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Oral Mucosa Flashcards

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1
Q

what are the different disease of the oral cavity and their composition

A

40% is caries
40% is periodontal disease
20% is oral diseases like cancer and herpes

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2
Q

what is the protection of the oral mucosa associated with

A

mechanical forces, infection and immunity

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3
Q

how is the oral mucosa responsible for sensation

A

it can recognise the texture of food through the periodontal ligament, but can also use the tongue to press the bolus against the hard palate

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4
Q

how can medicines be absorbed in the oral cavity

A

through the oral mucosa

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5
Q

that are the three types of oral mucosa

A

lining
masticatory
gustatory

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6
Q

where is the lining mucosa found

A

under the tongue

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7
Q

where is the gustatory mucosa found

A

covering the superior dorsum of the tongue

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8
Q

what is dyplasia of the oral mucosa

A

keratinisation of the lining mucosa which could be carcinoma

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9
Q

where is masticatory mucosa found

A

in areas of the oral mucosa subjected to friction and compression and therefore requires keratinisation. this happens in a process that requries cells to divide and migrate to the surface, creating a layer of cells filled with keratin.

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10
Q

what happens if there is loss of tissue due to friction and compression that occurs faster than keratinisation

A

the cell may reach the surface before complete keratinisation, which leads to parakeratinisation.

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11
Q

what does the masticatory mucosa cover

A

the hard palate and the attached gingiva

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12
Q

give a breakdown on the features and properties of the lining mucosa

A
  • wide submucosa gives way for moving around
  • more rapid turnover, because the cells are non keratinised and therefore take less time to form
  • lining mucosa heals faster due to the rapid turnover, and can use stitches on the lining mucosa
    -base of the tongue is also lining mucosa, and is the region with the greatest risk of serious lesions like cancer.
  • mouth has limited space for removal of cancerous lesions, and we cannot remove large portions of tissue without too much damage. this is why it is important to identify within the early stage
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13
Q

what is gustation

A

taste

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14
Q

where is gustatory mucosa found

A

the dorsum of the tongue

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15
Q

what is the gustatory mucosa characterised by

A

papillae

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16
Q

what are the layers of the epithelium of the oral mucosa

A
  • stratum germinativum
  • stratum spinosum
  • stratum granulosum
  • stratum corneum
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17
Q

what is the stratum germinativum layer

A

the basal layer where cells divide. there are mitotic figures found here

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18
Q

what is the stratum spinosum layer

A

the prickle cell layer. there are desmosomes responsible for the interconnection of epithelium, which is important when looking into cysts

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19
Q

what is the stratum granulosum

A

the granular layer. keratin becomes visible and gives the vision of granules

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20
Q

what is the stratum corneum

A

the cornified layer, which is more keratinised.

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21
Q

what may be different about the cornified layer of parakeratinised cells

A

some of the cells may have nuclei

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22
Q

where do the cells multiply

A

the basal and prickle cell layer

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23
Q

how do you know there is dysplasia by looking at the epithelial layers of the oral mucosa

A

there is mitotic figures in the corneum and granulosum layer

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24
Q

what is the mucoperiosteum formed from

A

the lamina propria interacting with the periosteum

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25
Q

describe the process of keratin formation

A

this is a process that takes time, and the cells need to go through the process. it is important to understand that keratin needs time to mature, and time will be replicated in the time that it takes for the tissue to heal

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26
Q

what allows the lining mucosa to move

A

the submucosa layer between the lamina propria and the periosteum

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27
Q

what is the mucogingival

A

the junction between masticatory and lining mucosa

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28
Q

describe non keratinocytes

A

clear cells lacking keratin
melanocytes which produce pigment melanin found on the stratum germinativum
there are also merel cells associated with the mechanoreceptors. and langerhaans cells fonud above the stratum germinativum

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29
Q

what do pilliform papillae look like

A

leaves

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30
Q

what do fungiform papillae look like

A

mushrooms

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31
Q

how much of the dorsum of the tongue is keratinised

A

all of it

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32
Q

what does the lip separate

A

the skin from the mucosa

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33
Q

what is geographical tongue

A

benign migratory glossitis, and presents as irregular smooth patches of the tongue lacking filliform papillae. there are red margins where the glossitis can be found. the pattern changes over time and is very localised. histologically it is very similar to psoriasis. corticoids can be used but they are not necessary if there are not many symptoms, although some can find discomfort with spicy foods

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34
Q

what are the diseases of the oral mucosa

A

recurrent oral ulcerations
oral infections
vesiculo bullous lesions
white patches
premalignant conditions

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35
Q

what are recurrent oral ulcerations

A

these are special in terms of treatment and cause. some recurrent ulcerations are viruses associated with auto inflammatory responses

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36
Q

what are vesiculo bullous lesions

A

bubbles forming on the tongue, when burst they become ulcerations.

