Griffith University Oral Biology 2 1009 DOH

Oral mucous membrane and Salivary glands

Dr. Mahmoud Bakr Lecturer in General Dental Practice B.D.S, M.D.S (Cairo University), ADC (Australia) Member of the Australian Dental Association (ADA), the Australian Biology Institute Inc. (ABI) and the Egyptian Dental Union (EDU)

Learning objectives:
After completing this lecture you should be able to: 1- Identify, describe and distinguish the location, special features or functions, blood and nerve supply, lymphatic drainage and surface markings of major and minor salivary glands according to their size and secretion; including the histological structure and morphology of their secretary units. 2- Describe age related changes to Enamel and their effects.

Learning objrctives (Cont.)

3- By observing the histological details of cells and tissues, you should be able to use a microscope to identify different histological structures of Enamel and understand the histological processes involved in preparing slides.

 All Microscopic images are taken from the Digital Library of the Oral Biology Department (Cairo University).

 It is the inner moist lining of the Oral cavity

Oral mucous membrane

Hard palate

Dorsal surface of the tongue Check mucosa Floor of mouth

Ventral surface of the tongue

Gingiva Vestibular fornix Labial mucosa

Alveolar mucosa

Classification of oral mucous membrane

1-Keratinized mucosa ( Masticatory mucosa)
(A) Gingiva (B) Hard palate

2- Non-keratinized mucosa (Lining mucosa)

(A) Firmly attached

I- Soft palate IV-ventral S tongue

(B) Loosely attached

I- Floor of mouth II-Vestibule

II-lip

III-check

3- Specialized mucosa
Dorsal surface of the tongue

III-alveolar mucosa

 Firmly attached mucosa prevent biting of the mucosa during function.

Loosely attached mucosa allow movement of associated structures as the tongue.

Keratinized and non-keratinized mucosa

Stratum cornium Stratum granulosum Stratum superficial Keratohyaline Gs. Stratum spinosum

Stratum intermedium
Odland body

Stratum basal

Keratenized epithelium

Non-keratenized epithelium

Keratinized Epithelium
Consists of the following layers from bottom to top: 1- Basal cell layer: (Stratum Basale) Its a single of columnar cells attached together by desmosomes and to the basement membrane by hemi-desmosome.
Its the least differentiated layer responsible for renewal of the most superficial layers that shed off during function.

It has the criteria of protein forming cells. (what are they?)

2- Prickle (Spinous) cell layer: (Stratum Spinosum) It consists of 4-6 layers of polyhedral cells attached to each other by desmosomes and to the superficial and deep layers by hemi-desmosomes. There are intercellular spaces (bridges) between the cells giving it the Prickly(Spinous) appearance. The most deep layers of Stratum Spinosum shares the same functions with the Basal cell layer, while the superficial layers share the same functions with Stratum Granulosum.

So Stratum Basale + deep layers of Stratum Spinosum = Stratum Germinativum

3- Granular cell layer: (Stratum Granulosum) It consists of 2-3 layers of flat cells attached together by desmosomes and to the superficial and deep layers by hemi-desmosomes. It contains Keratohyaline granules that will form Keratin later on. It contains Odland bodies which are responsible for the thickening of the plasma membrane thickening that occurs prior to Keratinization.

Odland bodies
In keratinized epithelium its Tubular with parallel lamellae.
In Non-Keratinized epithelium its rounded with amorphous core.

4- Cornified cell layer: (Stratum Cornium) (Keratin layer) It consists of an amorphous acidophilic layer of dead cells and tonofilaments. Its function is only a protective function.
It is formed as a result of fusion of keratohyaline granules which discharge their contents after thickening of the plasma membrane by Odland bodies.

Types of Keratin
1- Orthokertin: It contains no remnants of nuclei or cell organelles 2- Parakeratin: It contains some remnants of nuclei or cell organelles 3- Incomplete Keratinization: The cells become rehydrated again by fluids from intercellular spaces. This happens as a result of malfunction of Odland bodies

Non-Keratinized Epithelium
1- Basal cell layer: (Stratum Basale) Exactly the same as in Keratinized Epithelium. 2- Intermediate cell layer: (Stratum Intermediate) It consists of 8-11 layers of polyherdal cells that have the following differences compared to the Prickle cell layer of Keratinized epithelium: A- Larger B- Closer to each other (no intercellular spaces) C- Thicker (more layers) All these differences are to compensate for the lack of the protective Keratin layer.

