This document provides an overview of the oral mucosa. It defines oral mucosa as the moist lining of the oral cavity that is a continuation of the skin and esophagus. It discusses the roles of oral mucosa including protection, barrier function, immunological defense, and sensory input. It describes the development, organization, types (masticatory, lining, specialized), glands, component tissues, and structure of the oral mucosa in different regions like the keratinized gingiva and hard palate.

1. Dr.sinu jayaprakash
1st year mds
Kmct dental college
ORAL MUCOSA

2. contents
• DEFINITION
• ROLE OF ORAL MUCOSA
• DEVOLOPMENT OF ORAL MUCOSA
• ORGANIZATION OF ORAL MUCOSA
• TYPES
• GLANDS
• COMPONENT TISSUES
• ORAL EPITHELIUM
• LAMINA PROPRIA

3. DEFINITION
• The moist lining of the oral cavity that is in continuation with
the exterior surface of skin and oesophagus on the other end
is called the oral mucosa or oral mucous membrane

4. ROLE OF ORAL MUCOSA
• PROTECTIVE mechanism against mechanical compressive and
shearing forces.
• BARRIER against micro oraganism, toxins and various antigent.
• IMMUNOLOGICAL DEFENCE both humoral and cell mediated.
• RELEX such as gaging retching and salivating are initated by receptors
in oral mucosa.
• Mucosa is richly innervated providing input for TOUCH
PROPRICEPTION,PAIN AND TASTE.
• Minor glands within the oral mucosa provide LUBRICATION AND
BUFFERING as well as secretion of some antibodies.

5. DEVELOPMENT OF ORAL MUCOSA
• Primitive oral cavity develops by fusion of embryonic stomatodeum with
forgut after rupture of buccopharyneal membrane at 26days of gestation.
• Structures from branchial arches like toungue epiglottis and pharynx
covered by epithelium derived from endoderm.
• Epithelium covering palate cheeks and gingivae are of ectodermal origin.
• 5-6 weeks single layers of cells have formed lining oral cavity

6. • 10-14 weeks:cellular degeneration forming oral vestibule,
• 8-11 weeks :palatal shelves elevates and close.capillary buds
and collagen fibres detected
• At this time morpholgy of future mouth is apparent

8. • 7 weeks: circumvallate and foliate papillae appear followed by
fungiform
• 10 weeks: filiform papillae appear
• 10-20 weeks future lining and masticatory mucosa
stratification of epithelium and different morphology
• Areas destined to become keratinised have darkly staining
columnar basal epithelium
• Epithelial cells in areas of future lining mucosa retain cuboidal
cells

9. • 13-20 weeks: all oral epithelia thicken with appearance of
sparse keratohyalin granules
• Melanocytes and langerhans cells appear
• Surface layers show parakeratinisation, orthokeratosis occurs
only after eruption of teeth post-natally
• 17-20 weeks: completely formed with appearance of elastic
fibres in the ectomesenchyme

10. ORGANIZATION OF ORAL MUCOSA
• The oral cavity consist of 2 parts
Outer vestibule (bounded by lips and cheeks.)
Oral cavity proper (separated from vestibule by the alveolus)
BOUNDARIES:
Superiorly: hard and soft palate
Inferiorly: floor of mouth, base of toungue
Posteriorly: pillars of fauces, tonsils

11. TYPES
3 main types of mucosa :
• Masticatory mucosa(60%)
• Lining mucosa (25%)
• Specialized mucosa (15%)

12. • MASTICATORY MUCOSA – free and attached gingiva and hard
palate comes in primary contact with food during mastication
and is keratinized.
• LINING MUCOSA – the lips ,cheeks, vestibule, floor of the
mouth, interior surface of the tongue and soft palate. It
does not function in mastication and therefore has little
attrition. It is soft, pliable and non-keratinized.
• SPECIALIZED MUCOSA – on the dorsal surface (dorsum) of
the tongue. It is covered with cornified epithelial papillae

13. SUBDIVISIONS OF ORAL MUCOSA
Keratinized areas
• Masticatory mucosa(gingiva and hard palate)
• Vermilion border of lip.
Non-Keratinized areas
• Lining mucosa (Lip, cheek, vestibular fornix, alveolar mucosa, floor
of mouth and soft palate)
• Specialized mucosa(Dorsum of tongue)

