Contents

March 13, 2023

Feb 6, 2023 ▪ Junctions in the oral mucosa

▪ Definition of the oral mucosa
▪ Mucocutaneous junction
▪ Functions of the oral mucosa
▪ Boundaries of the oral mucosa ▪ Mucogingival junction
▪ Components of the oral mucosa ▪ Gingiva
▪ Oral epithelium
▪ Junction of the epithelium and
▪ Dentogingival junction
lamina propria ▪ Development of the oral mucosa
▪ Lamina propria
▪ Development of gingiva
▪ Classification of oral mucosa
▪ Age change
 Classification of oral mucosa
According to the primary function, the oral mucosa is divided into 3 types :

▪ Found in the areas that exposed to compressive force,

shear force and abrasion such as gingiva, hard palate.
▪ Moderate thickness of orthokeratinized/parakeratinized
epithelium with a lot of CNT papillae/epithelial ridges.

▪ Nonkeratinized epithelium, thick

epithelium and lamina propria
▪ Smooth epithelial-CNT junction
▪ More elastic fibers, less collagen fibers

Sulcus terminalis
(terminal groove)

▪ Special masticatory mucosa with special

papillae and taste buds
 Major papillae

• Rough surface,
help press and
break food.

• Sensory cells, for tactile

and temperature, a few
taste buds

•, 8-12 papillae
 1. Epithelium
Components of the oral mucosa
2. Lamina propria

Keratinized epithelium Parakeratinized epithelium Nonkeratinized epithelium

Keratinized layer Superficial layer

Intermediate layer
Keratinized layer Prickle
Granular
layer cell
layer

Prickle
cell
Granular
layer
Prickle layer
cell
layer

Basal
Basal cell
Basal cell layer
cell layer
layer
Contents
 Junctions in the oral mucosa

Mucocutaneous junction :
▪ Junction between the skin and
mucosa

Mucogingival junction :
▪ Junction between gingiva and
alveolar mucosa

Gingiva
Dentogingival junction :
▪ Junction between gingiva and the Dentogingival junction
tooth
Tooth
 Mucocutaneous junction
Sebaceous glands
Mucocutaneous junction :
▪ Junction between the skin and mucosa
▪ Transitional region where appendages are
absent except for a few sebaceous glands
▪ Locate at the lips

Suckling pad Vermilion zone

(red zone)
 Mucogingival junction
▪ Junction between the masticatory mucosa and lining mucosa.
▪ Easily noticeable at where the attached gingiva meets the alveolar mucosa.
▪ Mucogingival groove

Deep pink
Alveolar mucosa Gingiva Pale pink

Mucogingival junction
Alveolar Gingiva
mucosa
Attached gingiva

Elastic Mucogingival junction

fibers
 Gingiva
▪ Sheets of stratified squamous epithelium covered on dense fibrous collagenous
lamina propria and attached to periosteum of alveolar bone or cementum.

▪ Clinically, gingiva is divided into 3 parts;

1) Free (marginal) gingiva
2) Attached gingiva
3) Interdental papilla

(2) (2)

(FREE GINGIVA) (FREE GINGIVA)

(1) (1)

INTERDENTAL PAPILLA
(3)
Gingiva
Free (marginal) gingiva
- Surround the teeth, movable
- Separated from the teeth by gingival sulcus
(gingival crevice).
- Free gingival groove locates at the same level
as the bottom of gingival sulcus.
- Gingival epithelium (outer), sulcular/crevicular
epithelium (inner)

Attached gingiva
- Locate between free gingival groove and alveolar
mucosa.
- Attach to the teeth and
alveolar bone. Healthy gingiva
- Healthy gingiva – stipplings
(collagen attachment)

Interdental papilla
- Triangle areas between Inflamed gingiva
crown of teeth .
- Peak
- Col
Normal gingiva

Stipplings
 Gingival ligaments 5 groups :
Fibers that connect free and attached gingiva to the periosteum of alveolar bone.

Between
cementums of Fibers in the free gingiva
two adjacent that run in circle around the
teeth (across tooth.
alveolar crest).

From cervical cementum to

lamina propria of free and
Transseptal group attached gingiva, the largest
group of gingival ligaments.

From cervical cementum to

periosteum of alveolar bone.

