Oral Histology -

Concept Maps
 DEVELOPMENT OF TOOTH

EARLY BELL STAGE:

• The columnar inner enamel epithelial layer undergoes histodiferentiation to
INTRO FACTS form tall columnar cells called as ameloblasts- responsible for enamel
BUD STAGE •At 5–6 week IUL, at some areas of oral formation.
• low columnar cells in the periphery and ectoderm basal cells proliferate to form the • undiferentiated ectomesenchymal cells of the dental papilla
polygonal cells in the center. primary epithelial band (future dental arches) diferentiate to form columnar cells –odontoblasts- responsible for
• Histophysiologic process: •Primary epithelial band gives rise to dental dentin formation.
Proliferation lamina and vestibular lamina • The basement membrane which separates the enamel organ and dental
•Condensed ectomesenchyme immediately papilla just before dentin formation is called membrana
under the enamel organ -dental papilla (gives preformativa and this membrane develops in to future
rise to dentin and pulp), and the portion dentinoenamel junction.
surrounding the enamel organ and the dental • The junction between the inner and outer enamel epithelia is known as
the zone of reflexion or cervical loop.
papilla is the dental follicle or the dental sac .
•Dental follicle gives rise to cementum, PDL, • stratum intermedium - few layers of squamous epithelial cells between
inner enamel epithelial cell layer and stellate reticulum
CAP STAGE and alveolar bone)
• Cells in the convex portion of the cap - cuboidal in • Histophysiologic process: Histodiferentiation and
shape - form the outer enamel epithelium
•Tooth germ -enamel organ+ dental papilla Morphodiferentiation
+ dental follicle
• cells in the concavity of the cap - columnar in shape - •The development of the tooth germ is divided
form the inner enamel epithelium
into bud stage, cap stage, and bell stage based
• polygonal cells in the center -synthesize on the shape of the enamel organ
glycosaminoglycans which pull water inside,
forcing the cells to move apart. The cells retain •Histophysiologic process: Initiation,
attachment through cytoplasmic processes. proliferation, histodifferentiation, ADVANCED BELL STAGE
• star-shaped cellular network called stellate reticulum morphodifferentiation, apposition • commencement of mineralization of hard tissues and root formation.
• Odontoblast elaborate organic matrix of dentin along the dentinoenamel
is formed. junction, initially in the region of future cusp.
• Histophysiologic process: Proliferation • Ameloblasts produce organic matrix of enamel which mineralizes almost
immediately.
• Histophysiologic process: Histodiferentiation, Morphodiferentiation, and
Apposition (Formation of organic matrix)

DENTAL LAMINA
• The dental lamina of the deciduous teeth undergoes
lingual
and distal extensions to give rise to the enamel
organs of the
TRANSIENT STRUCTURES OF CAP STAGE permanent teeth.
ROOT DEVELOPMENT
• The permanent central and lateral incisors, canines,
•Hertwig’s epithelial root sheath (HERS) arises from the cervical portion of
Enamel knot- vertically extends towards center-Enamel cord. and the
first and second premolars are formed by the the enamel organ- important role in the determination of the shape,
If enamel cord meets Outer enamel epithelium(OEE)- length, size, and number of roots.
Enamel septum. lingual
extensions of dental lamina (succedaneous teeth) • a double-layered structure composed of inner enamel epithelium and outer
So formed depression in OEE –Enamel navel. enamel epithelium cell layers.
• Permanent first, second, and third molars are • Remnants of HERS persists as cords or islands and are called as
developed from
the distal extension of dental lamina (non Epithelial cell rests of Malassez.
succedaneous •HERS bend at the future cementoenamel junction onto a horizontal
teeth). plane forming the epithelial diaphragm.
• The activity of the dental lamina extends for 5 years, •
after which it begins to degenerate because of
mesenchymal invasion.
• The remnants of dental lamina- cell rests of Serres
in the jaw or in the gingiva.
 ENAMEL Enamel tuft
•Consists of hypo calcified enamel rods & interprismic
ENAMEL RODS substance. 
•Shape- Cylindrical •They arise at DEJ & reach in to enamel to about 1/5 to
• Starts from DEJ to outer enamel surface 1/3 of its thickness.
• Number-5 million in lower lateral incisor to 12 million in upper 1st molar. •Their presence & their development are consequence
• Course-Tortuous from DEJ. of an adaptation to spatial condition of enamel. Enamel
•Length- greater than thickness of enamel. tufts prevents enamel fractures
•Diameter: 4 µm in light microscopy. It increases from DEJ to outer enamel Dentinoenamel junction
surface by a ratio of 1:2 since outer surface of enamel is greater than inner •Scalloped structure-The surface of the dentin at DEJ is
surface pitted, in shallow depression of dentin, fit rounded
Incremental lines of retzius
•Rods are oriented at right angles to the dentinal surface. projection of enamel.
• Brownish bands seen in ground sections of enamel that
illustrate successive apposition of layers of enamel during •In deciduous teeth, direction of rods is horizontal in cervical and central parts •It appears scalloped due to the mixing of crystals of
formation of the crown are called Incremental lines of Retzius. of the crown. Near incisal edge or tip of cusp they gradually increase in dentin and enamel with each other.
• In Longitudinal Section, They surrounds tip of dentin From oblique direction and almost vertical in the cusp tip region. Enamel spindles
the DEJ. In cervical parts they run obliquely, deviate to occlusal. •In permanent teeth, in occlusal two third of the crown direction of rods is •Occasionally Odontoblast processes pass across DEJ
oblique . into enamel, since many are thickened at their end, they
• In cervical region rods deviate from the horizontal in apical direction. have been termed enamel spindles