14. CLINICAL FEATURES
• Although continuous with skin oral mucosa differs in a
number of ways
COLOUR:
• oral mucosa is more deeply colour most obviosly at the lips.
• Thickness of epithelium
• Degree of keratinisation
• Amount of melanin pigment
• Moist surface and absence of appendages

15. • Glandular component of oral mucosa represented By minor
salivary galnds.Occasional sebaceous glands in upper lip and
buccal mucosa:fordeys spots.
• Smoother surface and fewer wrinkles
• Papillae on dorsum of toungue
• Transverse ridges of palate
• Linea alba may be present on cheek. A slight whitish ridge
occurs along the buccal mucosa in the occlusal plane of the
teeth and is keratinized.

16. COMPONENT TISSUES
• Oral epithelium : Startified squamous epithelium: (epidermis)
• Lamina propria:Connective tissue layers:(dermis)
• Interface: upward projections of connective tissue-connective
tissue papillae interdigitate with epithelial ridges or rete pegs
• Typically haematoxylin –eosin stain show this interface as a
structure less layer about 1-2 microns thick -base membrane

17. • The junction between oral epithelium and lamina propria is
obvious, unlike that between oral mucosa and underlying
tissue.
• Oral mucosa has no muscularis mucosa
• In cheeks lips and parts of hard palate a layer of loose fatty
granular tissue containing vessels and nerves supplying the
mucosa separates the oral mucosa from the underlying bone
or muscle: submucosa
• In gingiva and parts of hard palate oral mucosa from
underlying bone.this provides a firm in elastic attachment:
mucoperiosteum

18. GLANDS
• Minor salivary glands in submucosa
• Sebaceous glands in lamina propria produce sebum to
lubricate the surface of mucosa. This might actually be an
embryonic anomaly.
• Nodules of lymphoid tissue are present in various areas
consisting of crypts formed by invagination of epithelium into
lamina propria

19. • Capillaries carry adheshion molecules like;
• Endothelial cell leukocyte adheshion molecule
• Intercellular adhesion molecule
• Vacular cell adheshion molecule
• these facilitate trafficiking of leukocytes from blood
• Found as lingual palatine pharyngeal tonsils forming
waldeyers ring.
• Small nodules also in soft palate ventral surface of toungue
floor of mouth

20. ORAL EPITHELIUM
• They are the primary barrier b/n oral enviornment and deeper
tissue.
• The oral epithelium is a stratified squamous epithelium consisting of
cells tightly attached to each other and arranged in a number of
distinct srata

21. • Maintains structural entity by continuous cell renewal
• Cells produced by mitotic divisons in deepest layer replace
those are shed.
progenitor population
maturing population
It is divided in to two types, they are
KERATINIZED EPITHELIUM.
NON-KERATINIZED EPITHELIUM.

22. KERATINIZED EPITHELIUM:
The epithelial surface of the masticatory
mucosa(gingiva and hard palate) is inflexible and
resistant to abrasion.
It results from the formation of a surface layer of
keratin , and the process of maturation is called
keratinization or cornification.

23. It has four layers:
Stratum basale
Stratum spinosum
Stratum granulosum
Stratum corneum

24. • STRATUM BASALE [BASAL LAYER]
• It is a first layer
It rests on the basement membrane
The Cells are cuboidal or columnar
The nuclei is deeply stained & large
These are arranged in a uniform row
The Cells divide and migrate above to form the cells of other
layers.
This layer is occasionally called as stratum-germinativum or
proliferative layer.

26. STRATUM SPINOSUM
Above basal layer,are several rows of large elliptical or
spherical cells with the large nuclei called as stratum
spinosum.
The nuclei stain less intensely than those of the basal layer.
The Individual cells are clearly outlined by cell walls and
appear to be joined by intercellular bridges.
Tonofibrils course from cell to cell across the intercellular
bridges.

28. The intercellular spaces contain
glycoprotein,glycosaminoglycans and fibronectin.
These spike like intercellular bridges gives the cells spiny or
prickle like profile.hence it is called as stratum spinosum or
prickle cell layer.
The basal and prickle cell layers,together constitute half to
two thirds the thickness of epithelium.