From alveolar crest to lamina

propria of free gingiva.
 Blood supply
In oral mucosa :
▪ Arteries in submucosa or periosteum reticular layer papillary layer
▪ Blood supply as networks of arterioles and capillaries deep red
color, enhance wound healing
In gingiva :
▪ Major : alveolar artery interdental papilla, buccal and lingual gingiva
Nerve supply
 Dentogingival junction
▪ Junction between tooth surface and gingiva.
▪ No continuity of epithelium + bacterial accumulation at tooth surface ---> inflammation
and tissue destruction.
▪ Dentogingival junction is divided into 2 compartments:

Connective tissue compartments Epithelial compartments

1) Gingival epithelium
o Stratified squamous epith. (2)
o Keratinized/ nonkeratinized
o Epithelial ridges (1)
2) Sulcular epithelium
o Stratified squamous epith.
o Nonkeratinized (3)
o No epithelial ridge
3) Junctional epithelium
o Stratified squamous epithelium
o No epithelial ridge
o Special basal lamina on tooth surface
o Epithelium attaches to special basal
lamina on tooth surface.
 Junctional epithelium :
▪ Synthesize special basal lamina (without type IV collgen).
▪ Attach to special basal lamina at the tooth surface.
▪ No desquamation of the epithelium. The cells at the basal layer proliferate, differentiate and mature
and move to sulcular/gingival epithelium.
▪ Less tonofilaments and desmosomes--- > wide intercellular spaces ---- > cells of the immune system as
well as foreign materials can easily pass through the epithelium

Gingival sulcus :
Periodontal pocket
▪ Groove around the teeth, usually 0.5-3 mm. (average 1.8 mm.)
▪ Sulcus >>> 3 mm ----> periodontal pocket ----> periodontal disease
▪ Fluid in the sulcus = gingival crevicular fluid (GCF) = inflammatory
exudate from CNT that passes through junctional epithelium + dead
epithelial cells
▪ In normal situation, GCF flow rate
▪ In inflammation situation, flow rate , therefore, GCF can be used as
the marker for periodontal diseases
 Biologic width
▪ The natural distance between the base of the gingival sulcus and the highest point of the alveolar bone.

Tooth

Base of the gingival sulcus

The highest point of the

alveolar bone

▪ The biologic width is essential for preservation of periodontal health and removal of irritation that
might damage the periodontium (prosthetic restorations, for example).
 Development of oral mucosa
▪ At about 26 days of gestation the primitive oral cavity
develops by fusion of the embryonic stomatodeum
with the foregut after disintegration of the
buccopharyngeal membrane.
▪ Epithelium of the tongue, epiglottis and pharynx are
derived from endoderm.
▪ Epithelium of the palate, cheek and gingiva are
derived from ectoderm.
▪ Wk 10-14 ------ oral vestibule formation.
▪ Wk 8-11 ------- elevation and fusion of palatal shelves.
▪ Wk 7 papillae formation in tongue.
▪ Wk 10-12 ------- beginning of differentiation and
maturation of lining and masticatory mucosa
Development of gingival and junctional epithelium
Active eruption : a process in tooth development in which the
teeth enter the mouth toward the occlusal plane.
This is a natural path of eruption of all teeth as they
Tooth eruption emerge from gingiva and continue erupting until
they make contact with the opposing tooth.

Passive eruption : movement of the gingiva apically or away from

the crown of the tooth to the level of cementoenamel
junction (CEJ) after the tooth has erupted completely. In
this phenomenon, the gingival tissues fail to move
apically and thus lead to shorter clinical crowns.

Shorter
clinical crowns

Normal
clinical crown
 Development of gingival and junctional epithelium

Active eruption
The developing tooth
Reduced enamel epithelium moves toward oral
of developing tooth in fully mucosa, reduced
formed enamel stage. enamel epithelium will
fuse to oral epithelium.

The developing tooth

moves toward oral
mucosa, reduced enamel
epithelium becomes
junctional epithelium.
The junctional epithelium
moves apically (passive
eruption) while the tooth
moves toward occlusal
plane.
 Passive eruption
▪ The movement of the gingiva apically or away from the crown of the tooth to the level
of cementoenamel junction (CEJ) after the tooth has erupted completely.
▪ In this phenomenon, if the gingival tissues fail to move apically and thus lead to shorter clinical
crowns.
▪ According to the relationship between the junctional epithelium (JE) and the cementoenamel
junction (CEJ), passive eruption is divided into 4 stages.

CEJ
CEJ

Stage 1 2 3 4

Position of JE All attach to enamel Partially attach to All attach to All attach to
(found in young adult) enamel / cementum cementum cementum

Bottom of the gingival sulcus at enamel at enamel At CEJ At cementum

Anatomical crown: clinical Anatomical crown > Anatomical crown > Anatomical crown = Anatomical crown <
crown clinical crown clinical crown clinical crown clinical crown
(gingival recession)

Anatomical crown : the distance between cusp to CEJ.

Clinical crown : the distance between cusp to gingival sulcus.
 Age change
▪ Smooth and dry oral mucosa.
▪ Dry mouth, burning sensation, change in taste reception.

Histologically, thin epithelium with flat epithelium-connective tissue junction

Less filiform papillae, resulting in smooth tongue with prominent fungiform papillae

Normal tongue Dry tongue

Dry tongue
 Age change
Atrophy and fibrous tissue
replacement of minor salivary
glands

Increase Fordyce’s granules

Vascular change : varicosed vein

Normal salivary glands