ORAL MUCOSA ,GINGIVA

Lec-2-
Oral mucosa:- all the soft tissues of the mouth , it consists of
1-Masticatory mucosa:
Which includes the gingiva and the covering of the hard palate . The
boundaries are from the free gingival margin to the mucogingival
junction (MGJ) on the facial and lingual surfaces.

MGJ: is a distinct line between the attached gingiva apically and the
alveolar mucosa.

On the palatal side there is no mucogingival junction because both

gingiva and mucosa of the hard palate are of the same type which is
masticatory mucosa. This tissue is firmly attached to the
underlying bone and covered with keratinized epithelium to
withstand the frictional forces of food during chewing and
swallowing.
2- Specialized mucosa: Which covers the dorsum of
the tongue.
3- Lining mucosa: This tissue is loosely attached to the
underlying bone and covered with non- Keratinized
epithelium.
Examples of this type of mucosa are the tissues
covering the lips, cheeks, floor of the mouth, inferior
surface of the tongue, soft palate and the alveolar
mucosa
*alveolar mucosa: is located apical to the attached
gingiva and extends into the vestibule of the mouth, it is
darker red and moveable because there are more elastic
fibers in the alveolar mucosa.
Gingiva:- Is that part of the masticatory mucosa which covers the
alveolar process and surrounds the cervical portion of the teeth.
Clinically, the gingiva is divided into 3 parts:
1 -Marginal gingiva.
2-Attached gingiva.
3-Interdental gingiva.

1-Marginal gingiva :(Free or un attached)

Is the most coronal portion of the gingiva surrounding the teeth in
collar like fashion but not attached to them and it is demarcated
apically from the adjacent attached gingiva by the free gingival groove
*(which is a shallow linear depression of about 1 mm wide and is
positioned at a level corresponding to the level of the cemento-enamel
junction, it is only present in about 30-40%of adults).

*Free gingiva form the soft tissue wall of the gingival sulcus.
Gingival sulcus: the space bounded by the free gingival margin, the
tooth, and the most coronal attachment of the junctional epithelium, it is
lined with non-keratinized sulcular epithelium.
Clinically normal gingival sulcus measures from 1-3 mm deep, but, in
disease the space become deeper and is referred to as a pocket.
2- Attached gingiva:
It is demarcated coronally from the free gingiva by the free gingival groove and
extend apically to the mucogingival junction where it become continuous with the
alveolar mucosa. It is firm, resilient and tightly bound to the underlying teeth and
periosteum of alveolar bone. The irregular surface texture of the attached gingiva
(stippling) similar to the surface of an orange peel, found in 40% of adults.
The width of the attached gingiva differs in different areas of the mouth, on the
facial surface
It is greatest on the maxillary lateral incisor and

narrowest on the facial surfaces of the mandibular canines and first premolar ,

on the lingual surface,

it is widest near the first and second molars and

narrowest adjacent to the incisors and canines

3-Interdental gingiva :
It is located in the interproximal space beneath the area
of teeth contact. It’s triangular in shape from mesio-
distal aspect. The shape of the interdental papilla is
determined by:
1.The contact relationships between teeth.
2.The width of the approximal tooth surfaces.
3.The course of the cementoenamel junction.
In general, there are 2 shapes of the interdental gingiva:
1.Pyramidal shape: Present in the anterior region of the dentition
where there is approximal contact point between 2 adjoining teeth
and one papilla with its tip immediately beneath the contact point.
2.Col-shape:The interdental papilla between the posterior teeth
are more flattened and there is a concave depression that connects
a facial and lingual papilla and conforms to the shape of the
interproximal contact surface.
*If diastema or gingival tissue recession are present, no Col will be
seen.
*The significance of Col, it is covered by thin non_keratinized
epithelium, hence represents the most frequent site for initiation of
disease process.
 Attached gingiva
Free gingiva
Free gingival groove
Gingival margin
Gingival sulcus
(gingival crevice)
Interdental gingiva
Papilla/Papillae
Col
Clinical descriptive criteria of clinically healthy gingiva and
inflamed one:
1. Gingival color:
The normal color of gingiva is coral pink with some variations
depending on the amount of melanin in the tissues, the thickness of
the epithelium, the degree of the keratinization and the vascularity
of the connective tissue. Dark skinned people often exhibit dark
blue or brown color.
The color of inflamed gingiva may vary from red to bluish red due
to vasodilation which lead to bleeding tendency.
2. Gingival contour.
The gingiva usually ends coronallv in knife edged margins and
scalloped in contour .