30. STRATUM GRANULOSUM
Next to stratum spinosum there are rows of flattened or
round cells that contain deeply staining keratohyaline
granules in the cytoplasm, which are called as stratum
granulosum.
These granules are basophilic, staining intensely with acid
dyes such as hematoxylin.

31. Also contain lamellar granule, also called as Odland body or
keratinosome,discharge their contents into intercellular
spaces forming intercellular lamellar material,contributes to
permeability barrier.
This layer is absent in Non-Keratinized epithelium.
But it is clearly seen only in Keratinized epithelium.

32. STRATUM CORNEUM:
It is a Keratinized layer.
The surface layer is composed of cells, which are flat and
dehydrated in which all organelles have been lost
The cells are filled with packed fibrillar material and stain pick
with eosin

33. • They do not contain any nuclei and pattern is called ortho-
keratinization. Some times surface layer may retain nuclei,
which is called as Para Keratinization. In this, nuclei are
shrunken or pyknotic.

34. NON-KERATINIZED EPITHELIUM
Non-keratinizing epithelia differ from keratinizing epithelia
because they do not produce a cornified surface layer.
It has four layers
Stratum basale
Stratum prickle
Stratum intermedium
Stratum superficiale
There is no Stratum granulosum and stratum corneum in Non-
Keratinized epithelium.

36. STRATUM BASALE:
 Contain cuboidal or columnar cells containing cell organelles.
 Site of most cell divisions .
STRATUM PRICKLE:
Contain large ovoid cells,membrane coating granules.
STRATUM INTERMEDIUM:
 The cells are larger in size than the cells of Stratum spinosum of a
keratinized epithelium.
 Cells are flattened containing tonofilaments and glycogen

37. STRATUM SUPERFICIALE:
Cells are flattened with dispersed filaments and
glycogen,fewer organelles present.
The cells do not stain intensely with eosin.
The cells in this layer retain their nuclei.

38. • BASEMENT MEMRANE:
Is evident at the light microscopic level.
It is found at the interface of epithelium and connective
tissue.
 It is 1 to 4 micron meter wide and is relatively cell free.
Contains glycosaminoglycans,reticulin fibrils.

39. LAMINA PROPRIA:
It is a connective tissue of variable thickness and supports the
epithelium.
The lamina propria contains cells,blood vessels,neural
elements and fibers embedded in an amorphous ground
substance.
It is divided in to two parts:papillary and reticular.

40. Papillary portion contain connective tissue papillae.
Reticular portion contain reticular fibers, found just beneath
the basement membrane.
The reticular zone is always presents but papillary zone may
be absent in certain areas like the alveolar mucosa where
papillae are absent.
The lamina propria may attach to the periosteum of the
alveolar bone, or it may overlay the submucosa.

42. SUBMUCOSA
Consists of connective tissue of varying thickness and density.
Attaches the mucous membrane to the underlying structures.
It may be loose or firm.
All lining mucosa have a sub mucosa.
Gingival & certain parts of the hard palate do not have sub
mucosa.
The Glands, adipose tissue, blood vessels & nerves, which
divide & extend into the lamina propria are present in this
layer.

43. CELLS IN ORAL EPITHELIUM
Certain cells within the oral epithelium differ from
Keratinocytes in their appearance, which are called as Non-
Keratinocytes.
They have a clear halo around their nuclei.
They are: 1. Melanocytes
2. Langerhans’ cells
3. Merkel’s cells
4. Lymphocytes

44. MELANOCYTE
• Level in epithelium-Basal layer
• Specific staining reactions-Dopa oxidase-tyrosinase;silver
stains.
• Ultrastructural features-Dendritic,no desmosomes or
tonofilaments;premelanosomes and melanosomes present.

45. • Function-Synthesis of melanin pigment
granules(melanosomes)and transfer to surrounding
keratinocytes by dendritic processes of melanocytes.

46. LANGERHANS’ CELL
• Level in epithelium: is predominantly supra basal.
• Specific staining reaction: ATPase;cell surface antigen
markers.
• Ultra structural features: are dendritic, no desmosomes and
tonofilaments; characteristic langerhans granules are
present.
Function: is unknown; proposed roles include effete
Melanocyte, Neural element, Regulatory cell, Macrophage, and
Antigen trap.

