Introduction to oral mucosa Flashcards by Y Clayton

List the cells found in the squamous epithelium of the oral mucosa

Keratinocytes
Melanocytes
Langerhans cells
Neurosensory cells
Lymphocytes

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What cell is predominant in the squamous epithelium

Keratinocytes

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List the layers of the squamous epithelium

Basal cell layer
Prickle cell layer
(sometimes) keratinised layer

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What does the basal cell layer of the squamous epithelium rest on?

The basement membrane

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How are keratinocytes attached?

Via desmosomes

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How are keratinocytes attached to the basement membrane

Hemidesmosomes

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What is the importance of the basement membrane?

Maintains integrity of the mucosa by ‘sticking’ the squamous epithelium to the lamina propria

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What are the two types of keratinisation seen in oral mucosa?

Parakeratinisation

Orthokeratinisation

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Describe the cells in parakeratinisation

Surface keratinocytes are flattened and the nucleus is dark and shrunken (pyknotic)
They are eventually lose by desquamation

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Describe the cells in orthokeratinisation

Granular cell layer present between the prickle and keratinised layer, containing keratohyaline granules
The surface squares are flat with no visible nucleus

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Role of melanocytes

Synthesis of melanosomes

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Role of Langerhans cells

Antigen trapping and processing

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What are the neurosensory cells in the squamous epihtelium

Merkel cells

Taste budes

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Role of merkel cells

Tactile sensory cells

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What is the lamina propria

Connective tissue directly under the squamous epithelium

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What are the layers of the lamina propria

Corium (superficial layer) 
Reticular layer (deeper layer)

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Describe the composition of the lamina propria

Fibrous tissue with a rich neuromuscular supply

Fibroblasts which form collagen, elastin and extracellular matrix proteins

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List the other cells found in the lamina propria

Langerhans, macrophages, mast cells and lymphocytes

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What is found beneath the oral mucosa?

Either

Submucosa (in oral mucosa)
LP continuous with periosteum (in oral mucoperosteum)

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What is the submucosa composed of?

Fibrous tissue, adipose tissue, minor salv glands and neuromuscular bundles

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Where is the oral mucoperiosteum found?

Covering the maxilla and mandible

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Describe the difference between oral mucosa and oral mucoperiosteum

Oral mucosa has a submucosa

Oral mucoperiosteum has no submucosa, instead the LP is continuous with the periosteum that overlies the bone

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What factors influence the appearance of mucosa?

Thickness
Amount of keratinisation
Melanin or other pigments
Vacularity of the LP

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List the three main regional mucosal patterns and their relative %

Lining - 60%
Masticatory - 25%
Specialised - 15%

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List the areas with lining mucosa

- Vermillion border - LM, BM, FOM and ventral tongue - Soft palate - Alveolar mucosa

List the areas with masticatory mucosa

Hard palate | Gingiva

What is the reason for masticatory mucosa?

- Thick epithelium to enable resistance to heavy loading | - Production of an inelastic seal (attached mucosa)

List the area with specialised mucosa

Dorsum of the tongue

Why is specialised mucosa, 'special'?

- Essentially masticatory mucosa but it is special due to the sensory component (taste buds)

What is the dorsum of the tongue organised into?

Lingual papilla

Describe keratinisation of the gingiva by location

- Attached gingiva and external aspect of free gingiva = para and ortho - Sucular epithelium - non-keratinised

List the junctions in the oral mucosa

Mucocutaneous Mucogingival Dentogingival

Where is the mucocutaneous junction found?

Beterrn skin and oral mucosa of the lips

Where is the mucogingival junction found?

Between attached gingiva and alveolar mucosa

How can you clinically identify the mucogingival junction?

Scalloped border with slight indentation and contrasting change in colour

What is the dentogingival junction

Where the oral mucosa meets the tooth

What is the junctional epithelium?

The floor of the sulcus and the epithelium cervical to it | It is attached to the tooth

What does the junctional epithelium arise from?

Reduced enamel epithelium of the tooth germ

Describe the junctional epithelium

Stratified squamous, non-keratinised epithelium

What is the sucular epithelium?

Epithelium lining the walls of the sulcus and is continuous with the rest of the oral mucosa

What are the types of lingual papilla

Filliform Fungiform Circumvallate Foliate

Which papilla is most common?

Filliform | Gives the tongue the velvet appearance

Describe fungiform papilla

Dome shaped | Non-ker and keratinised

Describe the location of circumvallate pappila

V shaped line anterior to the sulcus terminals of the junction between middle and posterior third of the tongue

Describe the location of foliate papilla

Postero-lateral tongue

WHAT IS FOLIATE PAPILLA ASSOCIATED WITH

the lingual tonsil

Which papilla does not contain taste buds

Filliform (the most common type)

List the normal variable features of oral mucosa

Leukodema Fordyce spots Sublingual varicose Lingual tonsil

Describe leukodema

Translucent or milky white with a folded appearance to the mucosa Common in those with racial pigmentation

Describe Fordyce spots

Sebaceous glands in the oral mucosa | They are small, yellow bodies located on the upper lip, cheeks and anterior pillar of the fauces

What are sublingual varicies

Varicosities of the branches of the sublingual veins | Usually incr with age and associated with smoking or CVD

What is the lingual tonsil made of? where is it located?

- Mucosa-associated lymphoid tissue (MALT) | - Postero-lateral tongue

What pathologies are associated with lingual tonsil?

- Trauma from teeth/dentures - Reactive limped hyperplasia secondary to local inflammation or infection - Obstruction and cystic dilation of tonsillar crypts

What is Waldeyer's ring

Largest accumulation of lymphoid tissue found in the posterior aspect of the oral cavity

What makes up waldeyer's ring

Lingual, palatine and pharyngeal tonsils

What is linea alba

White line on the buccal mucosa, at the level of the occlusal plane Keratinisation in response to trauma (cheek biting)

Histology of the lining mucosa

Non-keratinised stratified squamous | Except for the vermillion border that is orthokeratinised

What are the features of the lining mucosa

Stretched and compressed | The presence of the submucosa allows compression of the superficial tissue

Histology of masticatory mucosa

Keratinised stratified squamous

Type of keratinisation of the hard palate

Orthokeratinised

Histology of specialised mucosa

Thick, keratinised and non-keratinised | The papilla are discrete structures of keratinised epithelium and LP