Oral mucous membrane/ oral surgery courses

.SHWETA POOVANI
•ORAL MUCOUS MEMBRANE
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.comwww.indiandentalacademy.com

 CONTENTSCONTENTS
 1. INTRODUCTION1. INTRODUCTION
 2.DEVELOPMENT2.DEVELOPMENT
 3.FUNCTION3.FUNCTION
 4.TISSUE COMPONENTS OF ORAL4.TISSUE COMPONENTS OF ORAL
MUCOSAMUCOSA
 5.DIVISION OF ORAL MUCOSA5.DIVISION OF ORAL MUCOSA

 PROSTHODONTIC CONSIDERATIONSPROSTHODONTIC CONSIDERATIONS
 6.BEHAVOIUR OF ORAL MUCOSA UNDER STRESS6.BEHAVOIUR OF ORAL MUCOSA UNDER STRESS
 7.INFLAMATION AND ORAL MUCOSA .7.INFLAMATION AND ORAL MUCOSA .
 8.INFLUENCE OF LOCAL AND SYSTEMIC DISEASE8.INFLUENCE OF LOCAL AND SYSTEMIC DISEASE
ONON ORAL MUCOSA.ORAL MUCOSA.
 9.SUMMARY & CONCLUSION9.SUMMARY & CONCLUSION
 10.REFERENCES.10.REFERENCES.

 INTRODUCTIONINTRODUCTION
 The oral cavity is in many respects a very interestingThe oral cavity is in many respects a very interesting
part of the human body .part of the human body .
 Many different kind of tissue from the hardest teeth toMany different kind of tissue from the hardest teeth to
the softest, the salivary glands are found therein.the softest, the salivary glands are found therein.
 The oral cavity is lined with an uninterrupted mucosaThe oral cavity is lined with an uninterrupted mucosa
which is continuous with the skin near vermillion borderwhich is continuous with the skin near vermillion border
of the lips and with the pharyngeal mucosa in the regionof the lips and with the pharyngeal mucosa in the region
of soft palate.of soft palate.

 DEVELOPMENTDEVELOPMENT
 Primitive oral cavity develops from the fusion of thePrimitive oral cavity develops from the fusion of the
embryonic stomodeum with foregut after the rupture ofembryonic stomodeum with foregut after the rupture of
buccopharyngeal membrane.(26 days)buccopharyngeal membrane.(26 days)
 Oral cavity is lined by both ectoderm and endoderm.Oral cavity is lined by both ectoderm and endoderm.
 Structures developed from brachial archStructures developed from brachial arch
 Ectoderm ---tongueEctoderm ---tongue
 Endoderm---Palate ,cheeks ,GingivaEndoderm---Palate ,cheeks ,Gingiva

 FUNCTIONS OF THE ORAL MUCOSAFUNCTIONS OF THE ORAL MUCOSA
 1.PROTECTION.1.PROTECTION.
• Protects the deeper tissues and organs.Protects the deeper tissues and organs.
• Adapts to withstand mechanical forces.Adapts to withstand mechanical forces.
• Barrier in preventing microorganism.Barrier in preventing microorganism.
 2.SENSATION.2.SENSATION.
• Receptors responsible for the taste , thirst,Receptors responsible for the taste , thirst,
temperature.temperature.
 3.SECRETION.3.SECRETION.
• Major &minor salivary gland secretions –secreteMajor &minor salivary gland secretions –secrete
protective substance.protective substance.

 COMPONENT TISSUECOMPONENT TISSUE
 A. ORAL EPITHELIUMA. ORAL EPITHELIUM
 B.LAMINA PROPRIAB.LAMINA PROPRIA
 C.SUBMUCOSAC.SUBMUCOSA

 DIVISION OF ORAL MUCOSADIVISION OF ORAL MUCOSA

 EPITHELIUMEPITHELIUM
 Epithelium of the oralEpithelium of the oral
mucosa is stratifiedmucosa is stratified
squamous epithelium.squamous epithelium.
 It may be ;It may be ;
1.Keratinized1.Keratinized
2.Non keratinized2.Non keratinized
 Keratinized layerKeratinized layer
ortho keratinizedortho keratinized
Para keratinizedPara keratinized

 KERATINIZED EPITHELIUMKERATINIZED EPITHELIUM

 NON KERATINIZED EPITHELIUMNON KERATINIZED EPITHELIUM

 CELLS OF NON KERATINOCYTESCELLS OF NON KERATINOCYTES
 MELANOCYTES;MELANOCYTES; SynthesizeSynthesize
melanin pigment granules & transfermelanin pigment granules & transfer
to surrounding keratinocytesto surrounding keratinocytes
 LANGERHANS CELL ;LANGERHANS CELL ; AntigenAntigen
trapping & processing.trapping & processing.
 MERKEL CELLMERKEL CELL ; Tactile sensory; Tactile sensory
cell.cell.
 LYMPHOCYTES ;LYMPHOCYTES ; Associated withAssociated with
inflammatory response in oralinflammatory response in oral
mucosa.mucosa.

 SMOKERS MELANOSISSMOKERS MELANOSIS
 Smoking tobacco imparts smokers melanosis.Smoking tobacco imparts smokers melanosis.
 Deposition of melanin in basal layer of mucosa.Deposition of melanin in basal layer of mucosa.
 Affects elderly person –heavy smokers.Affects elderly person –heavy smokers.
 Appears as a diffuse brown patch.Appears as a diffuse brown patch.
 Mandibular ant. Gingiva & buccal mucosa commonlyMandibular ant. Gingiva & buccal mucosa commonly
affected.affected.
 Labial mucosa ,palate, tongue, floor of the mouth ,Labial mucosa ,palate, tongue, floor of the mouth ,
lips .lips .

