Oral Mucosal Embryology and Histology
Oral Mucosal Embryology and Histology
Oral Mucosal Embryology and Histology
Histology
TRACEY A. WINNING, BDSc, GradDipHEd, PhD
GRANT C. TOWNSEND, BDS, BScDent(Hons), PhD, DDSc
T
he mucous membrane that lines the oral cavity oral cavity with the foregut and hence continuity be-
consists of two layers: an outer layer of stratified tween ectoderm and endoderm. Therefore, the oral mu-
squamous epithelium and an underlying layer of cosal epithelium develops mainly from ectoderm (lips,
dense connective tissue (lamina propria). In those re- cheeks, vestibule, palate, gingivae, floor of mouth) and
gions where there is looser connective tissue, beneath also from endoderm (tongue).
the lamina propria a submucosa exists containing blood The connective tissue of the oral mucosa is derived
vessels, fat and glands (eg, cheek, soft palate). The oral from ectomesenchyme—in particular, neural crest cells
mucosa has both epithelial and connective tissue struc- that migrate from the midbrain and anterior rhom-
tural modifications in the different regions of the oral bomeres to the developing facial region and relevant
cavity, providing three recognizable histological types. branchial arches.4 Once these cells have migrated, they
These types of epithelia correspond to the function of disperse within the mesenchymal tissues already
the tissues: masticatory (tough) mucosa in the gingivae present, proliferate extensively, and make essential con-
and hard palate; lining (flexible) mucosa in the lips, tributions to the development of oral cavity structures,
cheeks, vestibule, alveolar mucosa, soft palate, floor of including the oral mucosa. Epithelial–mesenchymal in-
mouth, and inferior surface of the tongue; and special- teractions are important in development of craniofacial
ized (mix of masticatory and lining) mucosa on the structures (eg, teeth)5 and the maintenance of oral mu-
dorsum of the tongue (Fig 1). cosa;6 however, further elucidations of these interac-
There are common features of the various tissues and tions during oral mucosal development have not been
cell products in the oral mucosa; however, features published. The ectomesenchyme also contributes to the
associated with the different types of oral mucosa lead muscles associated with the lips, cheeks, and soft pal-
to a range in histology and differentiation. This varia- ate, while the tongue muscles are derived from the
tion is, in turn, reflected in a variable clinical appear- occipital somites.
ance. This review will present initially an overview of Initially, a single layer of epithelial cells lines the oral
the development of the oral mucosa, followed by a cavity, followed by development of two cells layers at
summary of its histology and discussion of the different approximately 5 to 6 weeks. Soon after, the sparsely
types of oral mucosa, relating the histological structure populated ectomesenchyme begins to secrete extracel-
to the clinical appearance. Where applicable, compari- lular fibers. By 10 weeks, a multilayered epithelium is
son with skin will be made; we will also note aspects of present.3 At this time, surface features of the oral mu-
the oral mucosal structure and features that relate to cosa also commence development—namely the incisive
conditions discussed in other articles in this issue. papilla, palatal rugae, and the papillae of the anterior
two-thirds of the tongue. In the connective tissues, cap-
Oral Mucosal Development illary buds and collagen also begin to appear, and some
The beginning of an oral cavity (stomatodeum), albeit differences between the lining and masticatory muco-
primitive, occurs with the folding of the embryo in the sae are recognizable, such that the latter has more cells
head–tail line at approximately 4 weeks.1– 4 This results and fibers.
in the formation of an opening lined by ectoderm above Both epithelial proliferation and differentiation con-
the level of the buccopharyngeal membrane and tinue over several weeks, such that by approximately 23
endoderm below this membrane. Soon after folding of weeks in utero, an oral epithelium with adult charac-
the embryo, the buccopharyngeal membrane breaks teristics, including cytokeratin expression, has devel-
down, resulting in direct communication between the oped—that is, stratified ortho/parakeratinized palatal
and gingival epithelium and stratified nonkeratinizing
epithelium of the lips, cheeks, soft palate, ventral sur-
From the Dental School, The University of Adelaide, Adelaide, South face of tongue, and floor of mouth. During this process
Australia, Australia.