In inflamed gingiva, the contours are often rounded and enlarged

because of vascular stagnation and increases formation of collagen
fibers.
3. Gingival consistency.
The gingiva is usually resilient, firm and bound down to the
underlying bone because of the dense collagenous nature of the
gingival connective tissue.
In inflamed gingiva, the consistency may be soft and spongy
because of the vascular stagnation and decrease in the amount of
gingival collagen fibers or extremely firm because of excessive
formation of collagen (fibrosis), this is in case of chronic
inflammation.
4. Gingival surface texture:
Gingiva may have either stippled or smooth and shiny surface, the
attached gingiva is stippled, while the free gingiva is smooth. In
inflamed gingiva, reduction or lack of stippling is not an indicator
of health nor is the absence of stippling an indicator of disease..
Normal microscopic features:
The gingiva consists of fibrous connective tissue known as
lamina properia covered by stratified squamous epithelium.
Gingival epithelium may be differentiated as follows:

l. Oral epithelium: which faces the oral cavity,

2. Sulcular epithelium: which faces the tooth in the gingival

sulcus without being in contact with the tooth surface.

3. Junctional epithelium: which provides the contact

between the gingiva and the tooth
OE = oral epithelium
SE = sulcular epithelium
JE = junctional epithelium
CEJ = cementoenamel
junction
Gingival connective
tissue –
underlies the epithelium
and
provides support
through an
organization of collagen
fibers
Oral epithelium:
It covers the crest and the outer surface of the
marginal and attached gingiva. It is either
keratinized (no nuclei) or parakeratinized
(retained nuclei). The boundary between the oral
epithelium and the underlying connective tissue
has a wavy course.
The projection of epithelial cells into the
connective tissue are known as "Rete Pegs".
The intervening connective tissue portions which
project into the epithelium are called connective
tissue papillae.
This alternating pattern of depression and
protuberances of the connective tissue papillae
and epithelial rete pegs is thought to give the
attached gingiva the “stippled appearance”
The oral epithelium consists of four layers of cells:
1- Stratum basale: basal layer of cuboidal cells along the
basement membrane . This is where epithelial cell
replication and differentiation begins. Melanocytes are found
in this layer
2-Stratum spinosum: The cells appear to have cytoplasmic
spines .This is the thickest cell layer &Langerhans cells are
found in this layer
3- Stratum granulosum: Keratohyaline granules may be
seen in this layer. cells appear to be flattened.
4- Stratum corneum: .It is the most superficial layer.
The epithelial cells are formed as basal cells &gradually they
undergo the process of keratinization, this is achieved by
proliferation & differentiation of these cells(change to the
characteristics of each of the cell layers)as they migrate
toward the surface layer.
The Oral Epithelium contains the following types of cells :
1- keratinocytes cells : These are keratin producing cells which
comprise about 90%of the total cell population. These cells
undergo continuous proliferation &differentiation from basal layer
to the surface of epithelium .Keratin may be found in the stratum
corneum &contribute to the protective function of epithelium.
2- Melanocytes cells: of basal layer that produce melanin pigment
granules.
3- Langerhans cells : These cells plays role in the defense
mechanism of the oral epithelium. They have an immunological
function by recognizing &processing antigens.
4- Merkel cells: These are located in the deeper layers of the
epithelium, harbor nerve endings. They have been identified as
tactile receptors.
Under normal conditions

there is complete equilibrium between cell renewal &desquamation (cell turn

over).It takes approximately 3-4 weeks for keratinocytes to migrate from basal layer
until reach the outer epithelial surface, where it becomes desquamated from
stratum corneum.
The basal cells are found immediately adjacent to the connective tissue &are
separated from this tissue by a basement membrane (basal lamina)
The basement membrane consist of : 
1- Lamina Lucida: which is located immediately beneath the basal
cell layer.
2- Lamina Densa: Located beneath the lamina lucida from this
structure the anchoring fibers project into the connective tissue.

The epithelial cells are joined together by structure known as

desmosomes, which is composed of two hemidesmosomes
separated from each other by granulated material.

Ahemidesmosome composed from the following structure :

1-The outer leaflets(OL):of cell membrane of two adjoining cells.
2-The inner leaflet(IL): which is thicker leaflet of cell membrane.
Sulcular Epithelium:
It lines the gingival sulcus . It is a thin ,non keratinized stratified
squamous epithelium without retepegs &extends from the coronal
limit of the junctional epithelium to the crest of the gingival margin.

The sulcular epithelium is important because it is thin &may act as

a semipermeable membrane through which tissue fluid from the
gingiva seeps into the sulcus &makes easier for the bacterial
products of dental plaque to penetrate into the connective tissue of
the gingiva &stimulate inflammation &tissue destruction .

That is why the sulcular epithelium is considered as a poor

barrier against bacterial infection.