ORAL MUCOSA

DR/ MAHA HUSSUIEN

KANDIL
Professor of Dermatology – Faculty of
Medicine –Minia University
Definition:
 The mucous membrane that lines the
structures within the oral cavity.

This is a wet soft tissue membrane that

extends from the vermilion border of the lips
anteriorly to the palatopharyngeal folds
posteriorly.
Histologically:
The oral mucosa is formed by three layers:
1-Stratified squamous epithelium  (oral
epithelium): whose thickness and degree of
keratinization depend on the location and
functional requirements. 
2- Lamina propria: is an underlying
connective tissue.
3- Submucosa: a dense irregular connective
tissue at the deepest level, which is absent in
some regions, where the lamina propria is
directly bound to the bone or muscle.
Oral Epithelium:
Thisis a highly organized, avascular, and
semipermeable tissue.

An interdigitated interface connects the

epithelium and the lamina propria.

The undulating projections of the deeper

layer of the epithelium, known as rete pegs,
attach to the underlying papillary
projections of the lamina propria.
Between these two tissues, there is a non-
cellular basement membrane to which the
epithelium is tightly bound.
 
The basement membrane provides support
to the epithelium and connects them to the
connective tissue.

It is seen as a line of demarcation between

the epithelium and connective tissue of the
lamina propria.
The oral mucosa is classified into three
types:
1- The lining mucosa:
 Lines the mobile structures of the mouth.
 It is found on the soft palate, cheeks, lips,
alveolar mucosa, the floor of the mouth,
and vestibular fornix.
 It is covered by  non-keratinized  stratified
squamous epithelium.
2- The masticatory mucosa:
 The rigid mucosa tightly bound to the
underlying bone.
 In the attached gingiva and hard palate.
 It is covered with a keratinized  stratified
squamous epithelium; which provides the
better support during mastication.
3- Specialized mucosa:
On the dorsum of the tongue that shows
a stratified squamous epithelium that
receives different types of lingual papillae
and taste buds that allow taste perception.
Epithelium of Masticatory Mucosa:
Is a multilayered epithelium, Keratinocytes
constitute more than 95% of the epithelial
cells and they are arranged in four layers:
1-Basal layer(stratum basale):
Comprise stem and amplifying cells. These
cells sit on the basal membrane and provide
cell supply for above lying layers.
The cells are cuboidal and contain typical
organelles (mitochondria, ribosomes, ER,
Golgi).
2- Prickle cell layer : (stratum spinosum)
 It has a prick-like appearance, which is
caused by numerous desmosomes that
connect the neighboring cells.
 The cells polygonal in shape and contain all
regular organelles.
3- Granular cell layer (stratum
granulosum):
 Consists of flatter cells that contain
keratinohyalin granules.
 These granules are closely associated with
tonofilaments.
 Tonofilaments and tonofibrils occupy large
regions of the cytoplasm.
 Thus, cells comprise less organelles and
their nuclei show signs of degeneration.
4- Horny layer (stratum corneum) :
In this layer the cells dehydrate, lose their
organelles including the nucleus and are
completely filled with keratin until they
desquamates.
Epithelium of Lining Mucosa:
Organization of the epithelium differs from those at
the masticatory mucosa.
Although stratum basale und spinosum are largely
comparable.
Stratum intermedium is used instead of stratum
granulosum.
This stratum intermedium is characterized by no or
few keratohyalin granules.
It makes up the main layers of the epithelium and
The outermost superficial layer contains flatten cells
with an impaired number of organelles.
In contrast to stratifying epithelium, those cells stay
alive although their nuclei are shrunken and pyknotic.
Non-keratinocyte Cell Population:
Besides keratinocytes, other specialized
cells permanently reside within the oral
epithelium, referred to as non-keratinocyte
cells, including melanocytes, Langerhan
cells, and Merkel cells.
Melanocytes:
 It is the melanin producing cells.
 It lies between the basal keratinocytes.
 It is derived from neural crest.
 It is a dendritic cell. The dendrites transfer
melanin pigment to keratinocytes.
 The ratio of melanocytes to keratinocytes in the oral
epithelium's ranges from 1:10 to 1:15.
 The different skin colors and pigmentation of the
oral mucosa are determined by the size and quantity
of the melanosomes and the type of melanin
synthesized, eumelanin or pheomelanin.
 With age, there is an increased extent and
intensity of oral pigmentations that are
considered physiological. 