Address correspondence to T.A. Winning, PhD, Dental School, The of development, separation of the lips and cheeks from
University of Adelaide, Adelaide, South Australia 5005, Australia. the mucosa of the developing maxilla and mandible
© 2000 by Elsevier Science Inc. All rights reserved. 0738-081X/00/$–see front matter
655 Avenue of the Americas, New York, NY 10010 PII S0738-081X(00)00140-1
500 WINNING AND TOWNSEND Clinics in Dermatology Y 2000;18:499 –511
Figure 1. Intraoral views of the various types of oral mucosa. Masticatory (keratinizing) mucosa: (a) Hard palatal mucosa covering the
bony palate; (i) incisive papilla; (ii) palatal rugae. (b) Gingiva, i.e., oral mucosa surrounding the teeth; (iii) junction (transition) between
the gingiva and alveolar (nonkeratinized) mucosa (see Fig 3b); (iv) interdental papillae; (v) free gingiva, i.e., tissues not attached to tooth
or bone. Lining (nonkeratinized) mucosa: (c) Vestibule showing various lining mucosae: (vi) labial mucosa; (vii) alveolar mucosa; (viii)
cheek mucosa, (d) Soft palate; (ix) Line indicates junction between hard and soft palate; (x) uvula. (e) Floor of mouth and ventral surface
of tongue; (xi) sublingual gland ducts; (xii) submandibular gland ducts. Specialized mucosa: (f) Anterior two-thirds of dorsal surface of
tongue; (xiii) filiform papillae, which cover the majority of the anterior part of the tongue; fungiform papillae (arrows), which are dotted
between the filiform papillae. (g) Posterior aspect of anterior two-thirds of tongue where a line of circumvallate papillae (circled) are
located.
Clinics in Dermatology Y 2000;18:499 –511 ORAL MUCOSAL EMBRYOLOGY AND HISTOLOGY 501
oral cavity. When no nuclei are present, the epithelium gival epithelium. Like epidermis, the keratinized layer
is described as orthokeratinized. If pyknotic nuclei are reduces the permeability of the oral mucosa, although
retained, the epithelium is referred to as parakeratinized. palatal mucosa is approximately 10 times more perme-
This latter type of keratinized layer is common in gin- able than skin.13
Clinics in Dermatology Y 2000;18:499 –511 ORAL MUCOSAL EMBRYOLOGY AND HISTOLOGY 503
Figure 3. Keratinizing epithelia and underlying connective tissues (scale ⫽ 20 m). (a) Interfollicular skin from the lip; note the thin
epidermis and relatively flat junction between the epidermis and underlying dermis. (b) Vermilion zone of the lip; note the long connective
tissue papillae containing numerous superficially located capillaries, which contribute to the clinical red appearance of this structure. (c)
Hard palatal mucosa; note the thicker epithelium and more extensive connective papillae and dense connective tissue which is firmly bound to
periosteum. (d) Hard palatal mucosa from the postero-lateral aspect of the hard palate where the lamina propria is bound to a fibrous submucosa
containing salivary glands and fat (not visible); (i) basal layer; (ii) spinous layer; (iii) granular layer (arrows); (iv) keratinized layer.
Nonkeratinized Epithelium of Lining Mucosa barrier developing with the release of MCG contents,
The nonkeratinized epithelium of lining mucosa, which although the permeability of nonkeratinized mucosa is
is less able to resist damage but is capable of distension, greater than keratinized oral mucosa and skin.13 While
has a basal layer similar to masticatory mucosa, with the nuclei persist in this layer, there is a gradual de-
the additional expression of cytokeratin 19.11,14 Similar crease in volume of organelles and decreased desmo-
changes occur in these cells as they move and differen- somes, followed by desquamation of the cells.
tiate into the spinous layer, including an increase in
size, change in shape, and increased prominence of Epithelium of Specialized Mucosa
desmosomes and keratin filaments (Fig 4), with the
expression of major differentiation-associated cytoker- Specialized oral mucosa is found on the dorsal surface
atins 4 and 13. The next layer is the intermediate layer, of the tongue and consists of structures that are kera-
in which the cells become flattened with an increasing tinized (filiform, and dorsal surface of fungiform and
percentage of keratin filaments as they move through circumvallate papillae), as well as interpapillary regions
this and the superficial layer. Cells in this latter layer that are nonkeratinized (Figs 1 and 5). (Refer below for
demonstrate membrane thickening, with a permeability further discussion of the structure of these papillae.)