3- Superficial cell layer: (Stratum Superficial)

It consists of 3-4 layers of flat cells. It contains no Keratohyaline granules. Odland bodies are rounded with amorphous core.

Basement membrane
The Basement membrane separates between epithelial and C.T. Rupture of the Basement membrane and direct communication between Epithelium and C.T is a sign of Malignancy. Histologically, it is an acidophilic structureless band. By using E.M the basement membrane is known as Basal lamina.

 Basal lamina consists of: A- Lamina Densa: Electrodense band 45nm thick.
B- Lamina Lucida: Electrolucent band of 50nm thick.

The desmosomes
1- Thickening of the adjacent cell membrane.

2- A pair of attachment plaque.

3- Tonofilaments.

4- Extracellular structure.

The hemi-desmosomes and basal lamina

Keratenized and non-keratenized mucosa

Parakeratin Orthokeratin

Non-keratenized mucosa

Keratenized mucosa

Keratinocytes and non-keratinocytes

1- Pigment cell (Melanocyte, blast)

Shape

2- Langerhans cell

3- Merkels cell

Small body with long slender and branched process present in Similar in shape. the I.C.S of epith. Contain granules contain melanin (langerhans granules) granules (melanosomes)
Location

They do not have long processes. Contain small membrane bounded granules

Basal and parabasal layers

High level cell and may Basally in be found at lower epithelium levels. Not stained so called ( Clear dentritic cell ) Not stained so called ( Clear but not dentritic cell )

Stain by Not stained so called H&E ( Clear dentritic cell )

Special stain

DOPA reaction ( for tyrosinase enzyme)

Gold chloride

Origin

Neural crest cells

Bone marrow No tonofilaments. No desmosomes.

Neural crest cells -Little tonofilaments. -Little desmosomes. -Nerve cell seen to be associated with the cell with synapse-like cleft.

Cell No tonofilaments. junction No desmosomes.

Function

Pigmentation. If melanosomes engulfed by epithelial cell called (Melanophore) or by C.T. cell (Melanophage).

1-Neural element. 2- Degenerated melanocyte. 3- Intra epithelial Macrophage. 4- Regulatory cells (control epith. Cell division and differentiation) 5- Uptake and processing of antigen in contact allergic reaction

Responding to touch.

4- Inflammatory cells

They are transient cells

Macro-anatomy of the gingiva

Free gingival groove

Free gingiva

Interdental papilla Attached gingiva

Mucogingival junction

Alveolar mucosa

Pigmentation

Attached gingiva

Clinical consideration
Gingiva is pale pink in healthy individuals while the Alveolar mucosa is red. The line that separates Gingiva from Alveolar mucosa is called Muco-gingival junction or Health line (WHY?) Because when Gingiva is inflamed it becomes red in colour and the Health line cannot be seen. So Health line is a sign of Healthy Gingiva

Interdental papilla and gingival Col

Gingival col( nonkeratenized)

Histology of gingiva

Stratified squamous keratenized epithelium Tall Epithelial rete peg

Numerous
C.T papilla Slender Lamina propria Irregular

No submucosa

Gingival fibers

Circular group

Dento-gingival group Alveolo-gingival group Dento-periosteal group

Macroanatomy of palate
Incisive papilla

Palatine gingiva

Rugae area

Antro-lateral area (fatty zone) Median palatine raphe

Postro-lateral area (glandular zone) Soft palate Uvula

Histology of hard palate

Epithelial rete pegs are tall and numerous

Mucosa

Fatty zone

Glandular zone

Submucosa

 The main difference between Hard Palate and Gingiva is that Hard Palate has a Sub-mucosa which consists of: A- Fat cells in the Anterolateral zone and act as a shock-absorber B- Mucous S.Gs in the posterolateral zone and facilitate swallowing as a part of the mucous ring.

 But some areas of the hard palate has no submucosa such as: 1- Palatine Gingiva 2-Median palatine raphe 3- Palatine Rugae
In these areas the mucosa is attached directly to the periosteum of palatine bone.