 JUNCTION OF THEJUNCTION OF THE
EPITHELIUM, & LAMINAEPITHELIUM, & LAMINA
PROPRIA.PROPRIA.
 The region where connective tissue of the laminaThe region where connective tissue of the lamina
propria meets the overlying epithelium.propria meets the overlying epithelium.
 Metabolic exchange between epithelium & CT takesMetabolic exchange between epithelium & CT takes
placeplace
 Epithelium has no blood vessels.Epithelium has no blood vessels.

 The interface consistsThe interface consists
of CT ridges ,conicalof CT ridges ,conical
papillae projecting intopapillae projecting into
the epithelium.the epithelium.
 The surface area of theThe surface area of the
interface is flat &interface is flat &
provide betterprovide better
attachmentattachment
 It helps in dissipating theIt helps in dissipating the
force applied on theforce applied on the
epithelium to greaterepithelium to greater
area of CT.area of CT.
 MASTICATORYMASTICATORY
MUCOSA has greaterMUCOSA has greater
number of papillae pernumber of papillae per
unit area .unit area .

 It is also called asIt is also called as BASAL LAMINABASAL LAMINA..
 Two zones ;Two zones ;
Lamina Lucida Lamina densa.Lamina Lucida Lamina densa.
 45 nm wide. 50 nm thick45 nm wide. 50 nm thick..
 Towards epithelium . Towards tissue.Towards epithelium . Towards tissue.
 Quite clear. Granular.Quite clear. Granular.
 Glycoprotein. Type 4 collagenGlycoprotein. Type 4 collagen
 Bullous phemphigoid antigen. Proteoglycon.Bullous phemphigoid antigen. Proteoglycon. ..

 Basal lamina attached byBasal lamina attached by
hemidesmosomes.hemidesmosomes.
 The tonofilaments , desmosomes ,The tonofilaments , desmosomes ,
hemidesmosomes togetherhemidesmosomes together
represents the mechanical linkagerepresents the mechanical linkage

 FUNCTIONSFUNCTIONS
 Provides mechanical bond .Provides mechanical bond .
 Semipermeable, acts as a barrier.Semipermeable, acts as a barrier.
 Respond to tissue injury.Respond to tissue injury.
 MUCOSAL BLISTER;MUCOSAL BLISTER; Separation of theSeparation of the
epithelium from the connective tissue atepithelium from the connective tissue at
Lamina lucidaLamina lucida

 LAMINA PROPRIALAMINA PROPRIA
The connective tissue supporting the oralThe connective tissue supporting the oral
epithelium is termed lamina propria.epithelium is termed lamina propria.
 Two layers ;Two layers ;
 1.PAPILLARY LAYER.1.PAPILLARY LAYER.
 Close to epithelial ridges.Close to epithelial ridges.
 Arranged loosely.Arranged loosely.
2.RETICULAR LAYER2.RETICULAR LAYER
parallel to epitheliumparallel to epithelium
 fibers are very thick.fibers are very thick.
 form networkform network
 It consists of cells , blood vessels ,It consists of cells , blood vessels ,
neural elements & fibers embedded inneural elements & fibers embedded in
amorphous ground substanceamorphous ground substance

 CELLS FOUND IN LAMINACELLS FOUND IN LAMINA
PROPRIAPROPRIA
 FibroblastFibroblast - secretion of fibers &ground substance- secretion of fibers &ground substance
 HistiocytesHistiocytes - precursor of macrophage- precursor of macrophage
 MacrophagesMacrophages - phagocytosis- phagocytosis
 Mast cellMast cell - inflammatory mediator (kinins),- inflammatory mediator (kinins),
 vasoactive agent (histamine)vasoactive agent (histamine)
 Polymorphonuclear leucocytesPolymorphonuclear leucocytes - phagocytosis- phagocytosis
 LymphocytesLymphocytes - cell mediated immune response- cell mediated immune response
 Plasma cellsPlasma cells - synthesis immunoglobulin- synthesis immunoglobulin
 Endothelial cellsEndothelial cells - lining of blood & lymphatic- lining of blood & lymphatic
channelschannels

 SUBMUCOSASUBMUCOSA
..
 Consists of connectiveConsists of connective
tissue of various thickness .tissue of various thickness .
 It attaches the mucousIt attaches the mucous
membrane to themembrane to the
underlying structures.underlying structures.
 It may be a loose or a firmIt may be a loose or a firm
attachment - to glands,attachment - to glands,
blood vessels , nerves, andblood vessels , nerves, and
adipose tissuesadipose tissues

 DIVISION OF THE ORAL MUCOSADIVISION OF THE ORAL MUCOSA
 KERATINZED AREASKERATINZED AREAS
MASTICATORY MUCOSA.MASTICATORY MUCOSA.
 GINGIVAGINGIVA
 HARD PALATEHARD PALATE
 VERMILION BORDER OF LIPVERMILION BORDER OF LIP
 NON KERATINIZED AREASNON KERATINIZED AREAS
 LINING OR REFLECTING MUCOSALINING OR REFLECTING MUCOSA
 LIPLIP
 CHEEKCHEEK
 VESTIBULAR FORNIXVESTIBULAR FORNIX
 ALVEOLAR MUCOSAALVEOLAR MUCOSA
 FLOOR OF THE MOUTHFLOOR OF THE MOUTH
 SOFT PALATESOFT PALATE
 SPECIALIZED MUCOSASPECIALIZED MUCOSA
 DORSUM OF THE TONGUEDORSUM OF THE TONGUE

 REGIONAL VARIATIONS;REGIONAL VARIATIONS;
MAXILLARY EDENTULOUSMAXILLARY EDENTULOUS
FOUNDATIONFOUNDATION
 CREST OF THE RESIDUALCREST OF THE RESIDUAL
RIDGERIDGE
 Firmly attached to the bone.Firmly attached to the bone.
 Keratinized epitheliumKeratinized epithelium
 Dense collagen fibersDense collagen fibers
 Sub mucosa – fat or glandular cellsSub mucosa – fat or glandular cells
 Although the sub mucosa is thin itAlthough the sub mucosa is thin it
is thick to provide adequateis thick to provide adequate
resiliency for primary support ofresiliency for primary support of
denture .denture .