504 WINNING AND TOWNSEND Clinics in Dermatology Y 2000;18:499 –511
ample, altered expression of integrin subunits in squa- Junction Between the Epithelium and Lamina Propria
mous cell carcinoma (see other articles in this issue for
The epithelium is attached to underlying connective
further discussion).35,40,41,52
tissues via a basement membrane region. The morphol-
Nonepithelial Cells ogy of this junction varies depending on the type of oral
mucosa and is related to the functional demands of the
Like epidermis, other cells besides epithelial cells are
tissue (see below; Figs 2, 3, and 4). The relative height of
found in the oral epithelium: melanocytes, Langerhan
the connective tissue papillae to the thickness of the
cells, Merkel cells, and lymphocytes. These cells may be
epithelium is generally similar for the different regions
recognized at the light microscope level with routine
of oral mucosa (approximately 0.6 to 0.74 mm, with the
stains as small rounded cells with a clear halo around
their nuclei, but accurate identification requires special exception of floor of the mouth at 0.3 mm); however, the
techniques. Regional variations in the distribution and number of connective tissue papillae varies with result-
density of these cells (and their products) have been ant differences in the surface area of this junction.10 In
reported.53–55 As the oral mucosa also has the ability to matiscatory (gingiva and hard palate) mucosa, which is
interact with the environment, there are also other subjected to compressive and frictional forces, approx-
structures within the epithelium that contribute to the imately 1.5 to 2.5 times more connective tissue papil-
senses of taste, touch, temperature, and pain; however, lae/mm2 of mucosal surface can be found compared to
discussion of these is beyond the scope of this review. lining mucosa (cheek, labial, and alveolar mucosa) (Fig
506 WINNING AND TOWNSEND Clinics in Dermatology Y 2000;18:499 –511
Table 1. Summary of Comparison of Expression of Differentiation Markers and Adhesion Molecules Between Skin and Oral Mucosa
Similarities Differences from Epidermis
Differentiation markers and related function
• Intermediate filament-associated proteins and cornified envelope • Cornifin-/small proline-rich protein (keratinized and
proteins, eg, filaggrin, involucrin, loricrin, cornifin-␣/small nonkeratinized oral mucosa22
proline-rich proteins (keratinized oral mucosa)9,19–22
• Keratinocyte transglutaminase (keratinized oral mucosa)20 • Filaggrin (patchy), involucrin, cornifin-␣/small proline-rich
proteins, transglutaminase (nonkeratinized oral mucosa)9,19,20,22
• Cytokeratins 5, 14, 1, 10 (keratinized oral mucosa, mRNA only for • Cytokeratins 8, 18, 19 (junctional epithelium)9
1 and 10 in nonkeratinized buccal mucosa)9,23
• Cytokine production under various conditions,24 eg, interleukins, • Cytokeratins 19, 4, 13 (nonkeratinized oral mucosa)9
tumor necrosis factors, colony stimulating factors,25 chemokines,26,
growth factors,27 interferons, and associated receptors28,29
• Stratum corneum chymotryptic enzyme (keratinized oral mucosa)30 • Cytokeratins 2, 6, 16 (keratinized oral mucosa, eg, palate,
gingiva, tongue)9,31,32
• Different form and constituents of membrane coating granules in
nonkeratinizing epithelium33,34
• Permeability of oral mucosa increased between 10 times (palate)
to 20 times (floor of mouth)13
2) and up to seven times more connective tissue papil- layer, consists of connective tissue papillae that inter-
lae/mm2 than the floor of the mouth.10 These latter digitate with the rete ridges of the overlying epithelium
lining mucosae are not subjected to as much frictional (Fig 2). Deep to this layer of interdigitating connective
force and need to be more flexible. tissue papillae is the reticular layer, so-called because of
Differences in the basic structure and components of its fiber network. There is little regional variation in the
this attachment between oral mucosa and skin have not connective tissue of the oral mucosa, although there are
been reported. In summary, this attachment involves elastic fibers in the connective tissues of the lining
hemidesmosomal attachment of basal epithelial cells to mucosa, and the collagen fibers are less regularly orga-
a basal lamina, involving BP230, BP180, alpha-6 beta-4 nized. Expected connective tissue components are
integrin, laminin-5, and uncein in the lamina lucida, present in the lamina propria, namely cells and fibers
plus heparin sulphate, collagen IV, laminins, nidogen, embedded in ground substance. Fibroblasts are the pre-
and other proteins in the lamina densa. The basal lam- dominant cell involved in producing and maintaining
ina is in turn attached via anchoring fibrils (collagen the collagen fibers (Types I, III, V, and VI)57 and also the
VII) to collagen fibers of the underlying lamina pro- ground substance that consists of proteoglycans (eg,
pria.10,38,40,41 The functional importance of components hyaluronan, heparan sulphate, syndecan, decorin)58
of this attachment zone in wound healing and disease is and glycoproteins (eg, fibronectin, tenascin).59 The col-
similar for oral mucosa and skin—for example, changes lagen fibers in the lamina propria are thin and loosely
in expression of integrins in keratinocytes in healing arranged in lining mucosa but are arranged in bundles
wounds,56 alterations in integrin expression in squa- in masticatory mucosa.