Gnarled enamel INTRO FACTS

•Near the dentin in the region of cusps or incisal • Enamel is an epithelially derived protective covering of variable thickness
over the entire surface of the crown.
edge, bundles of rods seem to interwine more
•It is the hardest biologic tissue in the body.
irregular, especially in section cut obliquely. This
•Maximum thickness of about 2-2.5mm on the cusps of molars and
optical appearance of enamel is called gnarled
premolars.
enamel
•Hardness -296 (Knoop’s hardness no.)
Hunter-schreger Bands
•Enamel is selective permeable. Enamel lamellae :
•The regular change in the direction of rods is
•Specific gravity: 2.8 7. •Thin leaf like structures that extend from enamel surface
responsible for the appearance of alternating dark
•Inorganic content - 96% - Hydroxyapatite. Organic content - 4% toward DEJ.
and light strips of varying width
(Amelogenins 90% ,Low molecular weight, Rich in Prolin, Histidin, •Composition mainly organic, little mineral.
•Can be seen in longitudinal GS under oblique
Glutamin,Leucine. Non-Amelogenins ,10% - High molecular weight  Proteins •Crack is filled either by surrounding cells if it has
reflected light.
-Ameloblastin, Tuftelin,Enamelin. Rich in Glycine,Aspartic acid and Serine). occurred in unerupted tooth,or by organic material if it
has occurred after eruption.
•Type A : Consists of poorly calcified rod segments.
Restricted to enamel.
•Type B: Consists of degenerating cells. May reach into
•Prismless enamel :About 30 µm thick, called dentin.
prismless enamel.In 70% permanent teeth and all •Type C: Containing organic material, presumably from
deciduous teeth •Prismless enamel :About 30 µm thick, called prismless enamel.In 70% saliva. If connective tissue invades the cracks in enamel,
•Perikymata :These are transverse wave like permanent teeth and all deciduous teeth cementum may be formed
grooves, believed to be the external manifestations •Perikymata :These are transverse wave like grooves, believed to be the external
of striae of Retzius. 30 Perikymata per/mm in the manifestations of striae of Retzius. 30 Perikymata per/mm in the region of CEJ
region of CEJ in number. in number.
•Neonatal line :The enamel of the deciduous teeth •Neonatal line :The enamel of the deciduous teeth develops partly before &
develops partly before & partly after birth. The partly after birth. The boundary between the 2 portions of enamel in the
boundary between the 2 portions of enamel in the deciduous teeth is marked by an accentuated Incremental line of Retzius, the
deciduous teeth is marked by an accentuated Neonatal line/ring. Results from abrupt change in the environment & nutrition
Incremental line of Retzius, the Neonatal line/ring. of newborn infant
Results from abrupt change in the environment & •Enamel cuticle :A delicate membrane covers the crown of newly erupted
nutrition of newborn infant tooth called Nasmyth’s membrane or primary enamel cuticle. Covers the entire
•Enamel cuticle :A delicate membrane covers the crown of newly erupted tooth. Thickness: 0.2 µm.
crown of newly erupted tooth called Nasmyth’s
membrane or primary enamel cuticle. Covers the
entire crown of newly erupted tooth. Thickness: 0.2
µm.
 AMELOGENESIS