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37
Q

what are white patches in the mouth associated with

A

hyperkeratinisation of the tissue.

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38
Q

what can premalignant conditions be associated with

A

ulcers, infections, lesions

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39
Q

what is the lamina propria

A

the underlying connective tissue layer of the epithelium of the oral mucosa

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40
Q

where is the submucosa found

A

between the lamina propria and the underlying bone or muscle

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41
Q

what is masticatory mucosa

A

this is where the epithelium is keratinised and is found in areas subjected to significant loading like the hard palate and the gingiva

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42
Q

what is the lining mucosa

A

this is where the epithelium is non keratinised; found in regions like the lip, cheek, and the floor of the mouth as these experience far less stress

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43
Q

which section of the tongue is partly keratinised

A

the anterior two thirds

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44
Q

what is the anterior two thirds of the dorsum of the tongue lined by

A

the gustatory mucosa

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45
Q

what is the lining of the posterior one third of the tongue like

A

non keratinised

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46
Q

what is the health of the oral mucosa dependent on

A

the quality and quantity of saliva produced by glands lying in the submucosa

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47
Q

what does the oral mucosa show

A

specialisations that allow it to fulfil several roles

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48
Q

what are the roles of the oral mucosa

A
  • mechanical protection against compressive and shearing forces
  • barrier to microorganisms, toxins and various antigens
  • role in the immunological defence, both humoral and cell mediated
  • minor glands within the oral mucosa provide lubrication and buffering as well as secretion of some antibodies
  • richly innervated to provide input for touch, proprioception, pain and taste
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49
Q

what are the two layers of the oral mucosa

A

the outer layer (stratified squamous epithelium) and the lamina propria

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50
Q

what does the lamina propria of the oral mucosa consist of

A

a looser connective tissue containing fat deposits and glands

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51
Q

what can the oral mucosa be specialised into

A
  • masticatory
  • lining
  • specialised
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52
Q

does masticatory have a thin or thick lamina propria

A

thick

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53
Q

which epithelial layers can be found in the oral mucosa

A

the stratum germinativum, the stratum spinosum, the stratum granulosum, and the stratum corneum

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54
Q

what are the two outer epithelial layers replaced by in lining mucoss

A

non keratinising superficial layer

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55
Q

does the epithelium have the stratum lucidum of clear cells in the oral mucosa

A

no

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56
Q

is turnover of the lining mucosa faster or slower than masticatory mucosa

A

faster

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57
Q

give a description of the stratum germinativum

A

single cell layer adjacent to lamina propria. there are cuboidal cells with a population of stem cells
the stem cells can differentiate to give tise to replacement keratinocytes in the epithelial layers above
the cells of the basal layer are the least differentiated cell in the oral epithelium, and contain a limited number of organelles associated with the synthesis and secretion of proteins

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58
Q

what is the stratum spinosum

A

the prickle cell layer. comprised of round cells forming a layer several cells thick. in the upper part of the prickle cell layer, there are intracellular membrane coating granules, which are rich in phospholipids and in keratinised epithelium they consist of a series of parallel lamellae

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59
Q

what does slight shrinkage from histological preparation of the prickle cell layer lead to

A

cells separating at all points where the desmosomes do not anchor them together, giving them a spiny appearance

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60
Q

what is the deepest layer in the prickle cell layer

A

the parabasal layer

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61
Q

give a brief description of stratum granulosum

A

many organelles are reduced or lost and contain large numbers of granules called keratohyaline granules
the membrane coating granules are first seen in the prickle cell layer move toward the superficial surface of the keratinocyte and discharge their lipid rich contents into the intercellular space