 It is suspected that this augmentation may

result from cumulative possible
melanogenic stimuli such as inflammatory
conditions, medications, recurrent and mild
functional injuries, or smoking.
Langerhans Cells:
Dendritic cells derived from the bone marrow
that migrate to the oral epithelium, where they
reside within the stratum spinosum.
They function as antigen-presenting cells by
phagocytosing antigens in the epithelium and
migrating to the underlying lamina propria,
from where they can reach the regional lymph
nodes.
Here the antigenic peptides, are presented to T
cells.
Therefore, Langerhans cells are the link between
the oral mucosa and the immune system.
Merkel cells:
 It is found in the basal layer.
 It is considered a mechanoreceptor.
Lamina Propria:
Consists of cells, blood vessels, nerve fibers,
collagen and elastin fibres in an amorphous
ground substance, it reflects the dermis of the
skin.
 It is formed 2 layers:
 A superficial papillary layer: collagen fibers
are thin and loose organized.
 The reticular layer: collagen fibers are thick and
often parallel to the surface.
Fibroblasts: are the cells that produce the
fibers and ground substance.
Other cells : macrophages and mast cells.
Submucosa:
Composed of loose fatty connective tissue,
minor salivary, glands, nerves and blood
vessels.
Not present in all parts of the oral cavity,
especially in masticatory mucosa, as the
lamina propria is directly attached to the
underlying bone.
Functions of the Oral Mucosa:
1- Protection: - Mechanical protection
- Barrier function
2- Perception: - Taste
- Temperature
- Mechano perception
(pressure, vibration)
3- Nutrition: - Mastication
- Absorption
4- Secretion: - Saliva
- Sebum
Keratinocytes constitute more than 95% of the
epidermal cells, they are arranged in four layers:
1- Basal cell layer :

- It's the lowermost layer.
- It's composed of a single row of columnar cells

and responsible for the formation of KCs.
2- Spinous (Prickle) cell layer:

Consists of 5-7 rows of polygonal cells.

3- Granular cell layer

Consists of 2-3 rows of flattened cells.

4- Horny (Keratinous) cell layer:

Consists of dead KCs (losing their nuclei).



STOMATITIS
Definition:
Stomatitis is inflammation of
the mucous membrane of the mouth,
including the inner aspect of the lips, cheeks,
gums, tongue, and throat. 
It can be acute or chronic, mild or severe.
Symptoms of stomatitis:
It can present with:
Red patches
Mouth ulcers
Blisters
Swelling
Oral numbness
Soreness.
These can lead to dehydration and
malnutrition.
Causes stomatitis:
1- Bacterial infection
2- Fungal infection
3- Viral infection
4- Systemic disorder (Behcets, Pemphigus ,
nutritional deficiencies and Erythema
multiforme).
5- Drugs: ( methotrexate, chemoterapy)
6- Physical irritation ( theraml burns due to hot or
cold drinks) or (denture stomatitis).
7- Contact stomatitis: due to allergies or irritants .
8- Others: as SLE and Lichen planus.
Investigations:
It may include:
Bacterial swabs.
Viral swabs.
Tissue scrapings for fungal infections.
Biopsy for histology and
direct immunofluorescence.
Blood tests.
Patch test to identify contact allergy.
Treatment of stomatitis:
- Depends on the cause.
If it is due to allergy to a medication, the
medication must be promptly stopped.
Infections may require specific treatment
such as antibiotics or antifungals .
Nutritional deficiencies should be
corrected.
Systemic corticosteroids for immunologic
systemic diseases.
Symptomatic treatment: include:
Antiseptic mouthwashes.
Protective pastes
Local anaethetic mouthwashes or spray
Oral analgesics. (pain killers)
Topical or intralesional corticosteroids.