 SLOPES OF RESIDUAL RIDGESLOPES OF RESIDUAL RIDGE
 Non keratinized or Para keratinized.Non keratinized or Para keratinized.
 Tissues are loosely attached to periosteum.Tissues are loosely attached to periosteum.
 This marks the end of residual attached mucousThis marks the end of residual attached mucous
membrane.membrane.
 These tissues will not withstand the masticatoryThese tissues will not withstand the masticatory
and other stress.and other stress.
 Less stresses should be placed on the movableLess stresses should be placed on the movable
tissue during impression making.tissue during impression making.

 ALVEOLAR MUCOSAALVEOLAR MUCOSA
 EPITHELIUMEPITHELIUM ; thin; thin
nonkeratinizednonkeratinized
 LAMINA PROPRIA;LAMINA PROPRIA;
 Short papillaeShort papillae
 CT contains many elastic fibers .CT contains many elastic fibers .
 Capillary loops close to the surface.Capillary loops close to the surface.
 Vessels –run superficial to theVessels –run superficial to the
periosteum.periosteum.
 SUB MUCOSASUB MUCOSA
 Loose CTLoose CT
 Thick elastic fibers connects periosteumThick elastic fibers connects periosteum
–alveolar process–alveolar process

 REGIONS OF HARD PALATEREGIONS OF HARD PALATE

 HARD PALATEHARD PALATE
 .EPITHELIUM.EPITHELIUM;; thickthick
orthokeratinizedorthokeratinized
 LAMINA PROPRIALAMINA PROPRIA ;; long papillae, thicklong papillae, thick
collagenous tissue especially under rugaecollagenous tissue especially under rugae
Moderate vascular supply with short capillaryModerate vascular supply with short capillary
loops.loops.
 SUBMUCOSA;SUBMUCOSA;
Dense collagenous CT attaching mucosa toDense collagenous CT attaching mucosa to
periosteum .periosteum .
Fat & minor salivary gland – CT –overlyingFat & minor salivary gland – CT –overlying
neurovascular bundle.neurovascular bundle.

 CLINICAL SIGNIFICANCECLINICAL SIGNIFICANCE
 Tissues should be recorded in restingTissues should be recorded in resting
position .position .
 If the tissues displace during impressionIf the tissues displace during impression
procedures, they tend to return to normalprocedures, they tend to return to normal
 Such dentures cause soreness of mouth.Such dentures cause soreness of mouth.

 MID PALATINE SUTUREMID PALATINE SUTURE
 Extends from the incisive papilla to posteriorExtends from the incisive papilla to posterior
region of hard palate .region of hard palate .
 Sub mucosa is very thin .Sub mucosa is very thin .
 Mucosal layer is practically in contact withMucosal layer is practically in contact with
underlying bone .underlying bone .
 Tissue covering the suture is non resilientTissue covering the suture is non resilient

 CLINICAL SIGNIFICANCECLINICAL SIGNIFICANCE
 Little or no pressure should be applied to this regionLittle or no pressure should be applied to this region
..
 This area is highly sensitive .This area is highly sensitive .
 Excessive pressure in this area causes pain .Excessive pressure in this area causes pain .
 Relief should be given in this areaRelief should be given in this area

 PALATINE RUGAEPALATINE RUGAE
 Irregularly shaped rolls of soft tissue in the anterior part ofIrregularly shaped rolls of soft tissue in the anterior part of
hard palate.hard palate.
 It is a secondary stress bearing areaIt is a secondary stress bearing area
 It resists forward movement of denture.It resists forward movement of denture.

 SOFT PALATESOFT PALATE

EPITHELIUMEPITHELIUM;;
thinthin
Non keratinized, taste budsNon keratinized, taste buds
 LAMINA PROPRIA;LAMINA PROPRIA;
thickthick
numerous papillae, elastic fibersnumerous papillae, elastic fibers
Highly vascular- developed capillaryHighly vascular- developed capillary
network.network.
 SUB MUCOSA;SUB MUCOSA; diffuse tissue containingdiffuse tissue containing
minor salivary glandsminor salivary glands

 BLOOD & NERVE SUPPLY OF PALATEBLOOD & NERVE SUPPLY OF PALATE

 BLOOD & NERVE SUPPLY OF PALATEBLOOD & NERVE SUPPLY OF PALATE
 Tonsillar branch – glossopharengealTonsillar branch – glossopharengeal
nervenerve
 MOTOR SUPPLY ;Pharyngeal plexus.MOTOR SUPPLY ;Pharyngeal plexus.

 STOMATITIS NICOTINA PALATISTOMATITIS NICOTINA PALATI
 Response of oral mucosa toResponse of oral mucosa to
prolong smoking.prolong smoking.
 Middle , elderly men.Middle , elderly men.
 Initially- diffuse erythematous.Initially- diffuse erythematous.
 Palate becomes grayish whitePalate becomes grayish white
,sec to hyperkeratosis.,sec to hyperkeratosis.
 Multiple discrete keratoticMultiple discrete keratotic
papules with depressed redpapules with depressed red
center.center.
 opening of the glands dilate &opening of the glands dilate &
inflame.inflame.
 Papules enlarge if irritationPapules enlarge if irritation
persist.persist.

