Dr. Yashpreetsingh A.

Bhatia
Pg Student
Department of Prosthodontics & Crown &
Bridge,
College of Dental Science & Research Centre

Contents
Introduction
Definitions
General Functions
Structure
Classification
Maxillary Structures
Mandibular Structures

Gingiva
Tongue
Some Clinically
Relevant Pathological
changes
Conclusion
Refrences

Introduction
A good architect will not attempt to design a
building until he or she is very familiar with the
site. Likewise, the dentist must know all the oral
and facial anatomy that is associated with the
making of impressions.
- Bernard Levin
-Levin B. The basic requirements of impression making.
Impressions
for
Complete
Dentures.
Quintessence Publishing Co.; 1984:11.

Chicago:
3

The foundation for dentures is made up of bone

and covering soft tissues.

The denture base rests on the mucus membrane,

which serves as a cushion between the denture
base and the supporting bone.

- Jacob R. F., Zarb G. A. Maxillary and mandibular

substitutes for the denture bearing area. Prosthodontic
Treatment for Edentulous Patients: Complete Dentures
and Implant-Supported Prosthesis, 13/e. St. Louis
Missouri: Mosby; 2013:161-179.
4

The features of the mucus membrane that either

support the complete denture or come in contact
with it must be analyzed, for they determine how
this support can be used.

-Heartwell C. M. Anatomy and Physiology. Syllabus of

Complete Dentures 4/e. Pennsylvania: Lea & Febiger;
1981:15-18.
5

Definition
The term mucous membrane is used to describe the
moist lining of the intestinal tract, nasal passages
and other body cavities that communicate with the
exterior. In the oral cavity this lining is called the
oral mucous membrane or oral mucosa.
- Antonio Nanci

-Nanci A. Oral mucosa. Ten Cates Oral Histology 7/e.

Missouri: Mosby;2008:319-357.
6

Functions Of Oral Mucosa

1. Protection:
Protects the deeper tissues and organs.
Adapts to withstand mechanical forces.
Barrier in preventing microorganism.
2. Sensation:
Receptors respond to temperature, touch, taste.
3. Secretion:
Major & minor salivary gland secretions
maintain moist surface.
7

Organization of Oral Mucosa

Anatomically, oral mucous membrane is located
between skin of lips and gastrointestinal mucosa.
Oral cavity proper: Contains hard and soft palate
superiorly and floor of mouth and base of the
tongue inferiorly.
Vestibule: bounded by lips and cheeks on one side
and alveolar ridge/teeth on other side.

Boundaries
At the lips, it is continuous with the skin.
At the pharynx, it is continuous with the moist
mucosa lining the rest of gut.
It is separated from pharynx by pillar of the fauces
and the tonsils.

-Nanci A. Oral mucosa. Ten Cates Oral Histology 7/e. Missouri:

Mosby;2008:319-357.
10

Clinical appearance
Colour:
The concentration and the state of dilatation of
small blood vessels
The thickness of epithelium
The degree of keratinisation
The amount of melanin
Inflammation

Texture
Smooth with few folds or wrinkles
Exceptions: dorsum of the tongue, the rugae,
healthy gingival stippling
Consistency
The lining mucosa is soft and pliable
Gingiva and the hard palate are covered by a
firm and immobile mucosa.

Structure
Epithelium
Lamina Propria
Submucosa

13

Epithelium
Lamina Propria

Submucosa

Periosteum
Bone

-Ten Cates Oral Histology 7/e. Missouri: Mosby;2008

-Ten Cates Oral Histology 7/e. Missouri: Mosby;2008

15

Epithelium
Oral epithelium on the surface of the oral mucosa

forms a barrier between the oral environment and

the deeper tissues.
Epithelium of the oral mucosa is stratified

squamous epithelium.
It may be :1. Keratinized
2. Non keratinized
16

-Ten Cates Oral Histology 7/e. Missouri: Mosby;2008

17

-Ten Cates Oral Histology 7/e. Missouri: Mosby;2008

18

O
R
T
H
O

K
E
R
A
T
I
N
I
Z
A
T
I
O
N

P
A
R
A

-Ten Cates Oral Histology 7/e. Missouri: Mosby;2008

K
E
R
A
T
I
N
I
Z
A
T
I
O
N
19

Keratinized epithelium is associated with

masticatory function and have four layers of cells
Stratum Corneum
Stratum
Granulosum
Stratum Spinosum
Stratum Basale
20