Life cycle of ameloblast divided into 6 stages

depending upon their function
1.Morphogenic stage
2.Organising stage
3.   Formative stage
4.   Maturative stage
5.   Protective stage
6.   Desmolytic stage
 DENTIN
Peritubular dentin:
•The dentin that immediately surrounds
the dentinal tubules.
• It is more highly mineralized than
intertubular dentin.
• It is twice as thick in outer dentin
(approx. 0.75um) than in inner dentin
(0.4um).
• By its growth, it constricts the dentinal INTRO FACTS •The incremental lines of von ebner, or imbrication lines, appear as
tubules to a diameter of 1um near the
dentinoenamel junction.
• Provides the bulk and general form of fine lines or striations in dentin
tooth.  •Some of the incremental lines are accentuated because of disturbances
• Organic matrix is lost along with mineral •Consists of 35% organic matter and water & in the matrix and mineralization process. Such lines are known as
after decalcification.
65% inorganic material contour lines of owen.
• The calcified tubule wall has an inner
•The organic substance consists of collagenous •These lines represent hypocalcified bands.
organic lining termed the lamina limitans, • In the deciduous teeth and in the first permanent molars, the prenatal
high in glucosaminoglycans (GAG) fibrils and a ground substance of
mucopolysaccharides (proteoglycans and glycos and postnatal dentin is separated by an accentuated contour line. This is
Intertubular dentin:
aminoglycans). The inorganic component termed the neonatal line
•Forms the main body of dentin.
• It is located between the dentinal tubules consists of hydroxyapetite 
or, more specifically, between the zones of •The bodies of the odontoblasts are arranged in
peritubular dentin. Its organic matrix is a layer on the pulpal surface of the dentin, and
retained after decalcification. only their cytoplasmic processes are included in
the tubules in the mineralized matrix
•The course follows a gentle curve in the crown,
less so in the root, where it resembles S in Interglobular dentin.
shape. •Sometimes mineralization of dentin begins in small globular areas
Predentin: that fail to fuse into a homogenous mass. This results in zones of
•Is located adjacent to the pulp tissue. •These tubules end perpendicular to the
hypomineralization between the globules. The dentinal tubules pass
dentinoenamel and dentinocementum junctions.
•Is 2 to 6 um wide, depending on the uninterruptedly, thus demonstrating a defect of mineralization & not
activity of the odontoblast. of matrix formation
•It is the first formed dentin and is not ‘Tomes granular layer’
mineralized. •a zone adjacent to the cementum that appears granular.
•Slightly increases in amount from the cementoenamel junction to
• As the collagen fibers undergo the root apex.
mineralization at the predentin- dentin • Caused by coalescing and looping of the terminal portions of the
front, the predentin then becomes dentinal tubules.
dentin and a new layer of predentin
forms circumpulpally

Primary dentin:
!Mantle dentin is the first formed dentin in the crown underlying the
dentinoenamel junction.  It is the outer or most peripheral part of the
primary dentin & is about 20um thick.
!Circumpulpal dentin forms the remaining primary dentin or bulk of
the tooth. Represents all of the dentin formed prior to root
completion. 
Secondary dentin:
!A narrow band of dentin bordering the pulp and representing the
dentin formed after root completion.
! Contains fewer tubules than primary dentin.
! There is usually a bend in the tubules where primary and secondary
dentin interface.
 DENTINOGENESIS

THEORIES OF DENTIN SENSITIVITY

 PULP

INTRO FACTS
•Pulp cavity terminates at root apex as small opening •
called apical foramen The Pulp is a soft mesenchymal connective tissue
•Diameter in an adult that
! maxillary teeth-0.4mm • Occupies pulp cavity in the central part of the
! mandibular teeth-0.3mm teeth
Accessory canals •Total 52 pulp organs; 32: Permanent, 20: Primary
• Leading laterally from the radicular pulp into the • Total Volume of all permanent teeth pulp
periodontal tissue. organs is 0.38 cc.
•They are numerous in the apical third of the root. • Mean volume of a single adult human pulp is
• Formed due to premature loss of HERS or when 0.02 cc.
developing root encounters a blood vessel.  • The pulp cavity can be divided into two main
regions: the coronal pulp is located within the
crown of the tooth and the radicular pulp is
located within the root.