 BUCCAL- LABIAL MUCOSABUCCAL- LABIAL MUCOSA
 EPITHELIUMEPITHELIUM;; thickthick
Non keratinizedNon keratinized..
 LAMINA PROPRIALAMINA PROPRIA;;
 Long slender papillae, dense fibrousLong slender papillae, dense fibrous
CT containing collagen & elasticCT containing collagen & elastic
fibers .fibers .
 Rich vascular supply. AnastomosingRich vascular supply. Anastomosing
capillary loops into papillaecapillary loops into papillae..
 SUBMUCOSA;SUBMUCOSA; firmly attached tofirmly attached to
thethe
under lying muscles by collagen &under lying muscles by collagen &
elastinelastin
Fat, minor salivary gland .Fat, minor salivary gland .

 FORDYCE’S SPOTSFORDYCE’S SPOTS
 Fordyce’s spots are ectopicFordyce’s spots are ectopic
sebaceous glands present in thesebaceous glands present in the
buccal and labial mucosa.buccal and labial mucosa.

 LINEA ALBALINEA ALBA
 A raised white wavy lineA raised white wavy line
of variable length andof variable length and
prominence located at theprominence located at the
level of occlusion.level of occlusion.
 Thin keratin layer.Thin keratin layer.

VESTIBULAR SPACESVESTIBULAR SPACES
 It is bound facially by mucosa of lips , cheek &It is bound facially by mucosa of lips , cheek &
orally by mucosa of residual ridge .orally by mucosa of residual ridge .
 Vestibule is divided medially by labial frenum &Vestibule is divided medially by labial frenum &
laterally by buccal frenum.laterally by buccal frenum.
 Epithelium is thin & nonkeratinized.Epithelium is thin & nonkeratinized.
 Submucosa is thick ,Submucosa is thick ,
 Large amount of loose areolar tissue.Large amount of loose areolar tissue.

 FRENUMFRENUM
 It is fold of mucousIt is fold of mucous
membranemembrane
 Labial frenum is fanLabial frenum is fan
shapedshaped
 Buccal frenum isBuccal frenum is
associated with musclesassociated with muscles
 Relief should be providedRelief should be provided
in denturein denture

 VIBRATING LINEVIBRATING LINE
 It is an imaginary lineIt is an imaginary line
drawn across the softdrawn across the soft
palate.palate.
 Sub mucosa containsSub mucosa contains
glandular tissue .glandular tissue .
 Lamina propria hasLamina propria has
elastic fibers.elastic fibers.

 MUCOUS MEMBRANE OF HAMULARMUCOUS MEMBRANE OF HAMULAR
NOTCHNOTCH
 Space between the posterior part of theSpace between the posterior part of the
maxillary tuberosity & pterygoid hamulsmaxillary tuberosity & pterygoid hamuls
 It is thick and is made of loose areolarIt is thick and is made of loose areolar
tissue.tissue.

MANDIBULAR EDENTULOUSMANDIBULAR EDENTULOUS
FOUNDATIONFOUNDATION
SUPPORTING STRUCTURESSUPPORTING STRUCTURES
 CREST OF THE RESIDUALCREST OF THE RESIDUAL
RIDGERIDGE
 It is similar to maxillary ridge.It is similar to maxillary ridge.
 Keratinized epithelium .Keratinized epithelium .
 Sub mucosa is looselySub mucosa is loosely
attached.attached.
 Nutrient canal openings.Nutrient canal openings.
 When the soft tissue isWhen the soft tissue is
movable in the crest of themovable in the crest of the
ridge ,impression should beridge ,impression should be
recorded in its resting position.recorded in its resting position.

 BUCCAL SHELFBUCCAL SHELF
 Partially keratinized.Partially keratinized.
 Loosely attached.Loosely attached.
 Thick submucosal layer.Thick submucosal layer.
 Bone – compact boneBone – compact bone
 That why it is primaryThat why it is primary
stress bearing area.stress bearing area.

 VESTIBULAR SPACESVESTIBULAR SPACES
 Similar to the maxilla.Similar to the maxilla.
 Epithelium is thin .Epithelium is thin .
 Non-keratinized .Non-keratinized .
 Submucosa- loose areolar tissue ,elastin fibers.Submucosa- loose areolar tissue ,elastin fibers.

 MOLAR REGIONMOLAR REGION
 Here the sub mucosa is attached to theHere the sub mucosa is attached to the
mylohyoid muscle .mylohyoid muscle .
 Length and form of the lingual flange of theLength and form of the lingual flange of the
tray should reflect the physiologic activitytray should reflect the physiologic activity
of these structures .of these structures .www.indiandentalacademy.comwww.indiandentalacademy.com

 RETROMOLAR PADRETROMOLAR PAD
 Epithelium is thin .Epithelium is thin .
 Non-keratinized .Non-keratinized .
 Submucosa – glands , looseSubmucosa – glands , loose
areolar tissue , blood vesselsareolar tissue , blood vessels
…..…..
 CLINICAL SIGNIFICANCECLINICAL SIGNIFICANCE
 Because of these structuresBecause of these structures
impression should beimpression should be
recorded in resting position .recorded in resting position .

FLOOR OF THE ORAL CAVITYFLOOR OF THE ORAL CAVITY
 EPITHELIUMEPITHELIUM; very thin; very thin
Non keratinized .Non keratinized .
 LAMINA PROPRIALAMINA PROPRIA ;Short papillae.;Short papillae.
Elastic fibers.Elastic fibers.
Extensive vascular fibers.Extensive vascular fibers.
Short anastomosing capillary loopsShort anastomosing capillary loops
 SUBMUCOSASUBMUCOSA ;loose fibrous CT;loose fibrous CT
Fat, minor salivary glands .Fat, minor salivary glands .
 BLOOD SUPPLYBLOOD SUPPLY;;
Sublingual artery branch of lingualSublingual artery branch of lingual
artery.artery.