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62
Q

what is the stratum corneum

A

cells have lost all of their organelles including the granules
epitheial squames are shed in the process of desquamation necessitating the constant turnover of epithelial cells

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63
Q

what happens to allow for desquamation

A

desmosomes weaken and disappear

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64
Q

what epithelial layer provides the mechanical protective function to the mucosa

A

the stratum corneum

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65
Q

where are parakeratinised cells found

A

the gingiva. they contain small and shrunken nuclei

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66
Q

what happens to cells in the lining epithelium as they shift toward the surface

A

they enlarge and flatten

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67
Q

what do the cells in the lining epithelium lack

A

keratohyaline granules, and there are more organelles in the surface layer compared with those in the keratinised cells

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68
Q

are the layers of lining epithelium as clearly defined as in keratinised epithelium

A

no

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69
Q

what is the stratum superficiale

A

the outer superficial layer of lining epithelium

70
Q

what is keratin

A

tightly packed tonofilaments surrounded by the matrix protein filaggrin

71
Q

how much of the oral epithelium is made up of non keratinocytes

A

10%

72
Q

what are some examples of non keratinocytes found within the oral epithelium

A

melanocytes
langerhaans cells
merkel cells
inflammatory cells that have migrated through the epithelium, like lymphocytes

73
Q

what are melanocytes

A

pigment producing cells located in the basal layer. derived from the neural crest. present in the skin. long processes that extend in several directions and across several epithelial layers. produce melanin using tyrosinase. cytoplasm of melanocytes contains pigment that is packaged in small granules called melanosomes

74
Q

what are melanosomes

A

pigment packaged into small granules

75
Q

how many keratinocytes does a single melanocyte establish contact with

A

30 or 40

76
Q

what are langerhans cells

A

dendritic cells situated in the layers above the basal layer. leave the bloodstream to enter the lamina propria before penetrating the basal lamina to reach the epithelium. they act as part of the immune system as antigen presenting cells to provide immediate protection against invading pathogens, and they quickly respond to bacterial structures.

77
Q

where are merkel cells found

A

in the basal layer often closely apposed to nerve fibres. thought to act as a receptor and is derived from the neural crest. common in masticatory epithelia such as the gingiva, but less frequent in the lining mucosa such as the buccal mucosa

78
Q

describe the lamina propria

A

connective tissue underlying the oral epithelium with two layers, the superficial papillary layer between the epithelial ridges and a deep reticular layer. provides mechanical support.

79
Q

what are the two layers to the lamina propria

A

superficial papillary layer and the deep reticular layer

80
Q

where is the superficial papillary layer found

A

between the epithelial ridges, where the collagen fibres are thin and loosely arranged.

81
Q

describe the deep reticular layer

A

second layer of the lamina propria dominated by thick parallel bundles of collagen fibres

82
Q

what is found within the lamina propria

A

nerves with a sensory function, blood cells and salivary glands. fibroblasts, stem cells and found substance

83
Q

what are the roles of the blood vessels and salivary glands in the lamina propria

A

defence

84
Q

describe the stem cells found within the lamina propria

A

they exhibit high proliferation rates and have the capacity to differentiate into several different lineages, such as fat, bone and cartilage cells. they also demonstrate the feature of immuno privilege, which may be important in tissue engineering

85
Q

what does the ground substance of the lamina propria consist of

A

a hydrated gel of proteoglycans and glycoproteins. with all the general connective tissues, the usual defence cells are present, and macrophages can be seen here

86
Q

what is the basement membrane

A

a complex arrangement that links the surface epithelium to the underlying lamina propria in the oral mucosa.