Histological zones of pulp

1.Odontoblast layer
2. Cell-free zone
3. Cell-rich zone
4.Pulp proper
•OdontoBlastic layer - Adjacent to the predentin with the cell bodies in the pulp
and cell processes in the dentinal tubules.
•Cell Free zone
ücalled weil’s zone
ü40 microns wide &relatively free of cells Pulp calcification ((pulp stones)
ü Traversed by  Blood vessels, Unmyelinated nerves , Cytoplasmic process of
fibroblast !localized ,diffuse
Cell rich zone !False denticle ,True denticle
üPresent in subodontoblastic layer !free, attached and embedded.
üContains more proportions of fibroblast and undifferentiated mesenchymol
cells.  
Pulp proper
üIt is central region of the pulp
ü Contains major blood vessels and nerves of the pulp
CELLS OF PULP - Odontoblasts ,Fibroblasts, Undifferentiated Cells  and 
Defense Cells
 
 CEMENTUM
Types of Cementoenamel Junction
•Cementum overlaps the enamel- 60–65% (most
common) Cementoids
•Edge-to-edge butt joint -30% • Unmineralized layer of cementum on cemental surface (precementum) CLASSIFICATION
•Cementum and enamel fail to meet- 5–10% (least • New layer forms as old calcifies •The arrangement of collagen fibers in cementum can be
common) • 3 to 5 micrometer grouped into two:
•In case of primary teeth, edge-to-edge butt joint is • Embedded portion- Sharpeys fibers üExtrinsic fiber system -Consists of principal fibers (sharpeys fibers) 
most commonly seen Mostly arranged at right angles to cementum.
üIntrinsic fiber system -The fibers are dense and irregularly arranged
within the cemental matrix.Terminal portions of the principal fibers
that insert into cementum & bone are termed as “Sharpey’s Fibers”. 
INTRO FACTS •Based on presence or absence of collagen fibrils in organic
Cementum is a hard, avascular connective tissue that covers the root of matrix
the teeth. ü Fibrillar cementum
• Provides anchorage for collagen fibre bundles of periodontal ligament ü Afibrillar cementum
•Varies form 16-60 micrometer on the coronal half to 150-200 •On the basis of location, structure, function, rate of
micrometer in the apical third and furcation. formation, biochemical composition and degree of
•Inorganic Content -45-50%, Organic Portion (50-55%) mineralization cementum can be classified as:-
• ü Acellular Afibrillar Cementum. (AAC )
Cells of the cementum ü Acellular Extrinsic Fiber Cementum. (AEFC)
•Cementocytes ü Cellular Mixed Stratified Cementum. (CMSC)
!Cementoblasts incorporated into the cemental matrix. ü Cellular Intrinsic Fiber Cementum. (CIFC)
! Lie in spaces known as lacunae. ü Intermediate cementum.
•Cementoclasts: Multinucleated cells, Involved with cemental resorption
Cemento dentinal Junction  
•The dentin surface upon which
cementum is deposited is relatively
smooth in permanent teeth
•The cementodentinal junction in
deciduous teeth, however, is
sometimes scalloped
Incremental lines
• Called lines of salter- period of
rests are associated with these lines
•These lines are closer in acellular
cementum as this is formed slowly 
Whereas in cellular cementum,
theses lines are widely spaced
because of increased rate of
formation.
•