Soft palate
Nasal side Oral side

Respiratory epithelium

Lip

Mucous side

Lip

Vermilion border

Skin side

Skin

Skin

Skin side of the Lip

It differs from any keratinized Epithelium in two ways: 1- It contains Skin appendages A- Hair B- Sweat glands C- Sebaceous glands 2- Contains an additional clear layer between Stratum Granulosum and Stratum Cornium called Stratum Lucidum which contains an oily material called Eliadin that helps keeping moisture in skin. This oily material dissolves during preparation of the slide leaving this layer as a clear layer.

Skin appendages

Hair follicle Sebaceous gland

Sweat glands

Cheek mucosa
Nonkeratenized epithelium

Mixed salivary gland

Specialized mucosa

Tongue papillae

1- Filliform pap.

2- Fungiform pap.
Taste bud

4- Folliate pap. 3- Circumvallate pap.

Circumvallate papilla
Trough

Taste bud

Taste pore

1- Outer supporting cell

2- Inner supporting cell 3- Neuroepithelial cell

Taste sensation
Bitter Sour

Salt

Sweet

Lingual tonsil

Weber salivary gland (Pure mucous gland

Dento-gingival junction

Histogenesis of Dento-gingival junction

1
Desmolytic enzymes Epithelial plug

1ry D.G.J (from Reduced E. E.)

2nd D.G.J. (from oral E.)

Dento-gingival junction

Histology of Dento-gingival junction

Basal cell layer Superficial flat cells

Hemidesmosomes

External basal lamina

Internal basal lamina

Lamina propria

Stages of passive eruption

First stage

Clinical crown Anatomical crown Coronal end (E) Apical end C.E.J.

Anatomical crown>Clinical crown

1 year before shedding in deciduous teeth and in perm. Till 20-30 years.

Second stage

Clinical crown Coronal end (E) Apical end (C). Anatomical crown

Anatomical crown>Clinical crown

Persist till 40 years

Third stage

Clinical crown

Anatomical crown

Coronal end (C.E.J.) Apical end (C) Anatomical crown=Clinical crown

Transitory stage

Fourth stage

Clinical crown Coronal end (C)

Anatomical crown

Apical end (C)

Anatomical crown<Clinical crown

Persists till the tooth lost

Effect of Smoking on oral tissues

We all know that smoking is harmful to our health. Besides the obvious effects of smoking on oral tissues such as Staining of teeth and Halitosis (Unpleasant breath smell), there lots of other changes happening at a cellular level that our patients need to know about.

Severity of periodontal disease related to number of cigarettes smoked per day. As in Caranza , patients who smokes 100 cigarettes or more are considered Smokers. 50% of aggressive periodontitis patients are smokers. May cause tissue ischemia, as Nicotine is a powerful vasoconstrictor and immunosuppressor, so the problem is due to : 1- Change vascularity (Vasoconstriction) reducing the amount of O2 in subgingival area harbor more Anaerobic pathogenic subgingival Microflora (A.a. and P. gingivalis ) 2- The defense mechanism of PMN, by decreasing the Number and Functions (Chemotaxis and Phagocytosis).

3- Depress the T- Helper Lymphocytes Decrease the stimulation of B-cells function Decrease the Antibodies formation against bacteria.

4- Nicotine bind to bacteria and release of Tissue destructive enzymes ( IL-1 and IL-4 ) by Host Overreaction Immune system More tissue destruction. 5- Nicotine Impair Revascularization of Gingival and Hard tissue, inhibits Collagen fibers production, fibroblast Collagenase destructive activity, and suppresses the proliferation of Osteoblast and this lead to Healing retardation. All this occur due to less vascularity to the area due to vasoconstriction, and as result of this Bacterial activity increases and more bone destruction occurs and PD progress. Also there will be wound healing and susceptibility to infection.

Saliva
A-Definition:
Saliva is a complex fluid produced by the salivary glands, whose important role is maintaining the well being of the mouth. For example patients with deficiency of salivary secretion experience difficulty in eating, speaking& swallowing & become prone to mucosal infections & rampant caries.

B-Composition of saliva
1-Water: 97% 2-Electrolytes: sodium, potassium, chloride, Calcium, magnesium, phosphate& fluoride. 3-Secretory proteins: amylase, proline- rich protein, mucins, histatin, cystatin, peroxidase, lysosome. 4-Immunogloblins: IgA, IgG, IgM. 5-Small organic molecules: glucose, amino acids, urea, uric acid& lipids. 6-Other components: cyclic adenosine monophosphate-binding proteins,& serum albumin

C-Functions of saliva
1- Protection: *The lubricant saliva form a barrier against noxious stimuli& microbial toxins.