mous cell carcinoma,40 and deposition of autoantibod- Other cells found in varying numbers depending on
ies against BP180 or laminin-5 in mucosal (cicatricial) the site include leukocytes, macrophages, mast cells,
pemphigoid.37,38 and numerous blood vessels in the form of capillaries
that loop into the connective tissue papilla. There are
Lamina Propria also lymphatics and neural elements. The latter include
The lamina propria, a dense connective tissue, provides intraepithelial nerve fibers, organized nerve endings
support for the overlying epithelium.2 The superficial (lamellar, coiled, or glomerular) and Merkel cell–neu-
region of the lamina propria, referred to as the papillary rite complexes.60,61 The junction of the reticular layer of
Clinics in Dermatology Y 2000;18:499 –511 ORAL MUCOSAL EMBRYOLOGY AND HISTOLOGY 507
the lamina propria with the underlying tissues varies 40 m) (Fig 1e). The thickness of the hard palate epi-
depending on the type of mucosa. In the gingiva and thelium is somewhere in-between these two regions
anterior aspects of the hard palate, the lamina propria is (310 ⫾ 50 m).10
bound to periosteum (Fig 3c) and tooth, while in the The keratinized layer of the hard palate and the
posterolateral aspects of the hard palate it is bound to a gingival tissue reduces the level of redness from the
fibrous submucosa containing salivary glands and fat underlying blood vessels, such that these tissues appear
(Fig 3d). The lamina propria of lining mucosa is at- pink clinically. However, if they are inflamed, the vas-
tached to a submucosa of connective tissue associated cular response associated with inflammation results in a
with muscles (lips, cheeks, tongue, and soft palate) (Fig red appearance. The presence of fat in the submucosa
5a), fat (soft palate, cheek, and labial mucosa) (Fig 4a), (posterior-lateral regions of the hard palate, soft palate,
and salivary glands (lips, cheeks, palate, and tongue) and cheek) also imparts a yellow color to the mucosa in
(Figs 3d and 5b). these regions (Fig 1d). Because of the apposition of
mucosae with different types and thicknesses of oral
Relating Clinical Appearance to Histological epithelium and submucosal tissues, the color of the oral
Structure mucosa changes between regions—for example, there
is a clearly defined mucogingival junction between
The clinical appearance of the oral mucosa varies de- the gingiva and alveolar mucosa (Fig 1b), whereas
pending on the distribution of superficial blood vessels, there is a gradual transition from the hard to the soft
the type and thickness of epithelium, components of the palate (Fig 1d).
submucosa, presence of pigmentation and appendages, As noted above, melanocytes are found in the basal
various surface features of the mucosa, functional ad- layer of oral mucosal epithelium; however, the presence
aptations, and disease. Other articles in this issue dis- of pigmentation varies greatly between and within in-
cuss diseases affecting the oral mucosa and will not be dividuals,53 being related to the level of skin pigmenta-
dealt with here. tion.63 Though many areas of the oral mucosa are re-
ported to contain melanocyte products,53 pigmentation
Color of Oral Mucosa may not always be visible clinically such that light-
Clearly, the pink/red color of oral mucosa is derived skinned individuals rarely display pigmentation re-
from the extensive blood supply to these tissues. The lated to melanocyte activity. The gingiva, buccal mu-
distribution of blood vessels is also important in im- cosa, hard palate, and tongue most frequently display
parting the level of redness—for example, while the oral pigmentation.