47. MERKEL’S CELL
• Level in epithelium: is Basal
• Specific staining reaction: is probably positive with PAS
• Ultra structural features: are Non-dendritic; sparse
desmosomes and tonofilaments; the characterstic electron
dense vesicles and associated nerve fibers are present
• Function: Tactile sensory cell in function

48. LYMPHOCYTE:
• Level in epithelium: is variable
• Specific staining reaction: cell surface antigen marker.
• Ultastructural features: Large circular nucleus; scant
cytoplasm with few organelles are present but there are no
desmosomes and tonofilaments.
• Function: It is associated with the inflammatory response in
oral mucosa.

50. STRUCTURE OF THE MUCOSA IN DIFFERENT REGIONS
OF THE ORAL CAVITY
KERATINIZED AREAS
• Masticatory mucosa
• Vermillion border of lip
NON KERATINIZED AREAS
• Lining mucosa
• Specialized mucosa

51. KERATINIZED AREAS:
MASTICATORY MUCOSA
Rubbery surface texture and resiliency designed to withstand
the vigorous activity of chewing and swallowing includes:
Gingiva
Hard palate
Dorsal surface of tongue
Associated with keratinized stratified squamous epithelium
Highly interdigitated interface

52. Gingiva
• The gingiva is the part of oral mucosa that covers the alveolar
processes of the jaws and surrounds the necks of the teeth.

53. •The gingiva is divided anatomically in to:
•Marginal or Free gingiva
•Attached gingiva
•Interdental gingiva

54. MARGINAL ,FREE OR UNATTACHED GINGIVA:
• Is the terminal edge or
border of the gingiva
surrounding the teeth in
collar like fashion.
• Usually about 1mm wide,
and it forms a soft tissue
wall of the gingival sulcus.
• In 50% of cases,it is
demarcated from the
attached gingiva by a
shallow linear depression
called the free gingival
groove.

55. GINGIVAL SULCUS
• Is the shallow crevice or space around the tooth bounded by the
surface of the tooth on one side and the epithelium lining the free
margin of the gingiva on the other.
• It is v-shaped
• The probing depth of a clinically normal gingival sulcus in humans is
2 to 3mm.

56. ATTACHED GINGIVA
Is continuous with the marginal gingiva
Firmly bound and resilient.
The surface is Stippled
Extends from the base of the sulcus to the mucogingival
junction.
The width of the attached gingiva in the incisor region is
Maxilla-3.5-4.5 Mandible-3.3-3.9
In premolar region
Maxilla-I.9mm Mandible-1.8mm

57. INTERDENTAL GINGIVA
Occupies the gingival embrasure,which is the interproximal
space beneath the area of tooth contact.
Can be pyramidal or have a “col” shape.
The facial and lingual surfaces-tapered toward the
interproximal contact area
Mesial and distal surfaces-concave

58. GINGIVAL EPITHELIUM:
• It is thick [250 micron.m.],
• ortho Keratinized or ParaKeratinized,
• Stratified Squamous epithelium.
Lamina propria:
It has Long, narrow papillae, dense collagenous connective
tissue; not highly vascular but long capillary loops with
numerous anastomoses.

59. SUBMUCOSA:
• There is no distinct layer; mucosa is firmly attached by
collagen fibers to cementum & periosteum of alveolar
process.
• The gingiva contains dense fibers of collagen referred to as
gingival ligament.
• The fibers enter the lamina propria,attaching the gingiva
firmly to the teeth.

60. •Dentogingival
•from the cervical cementum in to the lamina propria
of gingiva.
•Alveololingual
•from alveolar crest to lamina propria of gingiva.
Circular
•small group of fibers circle the tooth.
Dentoperiosteal
•from the cementum in to the periosteum of the
alveolar crest.

62. CLINICAL FEATURES OF GINGIVA
• Color-coral pink and is produced by vascular supply,thickness
and degree of keratinization of the epithelium and presence
of pigment containing cells.
• Varies among different individuals,correlated with cutaneous
pigmentation.
• Size-corresponds with the sum total of the bulk of cellular and
intercellular elements and vascular supply.
• Alteration in size is a common feature of gingival disease.

63. • Shape-the shape and height of interdental gingiva is is
governed by the proximal tooth surfaces and location and
shape of gingival embrasures.
• Consistency-the gingiva is firm and resilient.
• The firmness of attached gingiva is determined by the
collagenous fibers,that of marginal gingiva is determined by
gingival fibers.