*Its mechanical washing action flushes away non adherent bacterial toxins& deris from the mouth.
*Clearance of sugar by salivas washing action limits action of acidogenic plaque bacteria *The Ca- binding proteins in saliva help to form the salivary pellicle which behaves as a protective membrane

2- Buffering:

*It denies many bacteria from optimal environmental conditions to colonize. *Acids produced by plaque microorganisms if not rapidly buffered& cleared by saliva can demineralize enamel. *Much of the buffering capacity of saliva resides in its bicarbonate &phosphate ions. 3-Digestion:
*It provides taste acuity.

* Neutralize esophageal content.

*Dilutes gastric chyme. * Form the food bolus.

*Due to its amylase contents, it breaks down starch. 4- Taste: * It enables the pleasurable sensations of food to be experienced.
*It permits the recognition of noxious substances. *Contains protein Gustin necessary for growth &maturation of taste buds

5-Antimicrobial action: *Lysosomes can hydrolyze the cell wall of some bacteria. Lactoferrin binds free ion and in so doing deprives bacteria of this essential element.

*The major salivary immunogloblin, IgA has the capacity to clump or agglutinate microorganisms.
6- Maintenance of tooth integrity: *Post eruptive maturation through diffusion of ions as Ca , phosphorus , mg &chloride from saliva into enamel.

DEFINITION:
glands are Merocrine Exocrine glands that produce and secrete saliva. Saliva is involved in the digestive process and in the protection of oral tissue Merocrine (merocrine manner involves exocytosis
or the discharge of only Secretory material without any loss of cytoplasm)

*Salivary

Exocrine ( means a gland related to the surface

epithelium by a duct)

Histological structure

Basic structure of salivary glands

A-Parenchymal element: 1-Secretory cells( serous & mucous acini) 2- Non secretory cells: a-Myoepithelial cells b-Oncocytes 3- Duct system B- Connective tissue element 1-Cells 2-Fibers 3-Groud substances 4-Blood supply 5-Nerves

Parenchyma:

1-Acini
2-Ducts 2

3-Myoepithelal cells (Basket cells)

A-Parenchymal element: 1-Secretory cells (Acini)

B- Mucous A-Serous

C- Mixed

A- Serous acini
Histological structure *Spherical or rounded acni *Small *Narrow lumen
*cells

are pyramidal

*Spherical nucleus in Basal 3rd

Ultra structure:

1-Nucleus basally 6 2-Deeply stained basophillic a e b cytoplasm 3-Apical cytoplasm contains 1 Zymogen secretory granules 4-Cytoplasmic organelles: a-Mitochondria, b-(4-6)golgi saccules c-Lysosomes, d- free ribosomes, e-RER 5 5-cytoplasm show basal striation due to numerous mitochondria arranged parallel 6-Intercellular canaliculi ends in form of junctional complex

Ultra structure:

Mitochondria

RER Golgi apparatus

Free ribosomes

B- Mucous acini
Histological structure *Tubular long acini *Large *Larger lumen *Short cuboidal or flattened cell *Flattened or angular nucleus

Ultra structure:

b a A RDR

1- Nucleus basally compressed 2- Cytoplasm: A-Vaculated lightly stained B- the cells appear empty Except: A thin rim of Cytoplasm form trabecular network 3- Cytoplasmic organelles: Vaculated cytoplasm a-mitochondria, b-(10-12) prominent golgi saccules C- few RER, d- few microvilli 4- Very few intercellular Canaliculi

C- Mixed acini may be either:

Mucous acini

Separate lobules

Intermingled

Serous cap over mucous blind end

Demilunes of vonEbner

4 5 2- Non secretory cells: 6 a-Myoepithelial (basket cells) 1- Spindle shaped 8 2-Related to secretory 7 &intercalated duct. 6 5 3- Has 4-8 processes. 4- Attached to the underlying cell by desmosomes. 5- Contain many microfilament which aggregate forming dark bodies 6- Cell organelles are perinuclear 7- Has a contractile function.