Oral Epithelium
-Keratinized

-Ten Cates Oral Histology 7/e. Missouri: Mosby;2008

21

1. Stratum Basale

Single layer
Cells cuboidal or low columnar cells
Maximum mitotic activity
2. Stratum Spinosum
Several layers thick
Cells polyhedral with short cytoplasmic
processes.
Most active in protein synthesis.
22

Stratum
Basale

Stratum
Germinitavum

Stratum
Spinosum
23

3. Stratum Granulosum
Cells flat
This layer is prominent in keratinized epithelium
and absent in nonkeratinized epithelium
Keratohyaline granules help to form the matrix of
the keratin fibres found in the superficial layer

24

4. Stratum Corneum

Cells flat, devoid of nuclei and full of keratin

filament surrounded by a matrix
Absent in non keratinised epithelium

These cells are continuously being sloughed and are

replaced by epithelial cells that migrate from the
underlying layers

25

Non keratinized epithelium has three layers of cells:-

Stratum
Superficiale

Stratum
Intermedium
Stratum Basale
26

-Ten Cates Oral Histology 7/e. Missouri: Mosby;2008

27

Stratum intermedium :Cells larger than the cells of the stratum

spinosum.
The intercellular space is not distended and hence
do not have a prickly appearance.

Stratum superficiale :Cells do not have keratin filaments in the

cytoplasm
The surface cells also have nuclei.
28

Lamina propria
The connective tissue supporting
epithelium is termed lamina propria.

the

oral

-Ten Cates Oral Histology 7/e. Missouri: Mosby;2008

29

1.Papillary layer
Close to epithelial ridges.
Forms finger like projections of connective tissue
that extend deep in the epithelial layers.
2.Reticular layer
Parallel to epithelium.
Fibers are very thick and form a network.
It consists of cells , blood vessels , neural elements
& fibers embedded in amorphous ground
substance.
30

Epithelium
Lamina Propria

Submucosa

Periosteum
Bone

-Ten Cates Oral Histology 7/e. Missouri: Mosby;2008

31

Submucosa
Layer deeper to lamina propria is known as
submucosa.
It attaches mucous membrane to underlying

structures.
It makes major bulk of mucous membrane. Its
thickness and density varies.
It contains glands, blood vessels, nerves and
adipose tissues and lymphatic vessels.

32

Classification Of Oral Mucosa

Though it shows
considerable structural
variation, most
classifications divide it
into 3 main categories :1) Masticatory 25 %
2) Lining 60 %
3) Specialised 15 %
- Nanci A. Oral mucosa. Ten Cates Oral Histology 6/e. Missouri:
33
Mosby;2003

Masticatory
mucosa
Hard palate
Attached gingiva

Lining mucosa
Lips & cheeks
Vestibular fornix
Alveolar process
peripheral to
gingiva proper
Floor of mouth
Inner surface of
lower alveolar
process
Inferior surface
of tongue
Soft palate

Specialized
mucosa
Dorsal surface of
tongue

-Bhaskar S N. Orbans Oral Histology and embryology 10/e

34

Edentulous patient
Masticatory
mucosa
Crest of the
residual
ridge,
including
residual attached
gingiva
firmly
adherent to bone
Hard palate

Lining mucosa
Lips and cheeks
Vestibular space
Alveolingual
sulcus
Soft palate
Ventral surface
of tongue
Unattached
gingiva on slopes
of residual ridge

Specialized
mucosa
Dorsal surface of
tongue.