 FLOOR OF THE MOUTHFLOOR OF THE MOUTH

 Extension of the denturesExtension of the dentures
posterior lingual flangesposterior lingual flanges
usually will allow for a stableusually will allow for a stable
denture.denture.
 This objective will not beThis objective will not be
fulfilled in this case,fulfilled in this case,
 Unfavorable highUnfavorable high
attachment & mobile floorattachment & mobile floor
of the mouth.of the mouth.

 LIPSLIPS
VERMILION ZONEVERMILION ZONE

EPITHELIUM;EPITHELIUM; thin ,thin ,
orthokeratinized.orthokeratinized.

LAMINA PROPRIA;LAMINA PROPRIA; narrownarrow
papillaepapillae..
 Capillary loops close toCapillary loops close to
surface layersurface layer

SUBMUCOSA;SUBMUCOSA; mucosamucosa
firmly attached tofirmly attached to thethe
underlying musclesunderlying muscles ..www.indiandentalacademy.comwww.indiandentalacademy.com

 INTERMIDIATE ZONEINTERMIDIATE ZONE

EPITHELIUM;EPITHELIUM; thinthin
Para keratinizedPara keratinized

LAMINA PROPRIALAMINA PROPRIA;; longlong
,irregular papillae, elastic,irregular papillae, elastic
fibers ,collagen fibersfibers ,collagen fibers
 SUBMUCOSA;SUBMUCOSA; mucosa ismucosa is
firmly attached to musclefirmly attached to muscle
,sebaceous gland,sebaceous gland
 ,minor salivary gland ,fat.,minor salivary gland ,fat.

 BLOOD & NERVE SUPPLYBLOOD & NERVE SUPPLY
 BLOOD;BLOOD;
 UPPER LIP; SUPERIOR LABIAL ARTERYUPPER LIP; SUPERIOR LABIAL ARTERY
 LOWER LIP; INFERIOR LABIAL ARTERYLOWER LIP; INFERIOR LABIAL ARTERY
 MENTAL ARTEYMENTAL ARTEY
 branch of inferior alveolar artery.branch of inferior alveolar artery.
 NERVENERVE
 UPPER LIP ; INFRAORBITAL branch of max nerve .UPPER LIP ; INFRAORBITAL branch of max nerve .
 LOWER LIP; MENTAL branch of inferior alveolar .LOWER LIP; MENTAL branch of inferior alveolar .
BUCCAL branch of mandibular nerve .BUCCAL branch of mandibular nerve .

 GINGIVAGINGIVA..
 EPITHELIUM;EPITHELIUM; Ortho-keratinizedOrtho-keratinized
Para-keratinized ,stippling .Para-keratinized ,stippling .
 LAMINA PROPRIALAMINA PROPRIA ;long narrow;long narrow
papillaepapillae
 Dense collagenous CT .Dense collagenous CT .
 Not highly vascular, but long capillaryNot highly vascular, but long capillary
loops with anastomoses are presentloops with anastomoses are present ..
 SUB MUCOSASUB MUCOSA ;; no distinct layer .no distinct layer .
 Mucosa is firmly attached by collagenMucosa is firmly attached by collagen
fibers to cememtum & periosteum offibers to cememtum & periosteum of
alveolar processalveolar process..

 GINGIVAGINGIVA
A. ALVEOLAR MUCOSA B. GINGIVA C. MUCOGINGIVAL JUNCTIONA. ALVEOLAR MUCOSA B. GINGIVA C. MUCOGINGIVAL JUNCTION
D. ATTACHED GINGIVA E. FREE GINGIVA F. INTERDENTAL GINGIVAD. ATTACHED GINGIVA E. FREE GINGIVA F. INTERDENTAL GINGIVA

 TYPES OF EPITHELIUM IN GINGIVATYPES OF EPITHELIUM IN GINGIVA
 3 TYPES;3 TYPES;
 1.Outer epithelium1.Outer epithelium
 2. Sulcular epithelium2. Sulcular epithelium
 3.Junctional epithelium3.Junctional epithelium

 INTERDENTAL GINGIVAINTERDENTAL GINGIVA
 COLCOL
 Non keratinizedNon keratinized
 Depression betweenDepression between
buccal & lingual papillabuccal & lingual papilla
 Connects both the papillaConnects both the papilla
 Found below the contactFound below the contact
pointpoint
 Anteriorly – pyramidalAnteriorly – pyramidal
 Posteriorly – tent shape.Posteriorly – tent shape.

 UPPER GINGIVAUPPER GINGIVA
 ANTERIORANTERIOR;ANTERIOR SUPERIOR ALVEOLAR ARTEY;ANTERIOR SUPERIOR ALVEOLAR ARTEY
 PALATALPALATAL; GREATER PALATINE ARTERY; GREATER PALATINE ARTERY
 BUCCALBUCCAL ;BUCCAL ARTERY;BUCCAL ARTERY
 POSTERIORPOSTERIOR; POSTERIOR SUPERIOR ALVEOLAR ARTERY; POSTERIOR SUPERIOR ALVEOLAR ARTERY
 LOWER GINGIVALOWER GINGIVA
 ANTERIOR BUCCALANTERIOR BUCCAL; MENTAL ARTERY; MENTAL ARTERY
 ANTERIOR LINGUALANTERIOR LINGUAL; INCISIVE ARTERY; INCISIVE ARTERY
SUBLINGUAL ARTERYSUBLINGUAL ARTERY
 POSTERIOR BUCCALPOSTERIOR BUCCAL; INFERIOR ALVEOLAR ARTERY; INFERIOR ALVEOLAR ARTERY
BUCCAL ARETRYBUCCAL ARETRY
 POSTERIOR LINGUALPOSTERIOR LINGUAL; INFERIOR ALVEOLAR ARTERY; INFERIOR ALVEOLAR ARTERY
SUBLINGUAL ARTERYSUBLINGUAL ARTERY
•BLOOD SUPPLY