3 4

b- Oncocytes:

Are small rounded cells with deeply stained shrunken nuclei Contain very few cell organelles It represents an age change and may be related to neoplasm formation (oncogenesis)

3- Duct system
Intralobular (within lobules) a- Intercalated. b-Striated. Interlobular ( in C.T. between lobules): a-Excretory ducts b- Main ducts

1-Intralobular (within lobules)

a- Intercalated 1- Small diameter. 2-Lined by simple cuboidal epithelium 3-Central nucleus. 4- Little cytoplasm. 5- Basal RER. 7 6- Apical golgi complex 7- Few secretory granules 8- Numerous in watery secreted gland ( parotid)

1-Intralobular (within lobules)

b-Striated:

1- Lined by a single layer of columnar cells.

2- Central nucleus. 3-Esinophillic cytoplasm. 5a

4- Prominent Basal striations due 5b to : a- membrane infolding b-numerous elongated 4 a mitochondria 5- a-Cell organells, b-junctional b

complex & desmosomes are present

3-Excretory duct and main duct

1- Interlobular ducts lined by tall columnar cells. 2- Interlobar ducts are lined by pseudostratified columnar epithelium with goblet cells. 3- Main duct is lined by stratified squamous epithelium

Goblet cell

FUNCTIONS OF SALVARY GLAND DUCTS

MAIN EXCRE.DUCT

EXCRETORY DUCT

STRIATED DUCT
Modification of primary secretion.

INTERCALATED DUCT Passive conduit

Acinus

Secreted in primary secretion.

Reabsorbed from primary secretion .

Sec. Granules. Minor contribution in secretion Isotonic or Slightly hypertonic than plasma.

Reabsorbed

Secreted.

Note: At increased flow rates Na+ and CL- conc. increase, while K+ decreases., as the secretion is in contact with the ductal epithelium for a short time.

1 Contain Kallikrein enzyme synthesis of glycoproteins. 2 Presence of vesicles and lysosomes pinocytotic activity. 3 Basal infolding + conc. Mitochondria + Basal portion of cells contain Na+ & K+ activated adinosine triphosphatase

Na+, cl- Conc. = Plasma. K+ Conc Na+ andPlasma .

(transport enzyme) water and electrolyte transport .

B- Connective tissue elements

1 Cells: a-Fixed C.T. cells Fibroblasts, Plasma cells, Mast, and Fat cells. 2- Fibers: Reticular & collagen. 3- Ground substances: a-Glycoproteins
b-Migrating cells Macrophages Leukocytes.

b-proteoglcans

Classification of salivary glands:

I- According to site
II- According to size

III- According to secretion

I. According to site:
Oral vestibule:
Labial glands (upper and lower) Buccal glands. Parotid glands. Oral cavity proper: - Palatine glands (of hard and soft palates and uvula). - Glossopalatine glands. - Lingual glands (Weber glands, von Ebner glands, Blandin Nuhn glands) - Sublingual glands (major and minor). - Submandibular glands.

II- According to size

Major salivary glands: - Parotid glands. - Submandibular gland. - Sublingual gland (major) Minor salivary glands: -Labial and buccal glands. - Palatine glands. - Glossopalatine gland. - von Ebner gland. - Weber gland. - Blandin Nuhn glands. - Minor sublingual glands.

III- According to secretion

A) Pure serous glands: - Parotid gland of adult C) Mixed glands: - von Ebner gland.

- Labial and buccal glands. - Submandibular gland B) Pure mucous glands: - Major Sublingual gland. - Blandin Nuhn glands. - Palatine glands. - Parotid (new born) - Glossopalatine glands. - Weber glands. -Minor sublingual glands. -Labial gland.

Pure serous acini

Mixed acini

Types of human salivary glands

1- Major salivary glands:
A- Parotid. b- submandibular. c-sublingual.

2-Minor salivary glands:

A-Labial &buccal gland.
C- Glossopalatine gland.

B- Palatine gland.
D-Lingual gland.

1- Major salivary glands: A- Parotid gland

The largest
Its superficial portion lies subcutaneously Its deeper portion lies behind the ramus Pure serous in adult& mixed in infant &old age Main duct Stensens duct C.T.capsule surround it &send septa to divide the gland into lobes &lobules Secretes 25-30%of saliva Intercalated duct longer than in the other glands

b- Submandibular gland
Next in size Lies in the submandibular triangle behind & below the free border of the mylohyoid M. with small extension above it. Mixed predominatly serous Main duct Whartons duct Extensive C.T. capsule Secretes 60-70%of secretion Straited ducts longer than those of the parotid.