64. •Surface texture-presents a textured surface called
stippling is produced by alternate rounded
protuberances and depressions in the gingival
surfaces.
•It is a feature of healthy gingiva,reduction or loss is a
sign of gingival disease.

65. HARD PALATE:
Epithelium: It is thick, Ortho Keratinized, often Para
Keratinized in some parts. The Stratified Squamous
epithelium thrown into transverse palatine ridges (rugae).
Lamina propria: It has Long papillae; thick dense connective
tissue, especially under rugae; moderate vascular supply with
short capillary loops.

66. • Submucosa: The submucosa in the anterolateral region of the
hard palate contains adipose tissue and in the posterolateral
region contains glandular tissue.

68. Blood supply:
•Major palatine artery
•Nasopalatine artery
•Sphenopalatine artery
•Nerve supply:
•Greater,lesser and sphenopalatine branches of
maxillary nerve.

69. INCISIVE PAPILLA
The covering epithelium is keratinized.
The connective tissue is dense.
It contains nasopalatine ducts lined by columnar
epithelium,rich in goblet cells and mucous glands.

70. RUGAE
•Are ridges of mucous membrane extending from
the incisive papilla and the anterior part of the
raphe.
 Their core is made up of dense connective tissue
layer with fine interwoven fibers.

71. NONKERATINIZED AREAS:
LINING MUCOSA:
Soft, moist surface with ability to be compressed
and stretched
Ares of tissue coverage –
Alveolar mucosa
Labial mucosa
Buccal mucosa
Soft palate
Ventral surface of tongue
Floor of the mouth

72. •associated with nonkeratinized stratified squamous
epithelium
• smooth interface between epithelium and lamina
propria
• elastic fibers in lamina propria
• may contain Fordyce granules

73. ALVEOLAR MUCOSA
Epithelium: is thin, Non Keratinized Stratified
Squamous epithelium.
Lamina propria: it has short papillae, connective tissue
containing many elastic fibers, capillary loops close to
the surface supplied by vessels running superficial to
the periosteum.
Submucosa:loose connective tissue,containing elastic
fibers attaching it to periosteum of alveolar process.

75. LABIAL AND BUCCAL MUCOSA
Epithelium: is very thick [500 micron m.], Non-
Keratinized Stratified Squamous epithelium .
Lamina propria: Has dense fibrous connective tissue
containing collagen and some elastic fibers; the rich
vascular supply giving off anastomosing capillary
loops in to papillae.

76. •Submucosa: Mucosa is firmly attached to underlying
muscle by collagen and elastic fibers; dense
collagenous connective tissue with fat, minor salivary
glands, sometimes sebaceous glands are also present

77. SOFT PALATE
Is lined by non-keratinized stratified squamous
epithelium .
Overlying a thick lamina propria. Lamina propria
shows layers of elastic fibers.
Submucosa is relatively loose and contains
continuous layer of mucous glands.
It contains adipose tissue that gives the tissue its
yellow hue and compressibility.

79. • Blood supply:minor palatine artery
• Nerve supply:branches of maxillary and glossopharyngeal
nerve.

80. VENTRAL SURFACE OF TONGUE:
Epithelium: It is thin, Non Keratinized Stratified
Squamous epithelium.
Lamina propria: is thin with numerous papillae and
some elastic fibers, a few minor salivary glands are
present, capillary network in sub papillary layer,
reticular layer is relatively avascular.
Submucosa: Thin and irregular,may contain fat and
blood vessels

82. FLOOR OF THE MOUTH:
Epithelium: is very thin [100 micron m.], Non Keratinized
Stratified Squamous epithelium.
Lamina propria: It has short papillae, some elastic fibers, and
extensive vascular supply with short anastomosing capillary
loops.
Submucosa: Loose fibrous connective tissue containing fat and
minor salivary glands.
Blood supply:Sublingual artery branch of lingual artery.

84. SPECIALIZED MUCOSA:
DORSAL SURFACE OF TONGUE
Epithelium: it is thick, keratinized and non-keratinized
stratified squamous epithelium forming three types of
papillae, some bearing taste buds.
Lamina propria: it contains long papillae; minor salivary
glands in posterior portion; rich innervations especially
near taste buds; capillary plexus in papillary layer
Submucosa: No distant layer is present; mucosa is bound
to connective tissue surrounding musculature of tongue.