 UPPER GINGIVA;UPPER GINGIVA;
 ANTERIOR, POSTERIOR, MIDDLE SUPERIORANTERIOR, POSTERIOR, MIDDLE SUPERIOR
ALVEOLAR BRANCH OF MAXILLARY NERVEALVEOLAR BRANCH OF MAXILLARY NERVE
 LOWER GINGIVA;LOWER GINGIVA;
 INFERIOR BRANCH OF MANDIBULAR NERVEINFERIOR BRANCH OF MANDIBULAR NERVE
 BUCCAL BRANCH OF MANDIBULAR NERVEBUCCAL BRANCH OF MANDIBULAR NERVE
 SUBLINGUAL BRANCH OF LINGUAL NERVESUBLINGUAL BRANCH OF LINGUAL NERVE
•NERVE SUPPLY

 TONGUETONGUE
DORSAL SURFACE OF TONGUEDORSAL SURFACE OF TONGUE
 EPITHELIUM;EPITHELIUM; thickthick
 Keratinized &nonkeratinizedKeratinized &nonkeratinized
 Lingual papillae's are presentLingual papillae's are present
 Taste budsTaste buds
 LAMINA PROPRIA;LAMINA PROPRIA; long papillaelong papillae
 Minor salivary glands posteriorly.Minor salivary glands posteriorly.
 Rich innervations near taste buds .Rich innervations near taste buds .
 Capillary plexus in papillary layer large vessels lyingCapillary plexus in papillary layer large vessels lying
deeperdeeper
 SUB MUCOSA ;SUB MUCOSA ; No distinct layer .No distinct layer .

 FILLIFORM PAPILLAEFILLIFORM PAPILLAE
 keratinizedkeratinized
 Anterior tongueAnterior tongue
 Smallest & numerousSmallest & numerous
 Hair like extensionsHair like extensions
 FOLIATE PAPILLAEFOLIATE PAPILLAE
 Non keratinizedNon keratinized
 Lateral marginsLateral margins
 Leaf like projectionsLeaf like projections
 Few taste budsFew taste buds

 FUNGIFORM PAPILLAEFUNGIFORM PAPILLAE
Non keratinizationNon keratinization
AnterolateralAnterolateral
Taste budsTaste buds
Round & reddish.Round & reddish.
 CIRCUMVALLATE PAPILLAECIRCUMVALLATE PAPILLAE
Keratinized –superiorlyKeratinized –superiorly
Nonkeratinized- laterallyNonkeratinized- laterally
Anterior to sulcus terminalisAnterior to sulcus terminalis

 TASTE BUDSTASTE BUDS
 Chemoreceptor organsChemoreceptor organs
 Barrel shapedBarrel shaped
seen in –fungiform papillaeseen in –fungiform papillae
circumvallate papillaecircumvallate papillae
soft palate ….soft palate ….

VENTRAL SURFACE OF THEVENTRAL SURFACE OF THE
TONGUETONGUE
 EPITHELIUM;EPITHELIUM; Thin, nonThin, non
keratinized .keratinized .
 LAMINA PROPRIA ;LAMINA PROPRIA ;Thin ,Thin ,
• Numerous short papillae .Numerous short papillae .
 Few elastic fibers .Few elastic fibers .
 Minor salivary glands. capillaryMinor salivary glands. capillary
network in sub papillary layernetwork in sub papillary layer
 Reticular layer relatively avascularReticular layer relatively avascular
 SUBMUCOSASUBMUCOSA; Thin & irregular; Thin & irregular
 Fat & small vesselsFat & small vessels
 Bound to the CT surrounding theBound to the CT surrounding the
tongue musculature.tongue musculature.

 LINGUAL VERUCOSITESLINGUAL VERUCOSITES
( PHLEBECTASIA )( PHLEBECTASIA )
 Common in elder individuals.Common in elder individuals.
 Purplish blue nodular area.Purplish blue nodular area.
 Due to dilation & increased tortusity ofDue to dilation & increased tortusity of
lingual veins.lingual veins.
 Increase venous pressureIncrease venous pressure
 decrease in elasticity of venous wall.decrease in elasticity of venous wall.
 Lack of support by surrounding tissues.Lack of support by surrounding tissues.
 COMPLICATIONS;COMPLICATIONS;
 Ulceration, thrombosis, hemorrhage.Ulceration, thrombosis, hemorrhage.

 BLOOD & NERVE SUPPLY OF TONGUEBLOOD & NERVE SUPPLY OF TONGUE
 Ant 23Ant 23rdrd
-- deep lingual artery-- deep lingual artery
 Post 13Post 13rdrd
--dorsal lingual artery--dorsal lingual artery
 NERVE SUPPLY;NERVE SUPPLY;
 Glossopharengeal nerveGlossopharengeal nerve
 Lingual nerveLingual nerve
 Chorda tympani.Chorda tympani.
 Vagus nerveVagus nerve
BLOOD SUPPLY;

EFFECT OF AGING ON THE ORAL MUCOSAEFFECT OF AGING ON THE ORAL MUCOSA
 HISTOLOGYHISTOLOGY
 Epithelial thinningEpithelial thinning
 Decreased keratinizationDecreased keratinization
 Less prominent rete pegsLess prominent rete pegs
 Decreased cellular proliferationDecreased cellular proliferation
 Loss of submucosal elastin and fatLoss of submucosal elastin and fat
 Increased fibrotic connective tissue withIncreased fibrotic connective tissue with
degenerative alteration in the collagen.degenerative alteration in the collagen.