35
-Bouchers Prosthodontic Treatment for Edentulous Patients 10/e

Crest of Residual Ridge - Maxillary

Epithelium: Keratinised
Lamina propria: Dense
collagen fibers firmly

attach epithelium to the

periosteum of the bone.
Submucosa: thin still
sufficiently thick to
provide
adequate
resiliency for Primary
Support
of
upper
complete denture.
36
-Bouchers Prosthodontic Treatment for Edentulous Patients 10/e

Slopes of the residual ridge

Mucosa loses firmness
along the slope of
residual ridge.
Epithelium: thin, non
keratinized or slightly
keratinized epithelium.
So less stresses should
be placed on the
movable tissue during
impression making.
-Ten Cates Oral Histology 7/e. Missouri: Mosby;2008

Hard palate
Epithelium: thick, orthokeratinized, tightly fixed
to the underlying periosteum.
Lamina propria: long papillae, thick collagenous
tissue especially under rugae.
Submucosa: Anterolaterally Adipose tissue
Posterolaterally Glandular tissue

38

Clinical Relevance
These tissues should be recorded in resting
condition, because when they are displaced in
final impression they tend to return to normal
form within completed denture base, creating an
unseating force on the denture or causing soreness
in patients mouth.
-Zarb G. A. Biologic considerations for maxillary impressions.
Prosthodontic Treatment for Edentulous Patients: Complete
Dentures and Implant-Supported Prosthesis, 10/e. Missouri:
39
C. V. Mosby Company; 1998:147-168.

Median palatine raphae

Extends
from
the
incisive
papilla
to
posterior region of hard
palate .
Mucosa: practically in
contact with the bone.
Sub mucosa is extremely
thin .
Tissue covering the
median palatine suture
is non resilient.
40

Clinical Relevance
Relief should be provided during final impression.
Otherwise denture tends to rock over the centre of
palate when vertical forces are applied to the teeth.
It is very sensitive and excessive pressure can cause
excrciating pain.

41

Palatine rugae
Irregularly shaped rolls of soft tissue in the
anterior part of hard palate.

Should not be distorted.

Rebounding tissue tends to unseat the denture.

42

Soft palate
Epithelium: thin non keratinized, contains taste
buds

Sub mucosa: diffuse, containing minor salivary

glands

43

Difference between MM of hard palate and soft palate

Photomicrograph of the junction (dashed line) between mucosae

covering the hard and the soft palate. The difference in thickness
and the ridge pattern between keratinized epithelium of the hard
palate and nonkeratinized epithelium of the soft palate is apparent.
The thick dense bundles in the lamina propria of the hard palate
appear different from the thinner fibers in the soft palate

Buccal - Labial mucosa

Epithelium: thick non keratinized.
Lamina propria: dense fibrous connective tissue
containing collagen & elastic fibers .
Submucosa: firmly attached to the under lying
muscles.
Minor salivary glands.

45
Fig from http://www.dentalcare.com/en-US/dental-education/

Fordyces spots
Ectopic sebaceous glands present in the buccal and
labial mucosa.

Fordyce granules: Multiple

sebaceous glands below the surface
epithelium.

Vestibular spaces
Vestibule is divided medially by labial frenum &
laterally by buccal frenum.
Epithelium is thin & nonkeratinized.
Submucosa is thick.
Large amount of loose areolar tissue.

Frenum
It is a fold of mucous membrane.
Labial frenum is usally a single band of fibrous
connective tissue.
Buccal frenum is single/ double/ broad fan
shaped.
Relief should be provided in denture.

Crest of Residual Ridge - Mandibular

It is similar to maxillary
ridge.
Submucosa: is loosely

attached.
When the soft tissue is
movable in the crest of
the ridge, impression
should be recorded in
its resting position and
relief provided during
final impression.
49
-Bouchers Prosthodontic Treatment for Edentulous Patients 10/e

Buccal shelf
Partially keratinized.
Loosely attached.
Thick submucosal layer.
Bone compact bone. So, it is primary stress
bearing area.