86. Filiform Papillae
Clinically - most common; are about 2.5mm and are conical in
shape.
Microscopically - pointed structure with a thick layer of
keratinized epithelium overlying a core of lamina propria;
devoid of taste buds.
Function - Epithelial cells of the tips of the papillae are
keratinized this makes the surface rough and helps grasping
of the food.

88. Fungi form papillae
Clinically – These are rounded reddish elevations
situated discretely along the sides and tip of the
tongue.
- Are about 2mm long,1mm wide.
Microscopically - mushroom-shaped structure with a
thin layer of keratinized epithelium overlying a core
of lamina propria, with taste buds in the most
superficial portion
Function – salty taste

89. CIRCUMVALLATE PAPILLAE
• Clinically - 7 to 15 large, raised mush-room-shaped
structures anterior to the sulcus terminalis
• Microscopically - mushroom-shaped, lined by stratified
squamous epithelium.
• Epithelial lining contains taste buds
• surrounded by a trough which has von Ebner’s glands in
submucosa
• Function - bitter taste

91. FOLIATE PAPILLAE
• Clinically - 4 to 11 vertical ridges on the lateral surface of the
posterior tongue
• Microscopically - leaf-shaped structure of keratinized
epithelium overlying a core of lamina propria, with superficial
taste buds
• Function - sour taste

92. TASTE BUDS:
• -
1)Taste buds are seen in the papillae,mucosa of soft palate,and
pharynx.
2)They are barrel-shaped structures surrounded by stratified
squamous epithelium.
3)They consists of two types of cells,the taste cell and the
supporting cell.
4)The entire taste bud is intra-epithelial,the cells lying
perpendicular to the basement membrane.

94. There are 4 to 20 taste cells per bud.
6)They are thin columnar cells and are also known as gustatory
or neuroepithelial cells.
7)The supporting cells are called sustentacular cells and are
wider than taste cells.
8)Nerve fibers enter the taste buds,branch repeatedly and run
between the taste and the supporting cells and end as knob-
shaped terminals on lateral or free surfaces of the cells.

95. JUNCTIONS IN THE ORAL MUCOSA:
MUCOCUTANEOUS JUNCTION
It presents between the skin and mucosa.
It is also called as red zone or vermilion zone.
The epithelium in this region is thin with long
connective tissue papilla.
In young persons this is sharply demarcated, but as a
person exposed to ultraviolet rays the border
becomes diffuse and poorly defined.

96. It is a junction between the masticatory mucosa and
lining mucosa.

That is it is the junction between attached gingiva
and alveolar mucosa.
The epithelium of attached gingiva keratinized or
parakeratinized
The lamina propria contains collagen bundles
attaching tissue to periosteum.

97. The epithelium of alveolar mucosa is non-keratinized
.
The lamina propria contains numerous elastic fibers.
The junction is clinically identified by the
mucogingival groove and from the bright pink of
alveolar mucosa to the paler pink of the gingiva.

98. DENTO GINGIVAL JUNCTION
It is a Junction between the gingiva and the tooth.
The Junction is made up of the junctional epithelium.
In younger ages the junction is on the enamel, as in
older age the junction is on the cementum.

99. Renewal rate and repair
•Oral mucous tissue renewal rate is higher than for
skin.
•Regional differences:
•– buccal and labial mucosa - 10 - 14 days
•– attached gingiva - 10 days
•– taste buds - 10 days
•– junctional epithelium - 4 - 6 days

100. AGE CHANGES
Clinically, the oral mucosa of an elderly person often has a
smoother and dryer surface than that of the youngster.
Histologically the epithelium appears thinner.
Smoothing of the epithelium-connective tissue interface
results from the flattening of epithelial ridges.

101. The dorsum of tongue may show a reduction in the number
of filliform papillae.
Decreased epithelial proliferation & decreased rate of
tissue turnover.
Langerhan’s cells become fewer with the age,which may
contribute to a decline in cell-mediated immunity.
In elderly persons nodular varicose veins on the
undersurface of the tongue (caviar tongue).