 These changes in the histology of oral mucosa are moreThese changes in the histology of oral mucosa are more
marked in women especially post menopausal.marked in women especially post menopausal.
 Vascular changes in the oral mucosa include theVascular changes in the oral mucosa include the
development of vascular nodules and nevi.development of vascular nodules and nevi.

 Wound healing and regeneration of tissue may be delayedWound healing and regeneration of tissue may be delayed
with age. Oral mucosal immunity is also believed to undergowith age. Oral mucosal immunity is also believed to undergo
some age related changes. The number of langerhan’s cellssome age related changes. The number of langerhan’s cells
decreases with age which contributes to a decline in celldecreases with age which contributes to a decline in cell
medicated immunity.medicated immunity.
 This decrease in rate of wound healing is more pronouncedThis decrease in rate of wound healing is more pronounced
in connective tissue than epithelium.in connective tissue than epithelium.

 AGING IN GINGIVAAGING IN GINGIVA
 With the aging there is decreasedWith the aging there is decreased
keratinization and stipplingkeratinization and stippling
 Though gingival recession increases with ageThough gingival recession increases with age
it is not necessary a physiologic process.it is not necessary a physiologic process.
 There is decreased width of attachedThere is decreased width of attached
gingival with constant relocation of thegingival with constant relocation of the
mucogingival junction throughout the adultmucogingival junction throughout the adult
life.life.

 There is stiffening of the walls of theThere is stiffening of the walls of the
blood vessels and decrease in theirblood vessels and decrease in their
diameter due to arthrosclerosis.diameter due to arthrosclerosis.
 Decreased connective tissue cellularityDecreased connective tissue cellularity
and oxygen consumption.and oxygen consumption.

 BEHAVIOUR OF ORAL MUCOSABEHAVIOUR OF ORAL MUCOSA
UNDER STRESSUNDER STRESS
 Oral mucosa under compression behaves in aOral mucosa under compression behaves in a
viscoelastic fashion.viscoelastic fashion.
 Loads imposed on masticatory mucosa – mastication &Loads imposed on masticatory mucosa – mastication &
prosthesis consists of shear & compressive force, theyprosthesis consists of shear & compressive force, they
produce regions of tensile stress in mucosaproduce regions of tensile stress in mucosa
 Loaded epithelium demonstrates decrease in the depthLoaded epithelium demonstrates decrease in the depth
of epithelial ridges & connective tissue papillaeof epithelial ridges & connective tissue papillae
 Care to be taken during impression procedures byCare to be taken during impression procedures by
applying minimal pressures.applying minimal pressures.

 Function & ParafunctionFunction & Parafunction
 PRESSURE FORCE TIMEPRESSURE FORCE TIME

 controlled by controlled bycontrolled by controlled by
 Tissue damage caused by 1 correct clinical nocturnal tissueTissue damage caused by 1 correct clinical nocturnal tissue
occluding local circulationoccluding local circulation technique resttechnique rest
2 permanent2 permanent
soft linersoft liner

 SOFT TISSUE CHANGES IN ORAL MUCOSASOFT TISSUE CHANGES IN ORAL MUCOSA
 SOFT TISSUE HYPERPLASIASOFT TISSUE HYPERPLASIA
 FIBROUS HYPERPLASIAFIBROUS HYPERPLASIA
 EPULIS FISSURATAEPULIS FISSURATA
 PAPILLARY HYPERPLASIAPAPILLARY HYPERPLASIA
 INFLAMMATORY PROCESS UNDER DENTURE BASESINFLAMMATORY PROCESS UNDER DENTURE BASES
 DENTURE STOMATITISDENTURE STOMATITIS
 STOMATITIS VENENATASTOMATITIS VENENATA
 CANDIDIASISCANDIDIASIS
 MECHANICAL IRRITATIONMECHANICAL IRRITATION
 DECUBITUS ULCERDECUBITUS ULCER
 ULCERATIVE LESIONSULCERATIVE LESIONS
 ANGULAR CHELITISANGULAR CHELITIS

 SOFT TISSUE HYPERPLSIASOFT TISSUE HYPERPLSIA
 Rolls of hyperplastic tissues under dentureRolls of hyperplastic tissues under denture
basebase
 Due to bone resorbtion, with lesion filling theDue to bone resorbtion, with lesion filling the
space under denture base.space under denture base.
 Develops slowly, painless.Develops slowly, painless.
 RxRx
 Surgical removal.Surgical removal.
 New dentures.New dentures.

 PAPILLARY HYPERPLASIAPAPILLARY HYPERPLASIA
 Granular type of inflammation seen in palatal region.Granular type of inflammation seen in palatal region.
 numerous papillary projections give a warty appearance.numerous papillary projections give a warty appearance.
 They show precancerous tendenciesThey show precancerous tendencies
 RxRx SurgerySurgery
Discontinue denture wearingDiscontinue denture wearing
New denturesNew dentureswww.indiandentalacademy.comwww.indiandentalacademy.com

 DENTURE STOMATITISDENTURE STOMATITIS
 Chronic inflammation of the denture bearingChronic inflammation of the denture bearing
area.area.
 CAUSES;CAUSES;
 Para functional habit.Para functional habit.
 ill fitting denture .ill fitting denture .
 Nocturnal denture wearing.Nocturnal denture wearing.
 Hypersensitivity.Hypersensitivity.
 Poor oral hygienePoor oral hygiene
 Infections –Candida albicansInfections –Candida albicans

 DENTURE STOMATITISDENTURE STOMATITIS
 SYMPTOMS;SYMPTOMS;
 Redness of the tissue.Redness of the tissue.
 Pain.Pain.
 Burning sensationBurning sensation
 Rx;Rx;
 Discontinue denture wearing .Discontinue denture wearing .
 good oral hygiene proceduresgood oral hygiene procedures
 Anti fugal Rx ( if candidal inf)Anti fugal Rx ( if candidal inf)
 New dentures.New dentures.