87
Q

what do all the major products of the basal lamina appear to be synthesised by

A

epithelial cells

88
Q

what are the two layers to the basal lamina

A

the lamina lucida and the lamina densa

89
Q

where is masticatory mucosa found

A

areas with high compression and friction. characterised by a keratinised epithelium and a thick lamina propria. found in the gingiva and palate, and is firmly bound down directly to the muceoperiosteum, except for the region at the side of the palate, where a submucosa is present

90
Q

why is the lining mucosa non keratinised with a loose lamina propria

A

it must be mobile and distensible

91
Q

where is lining mucosa found in the mouth

A

lips
cheek
buccal and labial sulci
alveolar mucosa
floor of the mouth
ventral surface of the tongue
soft palate

92
Q

break down the percentage composition that each mucosa type takes up in the mouth

A

60% lining mucosa
25% masticatory
15% specialised

93
Q

break down the principle features and regional variations of the oral mucosa in the floor of the mouth

A

thin, non keratinised epithelium. the lamina propria has short and broad with collagen and some elastin fibres. the submucosa is loose and is loosely attached to underlying muscle. lining mucosa

94
Q

what muscles does the lip contain and how does it aid the oral cavity

A

striated muscles are found in the core of the lip that are part of the muscles of facial expression

95
Q

what kind of salivary glands are found in the submucosa

A

minor mucous salivary

96
Q

what happens to epithelial thickness from the skin to the mucosa in the lips

A

gradually increases

97
Q

is the epithelium of the vermillion zone keratinised

A

yes, but it is thin and translucent

98
Q

describe the features of the connective tissue papillae of the lamina propria

A

long and narrow, contain capillary loops.

99
Q

what is the labial mucosa covered by

A

a relatively thick, non keratinised epithelium.

100
Q

describe the epithelium found on the labial mucosa

A

relatively thick and non keratinised

101
Q

what does the vermillion zone separate

A

the keratinised skin from the lining mucosa

102
Q

is there submucosa present in the cheeks

A

yes, and it contains many minor mucous salivary glands

103
Q

what is the gingiva

A

the portion of the oral mucosa that surrounds and attaches to the teeth and alveolar bone

104
Q

what are the two components of the gingiva

A

attached gingiva and free gingiva

105
Q

what is attached gingiva

A

the gingiva directly bound to the underlying alveolar bone and tooth

106
Q

what is free gingiva

A

the narrow rim of mucosa that is not bound down to an underlying hard tissue

107
Q

what is the gingival sulcus

A

unattached region between the free gingiva and the tooth

108
Q

what separates the attached gingiva from the alveolar mucosa

A

the mucogingival junction

109
Q

what is the alveolar mucosa loosely attached to

A

the lower part of the alveolar bone

110
Q

what allows for the wide degrees of movement that alveolar mucosa has

A

loose submucosa

111
Q

what is the difference in appearance between the alveolar mucosa and the attached gingiva related to

A

differences in keratinisation and translucency

112
Q

describe the alveolar mucosa

A

thin, non keratinised epithelium overlying a lamina propria that shoes poorly developed dermal papillae

113
Q

what is found under the surface of the alveolar mucosa

A

underlyung blood vessels

114
Q

what does the submucosa of the alveolar mucosa house

A

many minor mucous salivary glands and numerous loosely attached elastin fibres that allow for free movement

115
Q

what is the mucosa found on the surface of the attached gingiva

A

masticatory

116
Q

how are the papillae of the attached gingiva often aligned

A

in rows

117
Q

how do the stipples on the surface of the attached gingiva arise

A

from the intersecting epithelial ridges

118
Q

what is the lamina propria bound to

A

the bone - forms the mucoperiosteum

119
Q

what constitutes the crevicular epithelium and the junctional epithelium

A

the epithelium on the inner surface of the gingiva

120
Q

describe the interface of the crevicular epithelium

A

folded with underlying connective tissue

121
Q

describe the junctional epithelium

A

this is the epithelial collar that surrounds the tooth and extends from the region of the cementum enamel junction to the bottom o fthe gingival crevice

122
Q

what are the two zones of the junctional epithelium

A

a single cell layer of cuboidal cells overlying several layers of flattened cells equivalent to a stratum spinosum

123
Q

what is the junctional epithelium derived from

A

the rapidly replaced reduced enamel epithelium

124
Q

how does the length of the junctional epithelium attached to the enamel surface vary

A

according to the stage of eruption. when the tooth first erupts into the oral cavity, most of the enamel will be covered by junctional epithelium. by the time the tooth reaches the occlusal plane, about a quarter of the enamel surface is still covered by junctional epithelium.

