Lecture 1

Introduction to oral pathology

and oral mucosa
 Topics to be covered (contents)
• Introduction
• Classification of oral diseases
• Definition of oral mucosa
• Functions of oral mucosa
• classification of oral mucosa
• Structure of oral mucosa
• Keratinized oral epithelium
- 4 cell layers
- keratin formation
• Non keratinized epithelium
• Hyperkeratosis
• Basement membrane
• Connective tissue
• Submucosa
• Histopathology terms
• Principles of diagnosis and investigation
 introduction

Microscopic means by using histopathologic slides

 classification
classification of oral diseases according to the tissue
affected :-

1- hard tissues ( calcified ) like the teeth ( dental

disease and caries ) and jaw bones .
2- soft tissues like mucosa, gingiva and the
tongue .
This is a histopathological specimen
( shows microscopical features)
An intraoral photograph showing clinical features of a cyst.
An radiographic imaging of periapical cyst.
 Oral mucosa
Definition :
 and contributes to the maintenance of moist
surface.
4. Thermal regulation
-Type: non keratinized stratified squamous epithelium
Location of lining mucosa :

1- buccal mucosa
2- labial mucosa
3- Floor of the mouth
4- ventral of the
tongue
5- soft palate
6-alveolar mucosa
 ‫نعيدهم بساليد واحد‬
(Keratinized)

(Non keratinized)
Structure of
oral mucosa
 connective tissue ( lamina
propria)

May be not present

or absent ( hard palate
Without mucosa and
Presents mucoperiosteum)
 Stratified = more than one layer
Squamous = width>length (flattened)
If submucosa is not present
 Stratified squamous epithelium

Function or importance :
Protects underlying
tissues in areas subjected
to abrasion.
( masticatory mucosa)
 importance of keratin
During function or any physical effect, keratin is
released to overly the normal masticatory oral
mucosa

in order to resist the friction and to provide protection .

 (stratum basale)

(stratum corneum)
( basement membrane )
Continue …
and form the body of
epithelium.
3-
 4- Stratum corneum(keratinized layer)

• The Outermost layer that is absent in non keratinized

epithelium
 Keratin formation
 The stem cells or progenitor cells are located
in the basal cell layer .

 Then they divide into new progenitor cells or into

maturating cells .

( maturating cells move superficially and

differentiate into keratinocytes formation of keratin)
Continue …
Keratin in nature is a translucent material.
 ( lining mucosa)

 Absent of keratinocytes
 ‫كل الي حكيناه سابقا عن‬
keratinized and non keratinized epithelium
normal‫هو في الحالة الطبيعية ال‬
Hyperkeratosis ( abnormal condition)

may be due to

chemical irritant Physical trauma

( smoking) ( bruxism or clenching and
Cheek biting)
Frictional
= physical
(Lining mucosa)
Hyperkeratinized tissue is also associated with chemical
irritant and chronic heat production from smoking
on the Hard palate in the form of nicotinic stomatitis.
(Masticatory mucosa)
Basement membrane
 Prominent‫كون خـط وـاضح‬
‫بــ‬

• Early stages of malignancy that are limited to the epithelial layer by the
basement membrane are called carcinoma in situ ( means that the entire
thickness of the epithelium is replaced by atypical dysplastic cells while the
Basement membrane is intact ) .
Invasion of epithelial
cells in the
connective tissue
Connective tissue (lamina propria)
 The C.T supporting the oral epithelium
 Divided for descriptive purpose into

 Superficial papillary loose C.T

 Fibrous component (collagen fibers) thin and loosely arranged .
 Cellular component(mainly fibroblasts)
 Deeper dense C.T
 abundant amount of fibers as its main matrix element.
submucosa
  A deeper submucosa may or may no be
present.

 If the submucosa is not

present ( as in the hard
palate) the oral mucosa and
periosteum of the bone
combine and are then
considered a tightly adherent
mucoperiosteum
that is directly attached to
the underlying bone.
 mucoperiosteum
is a compound structure consisting of 
mucous membrane and underlying periosteum. It
includes epithelium and lamina propria, but
attaches directly to the periosteum of underlying
bone without the usual submucosa.
Histopathology terms
 Atrophy
Decrease in the size of an
Organ or tissue after complete formation
Normal epithelial atrophy
Which one is a normal
histopathological
specimen ??
Condylar aplasia
Acanthosis
thickness of epithelium.
Continue …
 Acantholysis is the loss of intercellular connections
( loss of attachments in
stratum spinosum due to
autoimmune disease),
intracellular clefting .
Continue …
Cellular Atypia features are :-
• Nuclear enlargement
• Increased mitotic activity
• Pleomorphism
• Nuclear hyperchromatism
• Dyskeratosis : Abnormal keratinization in deep
layers below stratum granulosum.
 (structural
differentiation loss)

(without structural
Metaplasia differentiation loss)
Principles of diagnosis and investigation
 provisional diagnosis ‫التشخيص األولي‬
: - ‫بحصل عليه من خالل‬

• Taking a history
• Clinical examination
( extraoral and intraoral )
-Inspection
-palpation
-Percussion
-Auscultation
 2- Investigations
‫ فحوصات‬3 ‫ تشمل‬:-
 X-ray
 lab test
 Biopsy ( for histopathological examination
which is the mainstay of diagnosis for the
diseases and leads to get the final answer).
 ‫التشخيص التفريقي‬
‫‪3-‬‬
4- final and definitive diagnosis
‫التنبؤات و التوقعات مثال كم مدة العالج و االنتهاء من المرض‬
‫هلراح يكون في تحسن أو أل‬
‫تم بعون اهلل تعالى‬