Retromolar pad
Sicher has described retromolar pad as a soft
elevation of mucosa that lies distal to 3rd molar.
It has loose connective tissue & aggregation of
mucus glands.
Less keratinised epithelium than gingivae.
Retromolar pad is posterior to the pear shaped
pad.
It is shiny, soft and not stippled.
-Levin B. The basic requirements of impression
making. Impressions for Complete Dentures.
Chicago: Quintessence Publishing Co.; 1984:11.
51

Pear-shaped pad

Craddock coined term pear-shaped pad referring

to area of residual scar of 3rd molar and retromolar
papilla.
Usually attached gingiva firm stippled and dull
appearance.
It is in line with the residual ridge and forms its
distal termination.
Mandibular denture should terminate over the
distal edge of pear shaped pad.
-Levin B. Principles of impression making. Impressions
for Complete Dentures. Chicago: Quintessence
Publishing Co.; 1984:13-34.
52

LL Lower lip; RP retromolar pad; PR- pterygomandibular

raphae; RMC Retromylohyoid curtain; BMC Buccal mucosa
of cheek
53

Vestibular spaces
Similar in nature to that of the maxillary
foundation.
The epithelium is thin and non keratinized and
the submucosa is formed of loosely arranged
connective tissue fibres and elastic fibres.

54

Alveolingual Sulcus

Epithelium thin and nonkeratinized.

Submucosa loosly arranged connective tissue.

Anteriorly the submucosa of the mucous
membrane lining the alveolingual sulcus contains
components of the sublingual gland.

Attachements
Anteriorly- Genioglossus.

Molar region Mylohyoid

Retromylohyoid curtain Superior constrictor.
55

Floor of the oral cavity

Epithelium: very thin non keratinized .
Lamina propria: Short papillae, elastic fibers
Submucosa: loose fibrous connective tissue,
adipose tissue, minor salivary glands.

Gingiva
Covers alveolar process,
surrounds teeth.
Types: Marginal,
Attached,
Papillary.

Marginal gingiva:Free gingival groove

Gingival sulcus

Epithelium: thick, ortho/para & non keratinized,

with stippled appearance.

Lamina propria: long narrow papillae, dense
collagenous connective tissue, not highly vascular
but has long capillary loops.
Submucosa: no distinct layer, mucosa firmly
attached by collagen fibers to cementum and
periosteum of alveolar process.

59

Gingival sulcus:
It is a shallow groove
between the tooth and the
normal gingiva that extends
from the free surface of the
junctional
epithelium
coronally to the level of the
free gingival margin.
Depth : 0.5 to 3mm, with
an average of 1.8mm.

Sulcular epithelium:
Nonkeratinized stratified squamous epithelium.
Lacks epithelial ridges, have smooth interface with
connective tissue.
Continuous with
Attachment epithelium
Gingival epithelium

Dentogingival junction:

Its the junction of

gingival and of tooth.
It has a
physiologic
importance.

great

It is a point of
lessened resistance
to mechanical forces
and bacterial attack.

Specialized Mucosa
Dorsal surface of tongue:

The mucous membrane of tongue is composed of

two parts, with different embryologic origins and is
divided by the v-shaped groove, the sulcus terminalis.

63

Embryological difference:
The anterior 2/3rds of tongue 1st pharyngeal
arch
The posterior 1/3rds of tongue 3rd pharyngeal
arch
Texture:
The anterior portion = papillary
Posterior part = the lymphatic portion

64

 The anterior 2/3rds = BODY.

The posterior 1/3rds = BASE.
The mucosa of base of
tongue contains extensive
nodules of lymphoid tissue,
the LINGUAL TONSILS.

Sagittal section through the tongue.

The dorsal surface is covered by a specialized keratinized and
nonkeratinized mucosa, whereas
The ventral surface shows a thinner, nonkeratinized
epithelium. Filiform papillae cover the entire anterior part of
the tongue.