Cementicles
•Abnormal, calcified bodies in the periodontal ligament
•Generally less than 0.5mm in diameter
Types
• Free cementicles
• Sessile or attached cementicles.
• Interstitial cementicles
• As the cementum thickens with advancing age, it may envelop
these bodies.
Age changes in cementum
• Cementum formation continues throughout life and is deposited
at a linear rate.
• More cementum is deposited apically than cervically.
 BONE
Classification of bone: Bone Cells
!Based on Shape  -long, short, flat and irregular •Ostoproginator cells-determined (DOPCs) and inducible osteogenic
bones. precursor cells (IOPCs)express transcription factors cbfa1/Runx-2 and
!Based on Development -endochondral bones and osterix
intramembranous bones •Osteoblasts- Osteoblasts are derived from undifferentiated pluripotent
!Based on Microscopic structure- mature bone and mesenchymal stem cells
immature bone. Mature bone is further classified as •Osteocytes - they are either entrapped in the bone matrix and become
compact bone and cancellous bone. osteocytes or remain on the surface as lining cells. .
•All mature bones have a dense outer sheet of compact
bone and a central medullary cavity. The cavity is filled
with red or yellow bone marrow in living bone
•The outer aspect of compact bone is surrounded by a
condensed fibrocollagen layer, the periosteum which
has two layers: an outer fibrous layer; and an inner
osteogenic layer, The inner surfaces of compact and
cancellous bone are covered by a thin cellular layer
called endosteum
•
•

INTRO FACTS
•At the periosteal and endosteal surfaces, the lamellae are arranged in parallel layers Bone is a specialized form of connective tissue.
surrounding the bony surface and are called circumferential lamellae •It consists of cells and extracellular substance (matrix and fibers
•Haversian (vascular) canal (about 50micron in diameter) and the concentric •Inorganic mineral component -hydroxyapatite crystals
lamellae together is known as the osteon or haversian system  Osteoclasts (bone resorbing cells - Osteoclasts are derived from hemopoietic cells of
• The organic matrix is known as osteoid and is made up of collagen( Type I collagen - 95%) and the noncollagenous
•Adjacent haversian canals are interconnected by Volkmann’s canals, channels that monocyte macrophage lineage.Osteoclasts lie in resorption bays called Howship’s lacunae. The
proteins (Osteocalcin (Gla proteins), Osteopontin, bone sialoproteins and Osteonectin).
contain blood vessels, creating a rich vascular network, throughout the compact formation of osteoclast requires the presence of RANK ligand (receptor activator of
•Alveolar bone contains type I, type V, type III and type XII collagen
bone Functions of bone: nuclear factor kB) and M-CSF (macrophage colony stimulating factor)
•Reversal line- It marks the limit of bone erosion prior to the formation of osteon •
•Serves as a reservoir for calcium and phosphate (containing 99% of body calcium).
highly irregular as it is formed by the scalloped outline of the Howship’s lacunae. •Contains bone marrow which function in hemopoiesis. Provides for attachment of muscles.
high content of glycoproteins and proteoglycans. •Protects and supports vital organs.
•Resting line, which denotes the period of rest during the formation of bone
•.