C-Sublingual gland
Smallest. Lies between floor of the mouth &mylohyoid muscle. The major gland is mixed predominantly mucous. The minor gland are pure mucous. Major-Bartholins duct opens near sumand.duct. Minor-Rivinus duct 8-10 open in sublingual fold. Poorly defined C.T. capsule with prominent C.T. septa. Secretes 5%or less of saliva.

Sublingual gland

2-Minor salivary glands:

- Distributed throughout the submucosa. - Small, discrete masses. - Posses numerous short ducts that open directly in the oral cavity. - Lack distinct capsule. - Secrete 7% of saliva. - Focal accumulation of lymphocytes around their duct wall. - Secrete high amount of IgA concentration.

A-Labial &buccal gland.

-More glands are present in the lower lip. - They are present on the surface of the orbicularis oris muscle while in the buccal mucosa they are present on the surface&inbetween the buccinator muscle. -Mixed gland but ultrastructurally they only show mucous cells. - Buccal glands duct open in the third molar area&are known as molar gland.

B- Palatine gland& C- Glossopalatine gland.

Palatine: Gland of hard palate Pure mucous. In H.P.250 Soft P.100 Uvula12 Glossopalatine: Pure mucous. Found in the isthmus region.

D-Lingual gland
1-Blandin- Nuhn Ant. part mucous Post. Part- mixed mucous. Open in the ventral surface 2-Von Ebner (VE) Pure serous under circumvallate& folliate papillae Washing function Contain amylase&lipase enzymes 3-Weber Pure mucous Open in the lingual crypt

MAJOR FEATURES OF SALIVARY GLANDS

Gland
Parotid
Feature
Largest major salivary gland
Second largest major salivary gland

Duct
Stensen's duct

Glands

Fat
Yes

Lymphoid

Tissue

Sebaceous Glands

Nerve Facial Nerve

Serous

Yes

Yes

Submandibular

gland

Wharton's duct

MucouSerous

Yes

None

None

None

Sublingual gland

Smallest of major salivary glands Scattered

throughout the tongue, palate and lip

Bartholin's duct, Rivinus ducts

MucouSerous

Yes

None

None

None

Small
salivary

Small

glands

Mucous except for those in tongue

Yes
(

Tongue)

None

None

No

Functions of Salivary glands

1- The most important function is saliva production& secretion. 2- Play a major role in iodine metabolism,since the cells of the striated ducts are engaged in iodine concentration.

3- The parotid gland secrete a hormone called parotin which: a.Promotes growth of mesnchymal tissues. b.Lowers serum calcium level. c.Stimulates calcifications&leucocytes production in bone marrow.

4- They secrete lots of enzymes &protein active substances of multiple effects e.g. peroxidase, lysosome, thiocyanate, sialin &amylase.

5-Salivary gland of certain animals species are active in producing epidermal &nerve growth factor involved in wound healing.

6-The plasma cells found in the stroma of the salivary glands form salivary immunogloblins particularly IgA which plays a role in the mucosal immune mechanism of the oral cavity

Age changes of salivary glands

1- Fatty degenerative change. 2- Atrophy of a part or awhole terminal portion with its replacement by fibrous tissue (Fibrosis). 3-Accumulation of lymphocytes in the stroma. 4- in the salivary secretion which leads to xerstomia. 5- xerstomia leads to difficulty in eating&swallowing as well as in dental caries. 6- Oncocyte cells in number& may form neoplasm in old people

Fatty degenerative change.

Old age

Young age

Clinical consideration
Xerostomia: (Dry mouth)
It decreased secretion of Saliva. It may be caused by several factors: A- Age b- Psychological factors C- Drugs (cold medications and Anti-depressant) D- Auto-immune diseases (Sjogrens syndrome) E- Salivary gland stone (Sialolithiasis)

 The consequences of Xerostomia are:

1- Increased caries and periodontal disease rates and severity 2- Difficulty in swallowing 3- Improper retention of Dentures 4- Cracking of Oral mucosa 5- Halitosis (Bad Breath)

Thank you&

Good luck