epithelium of the vermilion border of the lip is keratin- Another major difference between the appearance of
ized, it is thin, like interfollicular skin. The capillaries in skin and oral mucosa results from an absence of skin-
the numerous connective tissue papillae are, however, like appendages in oral tissues. An exception are seba-
superficially located just beneath the epithelium, im- ceous glands found in approximately 80% of adults.62
parting the red color to this tissue (Fig 3b). The vermil- They become clearly evident after puberty and are
ion border of the lip is at risk of ultraviolet damage, found symmetrically in the upper lip (rarely lower) and
especially the lower lip in fair-skinned individuals. cheeks. They are referred to as Fordyce spots or granules
Changes in color and texture may be noted, in particu- and appear as yellowish spots or occasionally plaques
lar the blurring of the junction between the vermilion that may be slightly raised above the otherwise pink
border and skin, patches of increased keratinization mucosa.
with loss of redness and loss of elasticity of the tissues As noted in Table 1, the expression of specific cyto-
due to degeneration of the collagen, and increase in keratin proteins for nonkeratinizing epithelium does
thickened elastic fibers.62 These changes may indicate not preclude the expression of cytokeratins specific for
early changes associated with malignancy (refer to keratinizing epithelium.23 This is evident in the whitish
other articles in this issue). ridges/lines, consisting of keratinized epithelium, that
Generally there are many more cell layers in oral may be found in the buccal mucosa at the level of the
epithelium compared with epidermis of interfollicular contact between upper and lower teeth. It is considered
regions of thin skin (eg, abdominal skin), which has a that this change in epithelial differentiation pattern is
reported thickness of approximately 100 to 120 m (Fig due to increased friction, related to cheek biting.
3a).10 However, as the thickness of epidermis varies in
different regions, so the oral mucosa displays variation
Oral Mucosal Surface Features
in epithelial thickness, which is related to the number of
cell layers. For example, cheek mucosa has compara- Structural features of the oral mucosa, which are spe-
tively thick epithelium (580 ⫾ 90 m) (Fig 1c), resulting cific to these tissues, include the palatal rugae, the
in a pinker clinical appearance compared with the epi- papillae of the dorsal surface of the tongue, and the
thelium in the floor of mouth, which is very thin (190 ⫾ attachment of the gingivae to teeth. The palatal rugae
508 WINNING AND TOWNSEND Clinics in Dermatology Y 2000;18:499 –511
are located in the anterior hard palate and consist of a tooth and/or bone, depending on the health of the
series of raised connective tissue ridges covered with gingival tissues, via the junctional epithelial attachment
keratinized epithelium (Fig 1a). These structures are to the tooth as well as collagen fiber bundles from the
well developed in some animals, but they are probably gingival connective tissues, which insert into the sur-
of no major importance in humans. face of the tooth root or the periosteum of the alveolar
bone (Fig 2a). In health, the attached gingiva has a
Lingual Papillae stippled appearance (small superficial depressions) due
As noted above, the anterior two-thirds of the dorsal to collagen fiber bundles that attach the gingival con-
surface of the tongue have three types of papillae that nective tissues to the tooth root and bone. Located
differ in gross and histological structure (Fig 5). The between the teeth are the interdental papillae consisting
predominant type is the filiform papillae, which are of keratinized epithelium on the facial/lingual aspects
thread-like projections of keratinized epithelium, con- overlying connective tissue (Fig 1b). These papillae are
tributing to the masticatory function of tongue (Figs 1f located on both labial/buccal and palatal/lingual as-
and 5a). Dotted between these papillae are the redder pects and are joined by the col, which is located beneath
fungiform papillae, which consist of a well-vascularized the contact areas of adjacent teeth and has an epithelial
connective tissue core, covered dorsally with keratin- covering consisting of JE. The margin of healthy gingiva
ized epithelium and with taste buds located laterally in relation to the teeth is in the region of the cementoe-
(Figs 1f and 5a). The remaining few papillae on the namel junction and its appearance is generally pink,
dorsal surface are the circumvallate papillae (8 to 12 in firm, well contoured, and stippled. In contrast, in-
number), located at the junction of the anterior two- flamed gingivae are red, swollen, puffy, nonstippled,
thirds and posterior third of the tongue. They are mush- and bleed readily.