125
Q

how is the blood supply of the lamina propria associated with the junctional epithelium arranged

A

as a complex anastomosing network

126
Q

what does the dento gingival junction do

A

seals the underlying connective tissue of the periodontium from the oral environment. the strength of the seal is dependent on the attachment of the junctional epithelium to the tooth as well as the pressure exerted by the fibres and tissue fluid of the underlying connective tissue.

127
Q

what is the gingival crevicular fluid

A

the tissue fluid and cells that pass readily through the epithelium from the connective tissue into the gingival crevice

128
Q

how can the gingival crevicular fluid collected

A

using capillary tubing, gingival washing, or absorbent paper strips

129
Q

what is interdental gingiva

A

the gingiva between adjacent teeth

130
Q

what does the shape and arrangement of the gingival tissues between the teeth depend on

A

the shape of the contact between the teeth

131
Q

what does interdental gingiva occupy

A

the space between the teeth and conforms to its shape

132
Q

how does the interdental gingiva appear from the buccal or lingual aspects

A

wedge shaped

133
Q

why is it hard to keep the interdental gingiva plaque free

A

the epithelium is thin.

134
Q

what can be seen infiltrating the underlying the lamina propria on the interdental gingiva

A

inflammatory cells

135
Q

where do dentogingival fibres arise from

A

the root surface above the alveolar crest and radiate the insert into the lamina propria of the gingiva

136
Q

where do longitudinal fibres extend in the gingiva

A

for long distances within the free gingiva and some possibly for the whole length of the arch

137
Q

where are circular fibres found

A

encircle each tooth within the marginal and interdental gingiva. some attach to cementum, some to alveolar bone. some cross interdentally to join the fibre group of the adjacent tooth

138
Q

where do alveologingival fibres run from

A

gingiva to alveolar bone

139
Q

where do dentoperiosteal fibres occur

A

only in buccal and lingual gingiva and arise from cementum and pass over the alveolar crest to insert into the periosteum

140
Q

where do transseptal fibres pass

A

horizontally from the root of one tooth above the alveolar crest, to be inserted into the root of the adjacent tooth.

141
Q

where do semicircular fibres emanate from

A

cementum near the cementum enamel junction and cross the free marginal gingiva and insert into a similar position on the opposite side of the tooth

142
Q

where do transgingival fibres arise from

A

cementum near the cementum enamel junction and cross the free marginal gingiva and insert into a similar position on the opposite side of the tooth

143
Q

what do transgingival fibres do

A

they reinforce the circular and semicircular fibres

144
Q

where do vertical fibres arise

A

in alveolar mucosa or attached gingiva and pass coronally toward the marginal gingiva and interdental papilla

145
Q

what does the submucosa of the hard palate contain

A

main neurovascular bundles. the minour mucous glands that open onto the surface by ducts and adipose tissue

146
Q

what is the nasal surface of the hard palate lined by

A
  • respiratory mucosa, consisting of ciliated columnar epithelial cells with many goblet cells. beneath this epithelium there is a vascular submucosa containing minor glands of both mucous and serous types
147
Q

describe the connective tissue papillae of the soft palate

A

short and broad

148
Q

what does the broad submucosa of the soft palate contain

A

many small mucous glands

149
Q

what are the ventral surface of the tongue and floor of the mouth covered by

A

typical lining mucosa. there is a little wear and tear but a need for considerable mobility

150
Q

describe the epithelium of the floor of the mouth

A

thin, non keratinised showing short papillae. an extensive submucosa

151
Q

why can drugs rapidly reach the bloodstream via the floor of the mouth

A

the thinness of the epithelium and vascularitu of the connective tissue

152
Q

what is the sulcus terminalis

A

this divides the tongue into an anterior two thirds and a posterior one third. the anterior is the palatal surface, and the posterior is the pharyngeal surface

153
Q

how can papillae be classified

A

into filiform, fungiform, foliate and circumvallate papillae. foliate may be present as one or two longitudinal clefts at the side of the posterior part of the tongue. circumvallate are large and rounded

154
Q

what are the clinical considerations of the oral mucosa

A
  • lingual thyroid
  • erythema migrans
  • median rhomboid glossitis
  • white lesions
155
Q

what is lingual thyroid

A

this is a benign developmental condition. the dorsum of the posterior third of the tongue mayu show a midline swelling that represents active thyroid gland tissue that has failed to migrate from its developmental situation att he site of the foreamen caecum.