•The major portion of the bone consists of the matrix. It has inorganic and organic components. The inorganic
component of bone consists of carbonated hydroxyapatite (Ca10[PO4]6[OH]2). They are in the form of needle-like
crystals or plates. The matrix is initially laid down as unmineralized osteoid and is later mineralized.
•The organic part of matrix is mainly composed of collagens. The types of collagen seen in bone are types I, III
•Bone remodelling is a continuous process of bone resorption and bone formation for maintaining normal
and V, of which type I is more predominant. Collagen provides resilience to bone tissue and helps prevent fractures.
bone mass. It involves the removal of mineralized bone by osteoclasts followed by the formation of bone
• Non-collagenous proteins also contribute to the organic component. Examples of non-collagenous protein
matrix through the osteoblasts. Bone remodelling serves to adjust bone architecture to meet changing
include proteoglycans and glycoproteins such as osteonectin, osteopontin and osteocalcin. Other exogenous
mechanical needs, and it helps to repair microdamages in bone matrix, preventing the accumulation of old
proteins which form part of the bone matrix include cytokines such as interleukins and growth factors.
bone. It also plays an important role in maintaining plasma calcium homeostasis. The regulation of bone
•
remodelling is both systemic and local.
•The part of bone that shows the beginning of resorption is called the cutting cone. This zone is lined by
osteoclasts. After a layer of bone is resorbed, mononucleated cells colonize that region and differentiate
into osteoblasts. Osteoblasts produce a layer of bone called the reversal line over which new bone is laid
down to form an osteon and is mineralized. This zone where laying of new bone takes place is called the
filling cone.
•The systemic factors that regulate remodelling are the parathyroid hormone (PTH), calcitriol and other
hormones such as the growth hormone, glucocorticoids, thyroid hormones and sex hormones. Factors such
as insulin-like growth factors (IGFs), prostaglandins, tumour growth factor-β (TGF-β), bone morphogenetic
proteins (BMP) and cytokines are also involved. The receptor activator of NF- κB (RANK) ligand
(RANKL) and osteoprotegerin (OPG) system regulates the osteoclast. RANKL induces formation of
osteoclast while OPG inhibits formation
 ALVEOLAR BONE PARTS OF THE ALVEOLAR BONE
The alveolar bone is a part of the maxilla and mandible that
FUNCTIONS forms and supports the sockets of the teeth. It consists of an
•Supports the teeth outer cortical bone and a central trabecular bone.
•Provides a framework for bone marrow •Along with the cementum, the alveolar bone forms the
•Acts as a reservoir for ions, especially ALVEOLAR BONE
attachment apparatus of the teeth.
calcium •The alveolar process forms with the development and the eruption of teeth
• The alveolar bone is similar to the bone in other parts of the
•Helps distribute and absorb forces •  Alveolar bone proper (known as lamina dura in radiographs) consists partly of
body. It is also referred to as pars alveolaris or the alveolar process.
during mastication lamellated and partly of bundle bone and is about 0.1–0.4 mm thick
•The alveolar bone in between the roots of teeth is called the
• Bundle bone is the term given to bone adjacent to the periodontal ligament that interdental septum. The bone which supports the alveolar bone is
contains a great number of Sharpey fibers called the basal bone
• Bundle bone is localized within the alveolar bone proper •The alveolar bone and the basal bone of the mandible do
•Bone between the teeth is called interdental septum and is composed entirely of not have any clear-cut boundaries. The alveolar bone can be
cribriform plate. divided into two parts on the basis of how it has adapted
•The turnover rate of alveolar bone is higher as compared •The interdental and interradicular septa contain the perforating canals of Zuckerkandl itself to provide its function.
to other parts of the skeleton. and Hirschfeld (nutrient canals) which house the interdental and interradicular arteries, The alveolar process has two parts:
veins, lymph vessels and nerves •Alveolar bone proper
•The alveolar bone is always under a constant state of
• In adults, the marrow of the jaw is normally of the fatty or yellow type. •Supporting alveolar bone
fluctuation. Formation and removal are continuous in the
alveolar bone. This internal remodelling is regulated by
local and systemic factors.
•The highest level of remodelling happens in the bundle
bone adjacent to the periodontal ligament. DEVELOPMENT
•The increased rate of remodelling is the result of •The alveolar bone is a tissue of mesenchymal origin. It ALVEOLAR BONE PROPER
forms in the early foetal life, during the initial stages of •The alveolar bone proper is just adjacent to the tooth socket around the root, and it
constant mesial and occlusal movement of the teeth.
tooth development. It develops from the cells of the gives attachment to the principal periodontal ligament fibres. The alveolar bone
