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Oral mucous membrane
The document presents a comprehensive overview of the oral mucous membrane, detailing its organization, types, embryology, and histological structure. It discusses various functions, clinical aspects, and age-related changes, emphasizing the importance of understanding oral mucosa for early diagnosis of systemic diseases. Key references and notable findings about conditions such as leukoplakia, lichen planus, and oral squamous cell carcinoma are also included.
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Oral mucous membrane
- 1. Oral Mucous Membrane Presenter- Dr. Ruchika Garg
- 2. References • Ten Cate’s-Oral Histology (6th ed.) • Orban’s- Oral Histology & Embryology (10th &12th ed.) • Satish Chandra’s- Oral Histology & Embryology • Neville’s Oral and Maxillofacial Pathology (3rd ed.) • Shafer’s -Textbook of Oral Pathology (5th ed.) • Burkitt’s Oral medicine (10th ed.)
- 3. Contents Introduction Organization Types Embryology Functions Histological structure Clinical Aspects Age changes Conclusion
- 4. Introduction Definition – The moistlining of gastrointestinal tract, nasal passages and other body cavities that communicate with the exterior. In oral cavity this lining is called Oral Mucous Membrane. # TEN CATE’S – Tenth edition
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- 10. Embryology Oral mucosa Endoderm Ectoderm Differences betweenKeratinized and Non-keratinized mucosa →13-20 weeks Reticular fibres Collagen fibres Elastic fibres
- 11. Functions 1. Protection 2. Sensation 3.Secretion 4. Thermal Regulation
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- 13. Epithelium EpithelialProliferation • Stem cells- smaller population • Amplifying cells – largerpopulation EpithelialMaturation • Keratinized • Non-keratinized
- 14. Proliferation • Stem cells 1)Small in number 2) Maintains genetics of cell • Amplifying cells 1) Regulates mitosis 2) Thus increases number of cells Turnover Time
- 15. MaturationOf Epithelium Keratinised • StratumBasale • Stratum Spinosum • Stratum Granulosum • Stratum Corneum Non-Keratinised • Same • Same • Stratum Intermediate • Stratum Superficial
- 16. Stratum Basale • Singlelayer in number • Supported by basement membrane • Serrated and non serrated types of cells • Non serrated are bound to membrane • k5 and k14 keratin chain • High level of desmosomes • Proteins like desmoglein and desmocollins ; desmoplakin and plakoglobin • Stem cell markers of Stratum Basale - Early diagnosis of Neoplasias
- 17. Stratum Spinosum • Firstlayer of differentiation • k1 and k10 • Desmosomes and few hemidesmosomes • Tonofilaments network – supporting system for epithelium • Synthesize additional proteins - Keratinization
- 18. Stratum Granulosum • Keratohyalinegranules • Only k1 • Markers like Filaggrin and Trichohyalin are present • Trichohyalin expression in Lichen planus - Negative Squamous cell carcinoma – Weekly positive • Keratinosomes also present Seung-chul Lee et al. Expression of Trichohyalin in Dermatological Disorders: a Comparative Study with Involucrin and Filaggrin by Immunohistochemical Staining. Acta DermVenereol (Stockh) 1999; 79: 122-126
- 19. StratumCorneum • Entirely madeof keratin filaments • Keratohyaline granules are absent • k1, k2, k10 and k11 • Orthokeratinization – Nuclei ; Organelles have disappeared • Parakeratinization – Nuclei ; Organelles are retained
- 20. Shibani Shetty etat. Keratinization and its Disorders. Oman Med J. 2012 Sep; 27(5): 348–357. doi: 10.5001/omj.2012.90. Ryynanen M et al. Bullous pemphigoid antigens (BPAGs): identification of RFLPs in human BPAG1 and BPAG2, and exclusion as candidate genes in a large kindred with dominant epidermolysis bullosa simplex. Genomics1991 Dec;11(4):1025-9.
- 22. BasalLamina BasalLamina LaminaDensa LaminaLucida Judith Joneset al. Integrin Expression In Normal, Hyperplastic, Dysplastic, And Malignant Oral Epithelium. Journal Of Pathology, Vol. 169 235-243 (1 993) T.Kainulainen et al. Altered distribution and synthesis of laminin-5 (kalinin) in oral lichen planus, epithelial dysplasias and squamous cell carcinomas. British Journal of DenmiUilofjii 1997; 156: 5il-3i6.