 CONTACT STOMATITISCONTACT STOMATITIS
 Certain individuals react to materials & drugsCertain individuals react to materials & drugs
differently than others do.differently than others do.
 In oral cavity it is termed as contact stomatitis.In oral cavity it is termed as contact stomatitis.
 Marked redness in limited area contact withMarked redness in limited area contact with
acrylic partial denture.acrylic partial denture.
 Such contact sensitivity isSuch contact sensitivity is
rarerare..

 CANDIDIASISCANDIDIASIS
 Usually seen in,Usually seen in,
 Unclean mouth.Unclean mouth.
 Debilitated patientsDebilitated patients
 Systemic disease such as diabetes.Systemic disease such as diabetes.
 Unhygienic conditions will facilitate theUnhygienic conditions will facilitate the
candidal growth.candidal growth.
 SYMPTOMS;SYMPTOMS;
 Redness with pain.Redness with pain.
 Swelling of the denture supporting tissue.Swelling of the denture supporting tissue.
 RxRx Discard the existing denture.Discard the existing denture.
 Anti fungal therapy.Anti fungal therapy.
 New dentures.New dentures.

 ANGULAR CHELITIS.ANGULAR CHELITIS.
 SIGNSSIGNS;;
 Bilateral lesion that develops at the angle of theBilateral lesion that develops at the angle of the
lips.lips.
 Deep fissure or crack may be seen.Deep fissure or crack may be seen.
 Appear ulcerated.Appear ulcerated.
 Exudatve crust may be present.Exudatve crust may be present.
 Rx;Rx;
 Anti fungal therapy.Anti fungal therapy.

LOCAL DISEASES AFFECTING ORALLOCAL DISEASES AFFECTING ORAL
CAVITYCAVITY
 WHITE LESIONS;WHITE LESIONS;
 Leukoplakia.Leukoplakia.
 Lichenplanus.Lichenplanus.
 Hyperkeratosis.Hyperkeratosis.
 MALIGNANT LESIONSMALIGNANT LESIONS..
 Carcinoma.Carcinoma.
 METABOLIC DISEASES.METABOLIC DISEASES.
 Diabetes mellitus .Diabetes mellitus .
 Nutritional disorders.Nutritional disorders.

 LEUCOPLAKIALEUCOPLAKIA

 LICHEN PLANUSLICHEN PLANUS

 ERYTHROPLAKIAERYTHROPLAKIA

 CARCINOMACARCINOMA

 NUTRITIONAL DEFICIENCYNUTRITIONAL DEFICIENCY

 SUMMARYSUMMARY
 The oral mucosa consists of stratifiedThe oral mucosa consists of stratified
squamous epithelium followed by Laminasquamous epithelium followed by Lamina
propria & Submucosa.propria & Submucosa.
 The structure varies according to functionThe structure varies according to function
in different regions they can be classifiedin different regions they can be classified
as – Masticatory mucosaas – Masticatory mucosa
 Lining mucosaLining mucosa
 Specialized mucosaSpecialized mucosa

 CONCLUSIONCONCLUSION
 The dentures must function in harmony with theThe dentures must function in harmony with the
remaining tissues that both support andremaining tissues that both support and
surround them .surround them .
 For this harmony of living tissues & non livingFor this harmony of living tissues & non living
materials (dentures) to coexist for reasonablematerials (dentures) to coexist for reasonable
period of time, the dentist must fully understandperiod of time, the dentist must fully understand
both the macroscopic & microscopic anatomy ofboth the macroscopic & microscopic anatomy of
supporting & limiting structures of dentures.supporting & limiting structures of dentures.

 REFERENCESREFERENCES
 1.A.R.Tencate -Oral Histology1.A.R.Tencate -Oral Histology
,Development ,Structure and Function -- 6,Development ,Structure and Function -- 6thth
EditionEdition
 2.Anne M R, Ming C Lee Grants atlas of2.Anne M R, Ming C Lee Grants atlas of
anatomy 10anatomy 10thth
Edition.Edition.
 3.Bouchers –Prosthodontic treatment for3.Bouchers –Prosthodontic treatment for
edentulous patients 10edentulous patients 10thth
& 11& 11thth
EditionEdition
 4.B.K.B .Bercovitz , Color atlas & text of oral4.B.K.B .Bercovitz , Color atlas & text of oral
anatomy .anatomy .
 5.Bernard .L. The anatomical basis of dentistry.5.Bernard .L. The anatomical basis of dentistry.
22ndnd
Edition.Edition.
 6.Colby, Kerr Color atlas of oral pathology. 46.Colby, Kerr Color atlas of oral pathology. 4thth
EditionEdition

 7.Hubert E Schroeder -Oral Structural7.Hubert E Schroeder -Oral Structural
Biology --3Biology --3rdrd
EditionEdition
 8.John J Sharry -Complete denture8.John J Sharry -Complete denture
prosthodontics 1962prosthodontics 1962
 9.Keith L Moore -Clinically Oriented9.Keith L Moore -Clinically Oriented
Anatomy --3Anatomy --3rdrd
EditionEdition
 10.Nagle & Sears -Dental Prosthetics ,10.Nagle & Sears -Dental Prosthetics ,
Complete denture.Complete denture.
 11.Orbans -Oral Histology And11.Orbans -Oral Histology And
Embryology 11Embryology 11thth
EditionEdition
 12.Zarb-Bolendar Prosthodontic12.Zarb-Bolendar Prosthodontic
treatment for edentulous patients 12treatment for edentulous patients 12thth
Edition.Edition.

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