102. In lamina propria decreased cellularity with increase
in collagen.
Increased sebaceous glands of lips & cheek.
Atrophy of minor salivary glands with fibrous
replacement.
Postmenopausal women-presents symptoms such as
dryness of mouth, burning sensation & abnormal
taste

103. EPITHELIAL PATHOLOGY IN CHILDREN
•Squamous cell papilloma
• Benign neoplasm of epithelial origin
• Induced by human papilloma viruslesion are less virulent
c/f:
• No sex predilicition
• May occur at any age
• Sites toungue lip sift palate
• Occurs as pedunculted painless exophytic mass with papillary
projection
• Hoarsness of voice

104. •Histopathology:
• proliferation of keratinized stratified squamous epitheliumin
the form of projections
• Underlying connective tissue is firbrocellular with chronic
inflammatory cell infiltrate
• Sometymes koilocytes seen in spinous layer
•Management:
• Surgical excision

105. Verruca vulgaris(common wart)
• Contagious disease causing focal hyperplasiaof starttified squamous
epithelium
• Associated with hpv virus 2,4,6,40
• Clinical features:
• Mostly seen in children
• Pink yellow or white pedunculated or sessile papules with papillary
projection mostly in hands
• Sites are vermillion border of lip ,labial mucosa and anterior toungue
• Sometimes keratin horns are seen on skin surface
• Histopathology:
• Keratinised squamous epithelium with acanthosis
• Club shaped rete ridges in normal level as adjacent cells
• Numerous virus altered Koilocytes in spinous layer
• Epithelial cells show altered nucleus with mitotic figures called mitosoid cells.

106. • Management :
• Liquid nitrogen cryotherapy
• Conservative surgical excision
• Curettage
• Topical salicylic and lactic acid
• Laser/ electrosurgery

107. Condyloma Acuminatum
• One of Most common sexually transmitted disease
• Induced by Human papilloma virus 2, 6, 11, 53, 54
• Type 16 & 18 found in anogenital wart
• Incubation period of virus is 2-3 months
CLINICAL FEATURES :
Fleshy , exophytic , sessile well demarcated painless lesion of
anogenital region
In oral cavity sessile, pink, well demarcated lesion on labial mucosa,
soft palate, lingual frenulum
common in children from 12 to 16 years
Occurrence rise in childern due to sexual abuse

108. • Histopathology:
• Lesion covered by stratified squamous epithelium with marked acanthosis
• Mild papillomatosis & hyperkeratosis
• Vacuolation of granular cells and pyknotic nuclei, in prickle layer. Such cells
with pyknotic nuceli surroundede by clear zone called koilocytes
• Special immunochemical staining used is MIB 1 in nuclei of upper 2/3 rd of
epidermis, but not diagnostic
• MANAGEMENT:
• Conservative surgical excision
• Laser ablation, but risk of airborne spread of HPV

109. FOCAL EPITHELIAL HYPERPLASIA
(HECK’s Disease)
• Oral infection with HPV type 13 and 32
• First described in 1965 in native americans
• CLINICAL FEATURES
• In children mostly
• No gender predilection
• Mostly involve labial, buccal, lingual mucosa. Gingival & tonsillar lesion also
reported
• Broad based lesion present as well demarcated plaques
• Appear papillary in nature, but relatively smooth surfaced , flat topped
• Papules & plaques are usually the colour of mucosa
• Hyperplastic lesions are small discrete well demarcated, cluster together
cobblestone or fissured appearance

110. • HISTOPATHOLOGY:
• Stratified squamous epitheliumwith hyperplasia, focal acanthosis
• Thickened mucosa extend upwars hence lesionla rete ridges are at the
same depth as adjacent rete ridges
• Some superficial keratinocytes show koilocytic changes
• Virus like particles noted ultrastructurally positive for HPV antigen in insitu
hybrisisation
• MANAGEMENT:
• Conservative sugical excisionis the treatment of choice

111. EPHELIS
• Appear as hyperpigmented macules & represent region of
increased melanin production
• more in children
• Autosomal dominant
• Uniform, multiple, light tan < 3 mm with defined borders
• Appear on vermillion border of lips, mainly in lower lip. Do not
occur intraorally

112. • HISTOPATHOLOGY:
• Increased pigmantation of basal cell layer without increase in
melanocytes or elongation of rete pegs. Epidermis is normal
• MANAGEMENT :
• No specific treatment
• Use of sunscreen