67

Filiform papillae:
These are numerous fine-pointed, cone shaped
papillae that give the dorsal surface a Velvet like
appearance.
These projections, the filiform (thread-shaped)
papillae, are epithelial structures containing a core of
connective tissue from which secondary papillae
protrude toward the epithelium which is keratinized.

Fungiform papillae:
Interspersed between the filiform papillae are the
isolated fungiform (mushroon shaped) papillae which
are round, reddish prominences.
Fungiform papillae contain a few (one to three) taste
buds found only on their dorsal surface.

Histologic section of a fungiform papilla with a CT core and

epithelial covering. 2 taste buds are located on the dorsal
surface of the papilla.
70

Circumvallate papillae:
In the front of sulcus terminalis, there are eight to ten
vallate (walled) papillae.
They DO NOT PROTRUDE above the surface of the tongue
but are bounded by a deep circular furrow so that their only
connection to the substance of the tongue is at their narrow
base.
Their free surface shows numerous secondary papillae that
are covered by a thin, smooth epithelium.

Aggregations of serous glands, called VON EBNERS

GLANDS(VE), open into the base of the circumvallate
clefts, secreting a watery fluid which dissolves food
constituents, thus faciliating taste reception. This is a main
source of salivary lipase.

Taste buds line the lateral walls

of circumvallate papillae

73

LINGUAL TONSIL:
LINGUAL FOLLICLES - round to oval prominences posterior
to sulcus terminalis.
Together the lingual follicles form the LINGUAL TONSIL.

LINGUAL TONSIL

Some Clinically Relevant

Pathologic changes of Oral
Mucousa

75

Soft tissue hyperplsia

Rolls of hyperplastic tissues under denture base
Due to bone resorption, with lesion filling the space
under denture base.
Develops slowly, painless.

Management:
Surgical removal.
New dentures.

www.indiandentalacademy.com

Papillary hyperplasia
Granular type of inflammation seen in palatal
region.
Numerous papillary projections give a warty
appearance.
They show precancerous tendencies.
Treatment: Discontinue denture wearing, surgery if
required and new dentures.

Denture stomatitis
Chronic inflammation of the denture bearing
area.

CAUSES:Para functional habit.

Ill fitting denture .
Nocturnal denture wearing.
Hypersensitivity.
Poor oral hygiene
Infections-Candida albicans

Symptoms:Redness of the tissue.

Pain.
Burning sensation

Management:Discontinue denture wearing.

Maintain good oral hygiene.
New dentures.

Contact stomatitis
Certain individuals react to materials & drugs
differently than others do.
In oral cavity it is termed as contact stomatitis.
Marked redness in limited area contact with
acrylic partial denture.
Such contact sensitivity is
rare.

Candidiasis

Usually seen in :Unclean mouth.

Debilitated patients.
Systemic disease such as diabetes.
Unhygienic conditions will facilitate the
candidal growth.
SYMPTOMS;
Redness with pain.
Swelling of the denture supporting tissue.
Rx Discard the existing denture.
Anti fungal therapy.
New dentures.

Conclusion
The dentures must function in harmony with the
remaining tissues that both support and surround
them.

For this harmony of living tissues & non living

materials(dentures) to coexist for reasonable
period of time, the dentist must fully understand
both the macroscopic & microscopic anatomy of
supporting & limiting structures of dentures.

Refrences
1. Levin B. Impressions for Complete Dentures.
Chicago: Quintessence Publishing Co.; 1984
2. Zarb G. A. Prosthodontic Treatment for Edentulous
Patients: Complete Dentures and Implant-Supported
Prosthesis, 10/e. Missouri: C. V. Mosby Company;
1998.
3. Heartwell C. M. Anatomy and Physiology. Syllabus of
Complete Dentures 4/e. Pennsylvania: Lea & Febiger;
1981:15-18.

83

Refrences
4. Nanci A. Oral mucosa. Ten Cates Oral Histology
7/e. Missouri: Mosby;2008:319-357.

5. Bhaskar S N. Orbans Oral Histology and

embryology 10/e.

84