Mesial drift/mesial movement occurs throughout life to dental follicle. proper is also called cribriform plate as it has a sieve-like arrangement because of the
compensate for the loss of teeth substance on the •After the first layer of radicular dentin is laid down, the presence of perforations and canals for the entry of vessels and nerves. The alveolar
proximal aspect (due to the mesial component of occlusal Hertwig’s epithelial root sheath gets invaded by the cells bone proper is made up of bundle bone and lamellated bone.
forces to which the teeth is constantly subjected to). of the dental follicle and loses its continuity. Bundle Bone The bone which is the site of attachment for the periodontal fibres is
called the bundle bone. These fibres which enter the bone are referred to as Sharpey's
•The cells of the dental follicle then come in contact fibres. Sharpey’s fibres are oriented oblique or at right angles to the surface of the
with the radicular dentin, following which there is tooth. These fibres are arranged in a regular manner in the form of bundles giving
differentiation of cementoblasts, osteoblasts and rise to the term bundle bone. The fibres attached to the alveolar bone are larger than
fibroblasts. The osteoblasts are responsible for the the fibres getting attached to the cementum. Sharpey’s fibres consist of a central
formation of the alveolar bone. core region which is uncalcified and is surrounded by a calcified outer layer; some of
the fibres are completely calcified.
Occlusal forces have an effect on the bundle bone. The normal physiologic tooth
movement can cause remodelling of this region. In some areas of the alveolar bone
SUPPORTING ALVEOLAR BONE proper, the bundle bone is absent.
The supporting alveolar bone has two regions: Lamina Dura A thin layer of compact bone of the alveolar bone proper appears as
•Cortical bone: It contains cortical plates. The a radiopaque area lining the tooth socket; this is called the lamina dura. The increased
cortical plates are narrower in the maxillary region and radiopacity of lamina dura when compared with the supporting alveolar bone is due
thickest in the molar region of the mandibular bone. to the difference in orientation of the mineral crystals. The total mineral content is
They are seen on the facial and lingual surface of the the same in both the regions.
alveolar bone. •
•Spongy bone: It is also called spongiosa or cancellous
bone. It contains trabeculae that enclose irregularly
shaped marrow spaces. The pattern of the trabecular
MISCH CLASSIFICATION arrangement varies widely as it depends on the •Lamellated Bone The bone immediately adjacent to the bundle bone is
•D1: Primarily made of cortical bone occlusal forces. The spongy bone is seen more in the the lamellated bone. It contains lamellae, which are thin plate-like structures
•D2: Consists of coarse trabecular bone maxilla than in the mandible and is predominant in the arranged parallel to each other. It also consists of Haversian systems, osteon
covered by dense cortical bone inter-radicular spaces. and canaliculi. Each osteon consists of concentric layers or lamella of
•D3: Consists of fine trabecular bone covered •The spongy bone is further divided into two types in osseous tissue that surround the central Haversian canal. The Haversian
by thin cortical bone a dentulous jaw: canal contains the bone's nerve and blood vessels. Between the adjoining
•D4: Contains only trabecular bone without •Type I: This contains trabeculae that are present osteons, there are angular intervals that are occupied by interstitial lamellae.
crestal cortical bone regularly in a ladder-like arrangement. •Interdental Septum The alveolar bone between the adjacent teeth is
•Type II: This contains trabeculae in an irregular called the interdental septum. It is composed of the compact bone of the
arrangement. alveolar bone proper and trabecular/cancellous bone. It is the bone that
•Type I is seen more in the mandibular alveolar bone divides one socket from another. The alveolar bone between the roots of
and Type II in the maxillary alveolar bone. the same tooth is called the inter-radicular septum and is seen in molars with
• two or three roots.
 Periodontal ligament
Periodontal ligament components
•Extra cellular
üFibres-collagen,elastic ,reticular,
indifferent fiber plexus and oxytalan •The periodontal ligament is a soft, fibrous
üGround substance proteoglycans, specialized connective tissue which is present in
glycoproteins and glycosaminoglycans the periodontal space, which is situated between Fibers Collagen
•Cellular the cementum of root of the tooth and the
üSynthetic cells-osteoblasts, cementoblasts, bone forming the socket wall
fibroblasts •53 – 74 % of periodontal ligament volume Principal fibers Type I
üResorptive cells-osteoclast, cementoclast, consists of collagen and oxytalan fibers. 1 – 2 %
fibroblast consist of vascular elements.  Remainder
üProgenitor cells consists of cells and neural elements.
üEpithelial cell rests of Malassez • The connective tissue of periodontal ligament Reticular fibers Type 3
üDefense cells-mast comprises collagen ,Proteoglycan, glycoprotein
cells,macrophages,eosinophils and small amount of glycogen. Major
component is Type – I collagen with Type III Basal lamina Type 4