113. LENTIGO SIMPLEX
• Most common form of lentigo
• Not induced by sun or systemis disease
• Round to oval macules 3 – 15 mm diameter
• Margines jagged or smooth
• Lesions few occur anywhere
• Appear first in early childhood
• HISTOPATHOLOGY:
• Hyperplasia of epidermis & increased pigmentation of basal layer
• Variable number of melanocytes
• MANAGEMANT:
• No specific treatment
• Conservative surgical excision

114. PIGMENTED NEVI
• Pigmented lesion composed of nevus cells, lack dendritic
process, otherwise similar to melanocytes
• Found in epithelium & connective tissue
• Lesion caused is not true neoplasm but a develeopmental
malformation
• CLINICAL FEATURES:
• Rare on oral mucosa if present on lower lip
• Appear at birth, puberty or early adulthood, more common in
females
• Raised well demarcated lesion brown to blue black, do not
blanch on touch
• In oral cavity intramucosal nevus ( 55% cases) & blue nevi ( 36 %
cases)

115. • Pigmented nevi of 4 types , Junctional, compound,
intramucosal & blue nevi
• Blue colour of nevi explained by TYNDALL effect
• Compoun nevi has two elements : intradermal & junctional
nevus
• Increase in colour , size, of junctional & compound nevi are
danger signs

116. • HISTOPATHOLOGY
• Location help in distinction
• Nevi is small round cell with clear cytoplasm and central nucleus. Contain
melanin
• Junctional nevus limited to lower 3 rd of epithelium, long epithelial ridges
• Compound nevus nevus cell seen in connective tissue and lower 3rd of
epithelium
• Blue nevus, fusiform / spindle cells contain melenin seen in masses
resemble schwann cells. A variant called cellular blue nevus can
metastasise to lymph node
• Lesion centred in reticular dermis. Occasional mitosis presentsignificant
atypia absent
• Malignant blue nevus synonimous with malignant melanoma
• Associated with significant atypia

117. • MANAGEMENT:
• No medicinal therapy
• Biopsy should be performed on any pigmented lesion that change from
time
• Solitary lesion simple excision

118. ORAL SUBMUCOSAL FIBROSIS
• 1952 Schwartz coined the term atrophica idiopathica mucosa oris.
• Joshi termed this submucosal fibrosis
• ETIOPATHOGENESIS
• Multifactorial
• Arecoline stimulates fibroblasts
• Incressed collagen formation
• Keratinocyte growth factor, Insulib like growth factor also increase
colagen formation
• Arecanut also increase copper content which stimulate fibrogenesis
• HLA B&, DR3 A 10 also implicatec in pathogenesis
• Iron deficience anemia, Bcomplex deficiency & malnutrition are
promoting factors

119. CLASSIFICATION
• Group I Very Early cases
• Burning sensation in mouth
• Acute ulcerationNo associated mouth opening limitation
• GROUP II Early cases
• Mottled and marble like mucosainterincisal distance 26 to 35 mm
• GROUP III Moderately advanced cases
• Trismus evident, interincisal distance 15 – 25 mm
• Ple buccal mucosaAtrophy of vermillion border
• GROUP IV A Advanced cases
• Severe trismus distance < 15 mm
• Uvula shrunken
• Tongue movement limited
• GROUP IV B Premalignant & malignant
• Hyperkeratosis, leukoplakia or squamous cell carcinoma

120. CLINICAL FEATURES
• Inflammation 7 progressive fibrosis
• Buccal mucosa is common site
• Trismus
• Oral pain & burning seasation, increased salivation, change of
gustatory sensation, dry mouth, Dysphagia to solids
• Impaired mouth movement

121. Management
• Depend on degree of clinical involvement
• 1) Steroids
• 2) Placental extracts like placentrex
• 3) Hyaluronidase
• 4) IFN Gamma
• 5) Lycopene
• 6) Pentoxifylline
• 7) Surgical treatment
• Simple excisionof fibrous bands
• Split thickness skin grafts
• Nasolabial & lingual pedicle flap
• KTP 532 laser

122. REFERENCES
• Carranza,Text book of Clinical Periodontology.
• Orban’s Oral Histology,And Embryology,10th Edition
• Essentials of pediatric oral pathology