156
Q

what is erthyema migrans

A

benign condition - inflammatory condition of unknown cause that is characterised by the recurrence and disappearance of red areas on the tongue. smooth red lesions on the tongue related to atrophy of the filiform papillae surrounded by a grey white irregular boundary. also known as geographical tongue - may be symptomless, some complain of a burning sensation. red coloration of affected areas coincides histologically with the thickening of the epithelium of the epithelium and the presence of inflammatory cells in the region

157
Q

what is median rhomboid glossitis

A

benign abnormality seen in the midline of the dorsum of the tongue at the junction between the anterior two thirds and posterior third. nodular red or pink region devoid of papillae. harmless and symptomless.

158
Q

what are white lesions associated with

A

areas of keratinisation in normally non keratinised lining mucosa. linea alba - mildest white lesion in the buccal mucosa and is level with the occlusal plane - the result of low grade trauma upon the folds of cheek mucosa trapped between the teeth. lichen planus - common chronic inflammatory disease that produces white striated lesions in the mouth usually in the buccal mucosa

159
Q

what can white patch lesions develop into

A

malignancies - should be kept under observation. change in form to a speckled appearance associated with a firmness on palpation, ulceration and a rolled border may signify a malignant change.

160
Q

what may signify a malignant change in white patch lesions

A

change in the form to a speckled appearance associated with a firmness on palpation, ulceration and a rolled border

161
Q

what is found on the inner surface of the lip

A

mucosa

162
Q

what is the vermillion zone

A

the junction on the lip between the skin and the mucosa

163
Q

break down the principle features and regional variations of the oral mucosa in the soft palate

A

thick non keratinised epithelium. the lamina propria has short papillae with many elastin fibres. the submucosa is loose and is loosely attached to the underlying tissue. lining mucosa

164
Q

what is found on the outer surface of the lip

A

skin

165
Q

break down the principle features and regional variations of the oral mucosa in the hard palate

A

thick keratinised epithelium. the lamina propria has long papillae with dense collagen in submucosa laterally, but the lamina propria firmly bound to the periosteum without the submucosa in the midline. masticatory mucosa

166
Q

break down the principle features and regional variations of the oral mucosa in the anterior two thirds of the dorsum of the tongue

A

thick primarily keratinised epithelium. the lamina propria has long papillae with collagen and some elastin fibres. the submucosa is not a very distinctive layer and is attached to the underlying muscle. specialised gustatory mucosa.

167
Q

break down the principle features and regional variations of the oral mucosa in the ventral surface of the tongue

A

thin non keratinised epithelium. the lamina propria has short and numerous papillae with collagen and some elastin fibres. the submucosa is not very distinctive, and is attached to the underlying muscle. lining mucosa

168
Q

break down the principle features and regional variations of the oral mucosa in the posterior third of the dorsum of the tongue

A

variable, generally non keratinised epithelium. the lamina propria has short or absent papillae with collagen and some elastin fibres. the submucosa is not a very distinctive layer and is attached to the underlying muscle. lining gustatory mucosa

169
Q

break down the principle features and regional variations of the oral mucosa in the alveolar gingiva region

A

thin, non keratinised epithelium. the lamina propria has short/absent papillae and has many elastin fibres. the submucosa is loose and is loosely attached to the underlying periosteum. has lining mucosa

170
Q

break down the principle features and regional variations of the oral mucosa in the labial and buccal region

A

a thick, non keratinised epithelium. their lamina propria have short and irregular papillae, and contain collagen and some elastin fibres. they have a dense submucosa which is firmly attached the underlying muscle. has lining mucosa

171
Q

break down the principle features and regional variations of the oral mucosa in the vermillion zone of te lip

A

a thick, keratinised epithelium. the lamina propria is long and narrow papillae and has collagen and some elastin fibres. has dense submucosa and is firmly attached to underlying muscle. specialised mucosa

172
Q

break down the principle features and regional variations of the oral mucosa in the attached gingiva region

A

thick, keratinised and parakeratinised epithelium. the lamina propria has long and narrow papillae, with dense collagen firmly attached to the underlying periosteum. there is no distinct submucosa. has masticatory mucosa

Oral Biology (27 decks)

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