PALATINE ARTERY BUCCAL ;BUCCAL ARTERY POSTERIOR; POSTERIOR SUPERIOR ALVEOLAR ARTERY LOWER GINGIVA ANTERIOR ANTERIOR BUCCAL; MENTAL ARTERY LINGUAL; INCISIVE ARTERY SUBLINGUAL ARTERY POSTERIOR BUCCAL; INFERIOR ALVEOLAR ARTERY BUCCAL ARETRY POSTERIOR LINGUAL; INFERIOR ALVEOLAR ARTERY SUBLINGUAL ARTERY www.indiandentalacademy.com
  59. 59. •NERVE SUPPLY       UPPER GINGIVA; ANTERIOR, POSTERIOR, MIDDLE SUPERIOR ALVEOLAR BRANCH OF MAXILLARY NERVE LOWER GINGIVA; INFERIOR BRANCH OF MANDIBULAR NERVE BUCCAL BRANCH OF MANDIBULAR NERVE SUBLINGUAL BRANCH OF LINGUAL NERVE www.indiandentalacademy.com
  60. 60.  TONGUE DORSAL SURFACE OF TONGUE          EPITHELIUM; thick Keratinized &nonkeratinized Lingual papillae's are present Taste buds LAMINA PROPRIA; long papillae Minor salivary glands posteriorly. Rich innervations near taste buds . Capillary plexus in papillary layer large vessels lying deeper SUB MUCOSA ; No distinct layer . www.indiandentalacademy.com
  61. 61.           FILLIFORM PAPILLAE keratinized Anterior tongue Smallest & numerous Hair like extensions FOLIATE PAPILLAE Non keratinized Lateral margins Leaf like projections Few taste buds www.indiandentalacademy.com
  62. 62.  FUNGIFORM PAPILLAE Non keratinization Anterolateral Taste buds Round & reddish.  CIRCUMVALLATE PAPILLAE Keratinized –superiorly Nonkeratinized- laterally Anterior to sulcus terminalis www.indiandentalacademy.com
  63. 63.  TASTE BUDS   Chemoreceptor organs Barrel shaped seen in –fungiform papillae circumvallate papillae soft palate …. www.indiandentalacademy.com
  64. 64. VENTRAL SURFACE OF THE TONGUE   •       EPITHELIUM; Thin, non keratinized . LAMINA PROPRIA ;Thin , Numerous short papillae . Few elastic fibers . Minor salivary glands. capillary network in sub papillary layer Reticular layer relatively avascular SUBMUCOSA; Thin & irregular Fat & small vessels Bound to the CT surrounding the tongue musculature. www.indiandentalacademy.com
  65. 65.  LINGUAL VERUCOSITES ( PHLEBECTASIA )         Common in elder individuals. Purplish blue nodular area. Due to dilation & increased tortusity of lingual veins. Increase venous pressure decrease in elasticity of venous wall. Lack of support by surrounding tissues. COMPLICATIONS; Ulceration, thrombosis, hemorrhage. www.indiandentalacademy.com
  66. 66.  BLOOD & NERVE SUPPLY OF TONGUE BLOOD SUPPLY;        Ant 23rd -- deep lingual artery Post 13rd --dorsal lingual artery NERVE SUPPLY; Glossopharengeal nerve Lingual nerve Chorda tympani. Vagus nerve www.indiandentalacademy.com
  67. 67. EFFECT OF AGING ON THE ORAL MUCOSA        HISTOLOGY Epithelial thinning Decreased keratinization Less prominent rete pegs Decreased cellular proliferation Loss of submucosal elastin and fat Increased fibrotic connective tissue with degenerative alteration in the collagen. www.indiandentalacademy.com
  68. 68.  These changes in the histology of oral mucosa are more marked in women especially post menopausal.  Vascular changes in the oral mucosa include the development of vascular nodules and nevi. www.indiandentalacademy.com
  69. 69.  Wound healing and regeneration of tissue may be delayed with age. Oral mucosal immunity is also believed to undergo some age related changes. The number of langerhan’s cells decreases with age which contributes to a decline in cell medicated immunity.  This decrease in rate of wound healing is more pronounced in connective tissue than epithelium. www.indiandentalacademy.com
  70. 70.  AGING IN GINGIVA    With the aging there is decreased keratinization and stippling Though gingival recession increases with age it is not necessary a physiologic process. There is decreased width of attached gingival with constant relocation of the mucogingival junction throughout the adult life. www.indiandentalacademy.com
  71. 71.  There is stiffening of the walls of the blood vessels and decrease in their diameter due to arthrosclerosis.  Decreased connective tissue cellularity and oxygen consumption. www.indiandentalacademy.com
  72. 72.  BEHAVIOUR OF ORAL MUCOSA UNDER STRESS     Oral mucosa under compression behaves in a viscoelastic fashion. Loads imposed on masticatory mucosa – mastication & prosthesis consists of shear & compressive force, they produce regions of tensile stress in mucosa Loaded epithelium demonstrates decrease in the depth of epithelial ridges & connective tissue papillae Care to be taken during impression procedures by applying minimal pressures. www.indiandentalacademy.com
  73. 73. www.indiandentalacademy.com