- 23. Nonkeratinocytes In OralEpithelium Cell Type Level Functions Melanocytes Basal Melanin synthesis Langerhan’scells Supra basal Antigen trap Merkel’scells Basal Tactile Lymphocytes Variable Inflammatory Teresa Y Basham et al. Recombinant Gamma Interferon Induces HLA-DR Expression On Cultured Human Keratinocytes. Journal Of Investigative Dermatology (1984) 83, 88–90; Doi:10.1111/1523-1747.Ep12262597.
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- 26. Leukoplakia • Hyperkeratosis –80 % • Dysplasia – 17 % •Carcinoma in situ – 3 % Enlarged and hyperchromatic nuclei Cellular and nuclear pleomorphism Premature keratinization of cells Increased nucleo-cytoplasmic ratio Increased mitotic activity
- 27. Lichen Planus Hyperpara orortho keratosis Saw tooth appearance of rete pegs Degenerating basal keratinocytes Band like subepithelial infiltrate of T-cells Max Joseph Spaces – Bullous lichen planus
- 28. Pemphigus Vulgaris •Intraepithelial blistersproducing suprabasilar split •Acantholysis
- 29. Cicatricial Pemphigoid •Subepidermal vesicles •BMdetaches with epithelium from connective tissue
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- 31. Oral SquamousCell Carcinoma •Sheetsof cells of squamous epithelial origin •Keratin pearls •Intercellular bridges
- 32. Recurrent Aphthous Ulcers Variableinfiltrate in base of ulcer of: •Lymphocytes •Macrophages •Neutrophils
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- 34. BUCCAL MUCOSA Parotid papilla Lineaalba Leukoedema
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- 37. EffectOf Aging HISTOLOGY: I. Epithelialthinning II. Decreased keratinization III. Less prominent rete pegs IV. Decreased cellular proliferation V. Loss of submucosal elastin and fat VI. Increased fibrotic connective tissue with degenerative alteration in the collagen.
- 38. Renewal Rates forOral Mucosa Hard palate - 24 days Floor of mouth - 20 days Buccal &labial mucosa - 14 days Attached gingiva - 10 days Taste buds - 10 days Junctional epithelium - 4-6 days
- 39. Conclusion • Structural complexityand regional variability of oral mucosa poses a challenge to its proper understanding. • But it is must to understand the morphology, histology and physiology • Many systemic diseases, cause characteristic change in the oral mucosa and careful examination can help in early diagnosis.
- 40. • Thank you!!!!!!!
Editor's Notes
- #32 Malignant neoplasm with squamous differentiation. Keratin formn or intercellular bridges. Most common malignant neoplasm of the oral cavity. Carc of tongue comprises 25 to 50 % of all intraoral cancers. Next most common sites in order of frequency are the tongue, floor of the mouth, mandibular gingiva, buccal mucosa, hard palate, and maxillary gingiva.
- #33 extends into epithelium at margins of ulcer30,35 Some intraepithelial lymphocytes appear activated with large indented nuclei36 May be degenerating prickle cells in marginal epithelium Plasma cells: virtual absence in early lesions may be prominent in older lesion. Common disease painful recurring solitary or multiple ulcerations of oral mucosa.immunological , infectious, vit B def, FE , endocrine. Sites buccal, labial mucosa , sulcus, tongue , soft palate pharynx, gingiva. Fibrinopurulent memberane ulcerated area.. Intesne inflammat cell infiltration in CT. considerable necrosis at surface.
- #34 Herpes labialis is clinically seen as multiple vesicles on the lip that rapidly break down to form shallow ulcers. Intraoral lesions of the gingiva are known as acute herpetic gingivostomatitis. Numerous pinhead size vesicles that rupture to form small ulcers with red base and yellow fibrin. HSV infection for more than a month in HIV patient indicates development of AIDS.
- #35 . A horizontal ridge can often be found on the buccal mucosa at the level of the interdigitation of the teeth (ie, the linea alba), which represents a benign hyperkeratosis secondary to mild long-term irritation from the teeth cusps
- #36 The presence of retained dental plaque and calculus also serves as a nidus for a number of reactive gingival lesions (eg, pyogenic granuloma). The gingivae also frequently are the initial site of occurrence of mucocutaneous diseases (eg, lichen planus, cicatricial pemphigoid, pemphigus vulgaris). Finally, the gingiva is often affected in HIV infection and may be the first indicator of immunosuppression.
- #37 . The dorsal surface of the tongue should be uniformly covered by numerous hairlike filiform papillae, shown below. Interspersed among the filiform papillae are dozens of mushroom-shaped fungiform papillae, each of which contains one or more taste buds