room-shaped structures, surrounded by deep troughs Differences in the response of oral mucosa to clinical
into which salivary gland ducts open. Their dorsal sur- manipulations are related to tissue structure. For exam-
face is keratinized with taste buds located on the non- ple, injection of fluid into the alveolar or buccal mucosa
keratinized lateral aspects, overlying a connective core is relatively easy and, if performed slowly, causes lim-
(Fig 5b). Located on the posterior aspect of the lateral ited discomfort due to the looser supporting connective
borders of the tongue are foliate papillae, which consist tissue (Fig 4). In contrast, injection into gingival or
of vertical mucosal folds/ridges separated by grooves palatal mucosa is difficult and tends to be painful as a
containing taste buds. result of the firm attachment of the mucosa to perios-
teum or fibrous submucosa (Fig 3c). The firm attach-
Gingivae ment of masticatory mucosa also means the cut edges of
Gingival mucosa surrounds the teeth on labial/buccal these tissues do not move; therefore, limiting the need
and lingual/palatal surfaces. The epithelial covering of for suturing and closure of wounds is not possible
the outer surface of the gingiva (ie, that facing the without raising a flap. The cut edges of buccal mucosa,
lips/cheeks or palate/tongue) consists of masticatory however, tend to gape and require suturing.
or keratinized epithelium. In contrast, the epithelium
facing the tooth (ie, that forming one wall of the gingi- Salivary Gland Ducts
val sulcus/crevice) consists of the coronally positioned The oral mucosa differs from skin in that it is continu-
nonkeratinizing sulcular component adjacent to the ally bathed with saliva, secreted by salivary glands of
deeper junctional component (Fig 2a). As noted, this the oral submucosa. The minor salivary glands in the
latter epithelium is attached to the tooth via hemides- lip submucosa are notable as they contribute a lumpy
mosomal attachment to a basal lamina, which is specific texture to these tissues. Various surface features of the
to this site and does not contain type IV collagen. The oral mucosa are associated with the openings of ducts
gingival tissues can be divided into components or of the major salivary glands. The bilateral parotid pa-
structures, based on the relationship of the tissue to the pillae are located in the cheek mucosa, opposite the
tooth, namely free and attached gingivae and interdental permanent molars, while the sublingual papillae, which
papillae (Fig 1b). As the terminology implies, the free mark the opening of the submandibular ducts, are lo-
gingivae are not attached to the tooth and form a short cated in the floor of the mouth (Fig 1e). The sublingual
cuff around the teeth. The gap created by this cuff is folds produced by the submandibular salivary gland
referred to as the gingival sulcus or crevice and is about ducts represent the multiple sites of opening of the
0.5 to 2 mm deep in health. The nonkeratinized nature sublingual glands (Fig 1e).
of the sulcular epithelium results from the mild inflam-
mation of the mucosa in this region as a result of the
Age Changes in the Oral Mucosa
response of the host to the continual presence of the oral
microflora (Fig 2a). Limited evidence is available of clinical changes to the
The attached gingival mucosa is connected to the oral mucosa that can be attributed to age alone. The
Clinics in Dermatology Y 2000;18:499 –511 ORAL MUCOSAL EMBRYOLOGY AND HISTOLOGY 509
majority of reports of atrophy of the oral mucosa with phogenesis and patterning: The right shape in the right
age have not been based on longitudinal studies of place. J Dent Res 1999;78:826 –34.
healthy subjects and probably indicate changes associ- 6. Mackenzie IC, Hill MW. Connective tissue influences on
ated with medications, inadequate nutrition, and/or patterns of epithelial architecture and keratinization in
skin and oral mucosa of the adult mouse. Cell Tissue Res
disease.64 A cross-sectional study of epithelial thickness
1984;235:551–9.