  74. 74.  Function & Parafunction  PRESSURE FORCE TIME    controlled by Tissue damage caused by 1 correct clinical occluding local circulation technique 2 permanent soft liner www.indiandentalacademy.com controlled by nocturnal tissue rest
  75. 75.  SOFT TISSUE CHANGES IN ORAL MUCOSA             SOFT TISSUE HYPERPLASIA FIBROUS HYPERPLASIA EPULIS FISSURATA PAPILLARY HYPERPLASIA INFLAMMATORY PROCESS UNDER DENTURE BASES DENTURE STOMATITIS STOMATITIS VENENATA CANDIDIASIS MECHANICAL IRRITATION DECUBITUS ULCER ULCERATIVE LESIONS ANGULAR CHELITIS www.indiandentalacademy.com
  76. 76.  SOFT TISSUE HYPERPLSIA       Rolls of hyperplastic tissues under denture base Due to bone resorbtion, with lesion filling the space under denture base. Develops slowly, painless. Rx Surgical removal. New dentures. www.indiandentalacademy.com
  77. 77.  PAPILLARY HYPERPLASIA     Granular type of inflammation seen in palatal region. numerous papillary projections give a warty appearance. They show precancerous tendencies Rx Surgery Discontinue denture wearing New dentures www.indiandentalacademy.com
  78. 78.  DENTURE STOMATITIS         Chronic inflammation of the denture bearing area. CAUSES; Para functional habit. ill fitting denture . Nocturnal denture wearing. Hypersensitivity. Poor oral hygiene Infections –Candida albicans www.indiandentalacademy.com
  79. 79.  DENTURE STOMATITIS          SYMPTOMS; Redness of the tissue. Pain. Burning sensation Rx; Discontinue denture wearing . good oral hygiene procedures Anti fugal Rx ( if candidal inf) New dentures. www.indiandentalacademy.com
  80. 80.  CONTACT STOMATITIS     Certain individuals react to materials & drugs differently than others do. In oral cavity it is termed as contact stomatitis. Marked redness in limited area contact with acrylic partial denture. Such contact sensitivity is rare. www.indiandentalacademy.com
  81. 81.  CANDIDIASIS            Usually seen in, Unclean mouth. Debilitated patients Systemic disease such as diabetes. Unhygienic conditions will facilitate the candidal growth. SYMPTOMS; Redness with pain. Swelling of the denture supporting tissue. Rx Discard the existing denture. Anti fungal therapy. New dentures. www.indiandentalacademy.com
  82. 82.  ANGULAR CHELITIS.      SIGNS; Bilateral lesion that develops at the angle of the lips. Deep fissure or crack may be seen. Appear ulcerated. Exudatve crust may be present.  Rx;  Anti fungal therapy. www.indiandentalacademy.com
  83. 83. LOCAL DISEASES AFFECTING ORAL CAVITY          WHITE LESIONS; Leukoplakia. Lichenplanus. Hyperkeratosis. MALIGNANT LESIONS. Carcinoma. METABOLIC DISEASES. Diabetes mellitus . Nutritional disorders. www.indiandentalacademy.com
  84. 84.  LEUCOPLAKIA www.indiandentalacademy.com
  85. 85.  LICHEN PLANUS www.indiandentalacademy.com
  86. 86.  ERYTHROPLAKIA www.indiandentalacademy.com
  87. 87.  CARCINOMA www.indiandentalacademy.com
  88. 88.  NUTRITIONAL DEFICIENCY www.indiandentalacademy.com
  89. 89.  SUMMARY     The oral mucosa consists of stratified squamous epithelium followed by Lamina propria & Submucosa. The structure varies according to function in different regions they can be classified as – Masticatory mucosa Lining mucosa Specialized mucosa www.indiandentalacademy.com
  90. 90.  CONCLUSION   The dentures must function in harmony with the remaining tissues that both support and surround them . For this harmony of living tissues & non living materials (dentures) to coexist for reasonable period of time, the dentist must fully understand both the macroscopic & microscopic anatomy of supporting & limiting structures of dentures. www.indiandentalacademy.com
  91. 91.  REFERENCES       1.A.R.Tencate -Oral Histology ,Development ,Structure and Function -- 6th Edition 2.Anne M R, Ming C Lee Grants atlas of anatomy 10th Edition. 3.Bouchers –Prosthodontic treatment for edentulous patients 10th & 11th Edition 4.B.K.B .Bercovitz , Color atlas & text of oral anatomy . 5.Bernard .L. The anatomical basis of dentistry. 2nd Edition. 6.Colby, Kerr Color atlas of oral pathology. 4th Edition www.indiandentalacademy.com
  92. 92.       7.Hubert E Schroeder -Oral Structural Biology --3rd Edition 8.John J Sharry -Complete denture prosthodontics 1962 9.Keith L Moore -Clinically Oriented Anatomy --3rd Edition 10.Nagle & Sears -Dental Prosthetics , Complete denture. 11.Orbans -Oral Histology And Embryology 11th Edition 12.Zarb-Bolendar Prosthodontic treatment for edentulous patients 12th Edition. www.indiandentalacademy.com
  93. 93. www.indiandentalacademy.com

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