Oral Mucosa

Learning Objectives:
 Describe the categories, locations and histology of oral mucosa
 Describe the types and locations of keratinisation of oral mucous
membrane
 Appreciate the factors that affect the mobility of various types of mucosa
 Recognise submucosa and where it is found

Oral Mucosa membrane:

- Specialised; Mucosa on dorsum of tongue
- Masticatory; Gingiva and hard palate, which undergo trauma or
compression during mastication
- Lining; All other areas of oral mucosa
 Mucous membrane made of stratified squamous epithelium and
connective tissue
 Surface characteristics: Keratinised, Para keratinised, non-keratinised
Keratinized:
- On the surfaced are layers of dead cells without nuclei

Para Keratinized:
 - Has some dead cells on surface missing nuclei, and some apparently dying
cells with slightly shrivelled nuclei
- Stratum granulosum not as evident

Non-Keratinized:
- Cells have nuclei on surface, appearing normal and healthy
- No Stratum Granulosum

Lining Mucosa:
- Non-keratinized to Para keratinized in most cases
- Basal layer of cells rests on underlying CT
- Basement membrane separates these two components
Interdigitation:
- Type of Interdigitation of epithelium and CT accounts for mobility of
mucosa: CT protrudes out into the epithelial tissue
- Definite Interdigitation between epithelium and connective tissue: 2-D;
ridges, 3-D; pegs seen as well

Attachment:
- Length of ridges and pegs determines how tightly the epithelium attachs
to underlying CT, and thus how movable epithelium is
Lining Mucosa:
- Poor Interdigitation; making it rather moveable
 - Degree of mobility influenced also by the type of tissue lying beneath the
connective tissue: Some areas it is attached to bone, in others it is
attached to muscle or fatty tissue
 Cheeks, lips, soft palate, floor of mouth beneath tongue, under surface of
ventral surface of tongue, alveolar mucosa
Masticatory Mucosa: (Protection)
- Gingiva and Hard Palate
- Pressure from food during mastication causes tissue to para keratinize or
keratinize

Attached gingiva:
- Tightly attached to underlying CT and bone
- Healthy gingiva is stippled, due to CT fibres attaching epithelium to
underlying bone
Palatal Mucosa:
- Palatal attached gingiva is directly continuous with masticatory mucosa of
hard palate
- Thickest mucosa in oral cavity, and most likely to be keratinized
- Interdigitations are long and narrow making epithelium adherent and
relatively immovable
Submucosa:
- CT beneath mucosa, containing blood vessels, nerves and CT
- Not always present in oral cavity areas
- When present, it has minor salivary glands, fatty tissue or both
- Little to no submucosa in gingiva and anteromedial hard palate
- Mucosa in gingiva and hard palate is tightly attached to the periosteum of
bone
Specialised oral mucosa:
- Tongue is covered with stratified squamous epithelium
- Ventral surface has very thin epithelium
- Dorsal (upper) surface has very thick para keratinized to keratinized
epithelium
Circumvallate papillae
 - V-shaped row of circular, raised papillae – thirteen elevations in the row
- V point faces posteriorly
- Appear to rest in troughs and support hairlike nerve endings for taste
perception
- Beneath papillae are small salivary glands (glands of Von Ebner), which
wash taste buds clean

Fungiform papillae:
- Tiny, round, raised spots on anterior two thirds of tongue
- Redder than surroundings
- Taste buds on these papillae found on upper surface

Filliform papillae:
 - Tiny pointed projections of keratinized to para keratinized epithelium

Foliate papillae:
- Roughened area on later surface of tongue, level with circumvallate
papillae

Introduction to skull and paraoral structures

Learning Outcomes:
 Be able to name and identify bones of the skull and important muscles
and nerves related to dentistry
 Understand anatomical terms as they relate to skull osteology and know
in detail features of the maxilla and mandible, and be able to identify and
label them
 Understand the basic function of major muscle groups and nerves of
importance in dentistry

Skull contains 22 bones;

- Neurocranium (8bones: frontal, sphenoid, ethmoid, occipital, 2x parietal,
2x temporal)
- Viscerocranium (14 bones: Mandible, Vomer, 2x Maxillae, 2x Palatine, 2x
Nasal, 2x Lacrimal, 2x Zygomatic, 2x Inferior nasal conchae)
- Skull bones connected via sutures (fibrous joints), except for mandible
which articulates with temporal bones by specialised synovial joins
known as temporomandibular joints
Neurocranium:
Viscerocranium:

Skull sutures:
- Ossification of most craniofacial sutures begins around 8 years old
Hyoid (Lingual) Bone:
- Does not articulate with other bones
- Joins floor of mouth and tongue with the pharynx and larynx

Anatomical terms – Depressions and openings

Fissure – narrow slit between adjacent parts of bones
Foramen – short tube-like opening through bone
Canal – Long tube-like opening through bone
Fossa – Shallow depression (trench)
Sulcus – furrow along a bone surface (groove)
Meatus – tube-like opening (passageway)
Condyle – large round protuberance at the end of the bone
Facet – smooth flat articular surface
Head – rounded articular projection supported on the neck (constricted portion)
of a bone
Crest – prominent ridge or elongated projection
Spinous process – sharp slender projection
Tubercle – small rounded projection
Tuberosity – large rounded usually roughened projection

Maxilla:

Mandible:

Temporomandibular Joint (TMJ):

 - Synovial joint (diarthrosis) with a hinge and slide action
(ginglymoarthrodial).
- The articular disc (fibrocartilage) and mandibular condyle are pulled
forward and down by the later pterygoid muscle

Muscles of Mastication:
- Three of the four muscles function to close the jaws, but lateral pterygoid
assists in opening of the mouth
- All four muscles innervated by cranial nerve V (trigeminal)
- Masseter: superficial and deep heads originate along the zygomatic arch
and insert at the angle and ramus of the mandible laterally
- Temporalis: originates in the temporal fossa/fascia and inserts at
coronoid process and anterior border of ramus of mandible
- Medial pterygoid: originates from portions of sphenoid, maxillary and
palatine bones and inserts at the angle and ramus of mandible medially
- Lateral pterygoid: originates from sphenoid bone and inserts at the TMJ
and mandibular condyle
Masseter:
Temporalis:

Lateral and Medial Pterygoids:

Tongue Muscles:
- Four extrinsic tongue muscles; first three innervated by cranial nerve XII
(hypoglossal), but palatoglosuss is innervated by Cranial nerve X (vagus).
- Genioglossus: depresses and protracts
- Hyoglossus: depress and retracts
- Styloglossus: retracts and elevates lateral borders
- Palatoglossus: elevates tongue and depresses soft palate
- There are also four intrinsic muscles named after their orientations of the
fibres; superior and inferior longitudinal, transverse and vertical muscles
Extrinsic tongue muscles and innervation of tongue:
Muscles of facial expression:
- All innervated by CN VII (facial)

Cranial nerves:
- Nerves which connect brain/brainstem directly rather than via spinal
cord
- Most important to dentistry are: CN V and CN VII
- Trigeminal nerve (CN V) has three major branches: Opthalmic (V1),
Maxillary (V2), Mandibular (V3)
- V2 innervates upper teeth, and V3 innervates lower teeth. V3 also relays
general sensation from tongue
- Facial nerve (CN VII) supplies muscles of facial expression; relays special
sensation of taste from anterior two-third of tongue