of subjects aged from 18 to 96 years generally showed a
7. Dale BA, Holbrook KA, Kimball JR, et al. Expression of
variable but small reduction in epithelial thickness with epidermal keratins and filiggrin during human fetal skin
age, and with flattening of the epithelial– connective development. J Cell Biol 1985;101:1257– 69.
tissue junction.65 Systematic study of human oral con- 8. Chen S-Y, Squier CA. The ultrastructure of the oral epi-
nective tissues with age has not been reported. In terms thelium. In: Meyer J, Squier CA, Gerson SJ, editors. The
of cell turnover, evidence of changes in human oral structure and function of oral mucosa. Oxford: Pergamon
mucosa with age is not available, and the evidence from Press, 1984:7–30.
animal studies is varied, although there is some evi- 9. Dale BA, Salonen J, Jones AH. New approaches and con-
dence of reduced turnover in epidermis.66 Increased cepts in the study of differentiation of oral epithelia. Crit
permeability with age has been reported in skin, Rev Oral Biol Med 1990;1:167–90.
10. Schroeder HE. Differentiation of human oral stratified
whereas results for oral mucosa overall have indicated
epithelia. Basel: Karger, 1981:30 – 4;146 –56.
some increase in permeability with age, but this is quite
11. Sawaf MH, Ouhayoun JP, Shabana AHM, et al. Cytoker-
variable between subjects and regions of the oral mu- atin expression in human tongue epithelium. Am J Anat
cosa.67 Evidence of dryness of the oral mucosa in asso- 1994;189:155– 66.
ciation with age is reported to be mostly associated with 12. Mackenzie IC, Rittman G, Gao Z, et al. Patterns of cyto-
medications.64 keratin expression in human gingival epithelia. J Peri-
odontal Res 1991;26:468 –78.
13. Lesch CA, Squier A, Cruchley A, et al. The permeability of
Concluding Remarks human oral mucosa and skin to water. J Dent Res 1989;
In summary, within the confined regions of the oral 68:1345–9.
cavity, the oral mucosa displays a range of regional 14. Su L, Morgan PR, Lane EB. Keratin-14 and -19 expression
differences that relate to its development and functional in normal, dysplastic and malignant oral epithelia. A
study using in situ hybridization and immunohistochem-
demands. A number of similarities between the epider-
istry. J Oral Pathol Med 1996;25:293–301.
mis and keratinized oral epithelium have been noted,
15. Bichenbach JR. Identification and behavior of label-retain-
although differences between skin and oral mucosa are ing cells in oral mucosa and skin. J Dent Res 1981;60:
evident. The oral mucosa represents some features that 1611–20.
are specific to the oral environment, including the con- 16. Mackenzie IC, Bichenbach JR. Label-retaining keratino-
stantly moist surroundings, the presence of teeth pro- cytes and Langerhans cells in mouse epithelia. Cell Tissue
truding through the oral epithelium, and the ubiquitous Res 1985;252:551– 6.
presence of inflammation in this region, along with the 17. Potten CS. Kinetic organisation in squamous epithelium.
consistent functional demands of eating and communi- In: Wright N, Camplejohn RS, editors. Psoriasis: Cell pro-
cating. The reader is referred to more detailed discus- liferation. Edinburgh: Churchill Livingston, 1983:149 – 62.
sions about the specific regions of oral mucosa or tissue 18. Hill MW. Cell renewal in oral epithelia. In: Meyer J, Squier
CA, Gerson SJ, editors. The structure and function of oral
components in recent dental histology texts1 and spe-
mucosa. Oxford: Pergamon Press, 1984:53– 81.
cialist journals.68 The remaining articles in this issue of
19. Smith SA, Dale BA. Immunologic localization of filaggrin
the journal will draw on the basics of oral mucosal in human oral epithelia and correlation with keratiniza-
development and structure and discuss the many dis- tion. J Invest Dermatol 1986;86:168 –72.
eases affecting the oral mucosa. 20. Ta BM, Gallagher GT, Chakravarty R, et al. Keratinocyte
transglutaminase in human skin and oral mucosa: Cyto-
plasmic localization and uncoupling of differentiation
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