collagen accounting for 15 – 20 % of total
collagen
•shape of periodontal ligament -hour glass
shape Thinnest around the middle third of the Alignment and organization of Type XII
root & widens both apically and near the crest periodontal fibers/in tooth development
Blood supply is derived mainly from  Inferior and superior alveolar •Width variable = average 0.15 mm– 0.38mm to cells within the periodontal ligament
arteries to mand. & max respectively from 3 sources:
Immunolocalized in the periodontal Types XII and VI
1. Apical vessels (Dental artery) – supply dental pulp
ligament and the gingiva
2. Transalveolar vessels (rami perforates-penetrating vessels from
alveolar bone)
3. Intraseptal vessels (anastomosing vessels from the gingiva) 
Nerve bundle divide → myelinated fibers → lose their myelin sheath
→ end in one of the 4 types of neural terminations
•Free endings with treelike ramifications-pure nociception
•Ruffini’s endings-Are mechanoreceptors.
•Meissner's corpuscles -mid-root, for tactile perception
•Encapsulated spindle type : temperature receptor, associated with root
apex.
Lymph vessels - Follow the course of blood vessels. 
 Oral mucous membrane CLASSIFICATION
On the basis of their primary function, the oral mucosa is
classified into three main types:
•Masticatory mucosa, which contributes to about 25% of
FUNCTIONS the total area comprising the gingiva and hard palate.
•Defensive: A large number of microorganisms reside in the •Lining mucosa, which contributes to about 60% of the
oral cavity and behave as commensals. These microorganisms total area. This includes lip, cheek, vestibular fornix, alveolar
can become pathogenic and can cause infection if they are able mucosa, floor of the mouth and soft palate.
to gain access to the underlying tissues. The oral mucosa acts as •Specialized mucosa, which contributes to about 15% of
an efficient barrier against the entry of these microorganisms the total area. This includes dorsum of the tongue
and the toxins produced by them. It also secretes antibodies
and has an efficient humoral and cell-mediated immunity.
•Protection: It separates and protects the deeper tissues from The two main components of the oral mucosa are
compressive and shearing forces that might result because of •
•Keratinized epithelium has four cell mastication and surface abrasion that might occur due to hard 1. stratified squamous oral epithelium
layers which are named on the basis of particles in diet. 2.underlying connective tissue layer known as
their morphological appearance •Secretion: The oral mucosa is kept moist due to saliva lamina propria ( Papillary layer & Reticular layer)
•Basal layer (stratum basale) secreted by the glands. Minor salivary glands are situated within •A structureless layer, the basal lamina, is seen at
•Spinous layer (stratum spinosum) the oral mucosa whereas the major salivary glands are situated the interface between the epithelium and
•Granular layer (stratum granulosum) at a distance from the mucosa. The moist surface prevents the connective tissue. In some regions such as the lip
•Cornified layer (stratum corneum) mucosa from drying. It helps in speech, mastication, swallowing and cheek, a layer of loose fatty or glandular
and perception of taste. It also helps to retain water and connective tissue separates the oral mucosa from
electrolytes. the underlying muscle. This layer is known as
•Sensory: The oral mucosa has receptors which respond to submucosa
Non Keratinocytes touch, pressure, pain and temperature. The sensation of taste is •In some regions such as the gingiva and hard
Non keratinised epithelium has three layers:
•melanocytes, perceived by the taste buds present in the dorsum of tongue palate, the oral mucosa is directly attached to the
•Stratum basale
•Langerhans cells, periosteum. of the underlying bone without any
•Stratum intermedium which is not found elsewhere in the body.
• Merkel cells intervening submucosa. This type of firm
•Stratum superficiale •
•inflammatory cells.  attachment is known as mucoperiosteum.

•Gingiva is a part of the masticatory mucosa which

Epithelial connective tissue interface •The two populations of epithelial cells are: covers the alveolar process of the jaws and surrounds
•Under a light microscope, this interface •Progenitor population: These groups of cells remain in the necks of the teeth.
appears 1–2 µ.m thick and stains the basal layer and divide to give rise to new cells. •Marginal Gingiva or Free Gingiva This is the
positively with periodic acid-Schiff stain •Maturity : These groups of cells, after their origin, terminal visible edge of the gingiva, about 1–2 mm
and is termed basement membrane. become determined an population and migrate from the wide, surrounding the tooth in a collar-like fashion. It
Ultrastructurally, it is called the basal basal layer to the surface to replace the cells that are shed. is also known as unattached gingiva. The surface
lamina and is made of three layers: facing the teeth forms the soft tissue wall of the sulcus.
Because of this migration, they become part of each layer
•Lamina lucida is a clear zone just below The surface of the gingival margin s smooth, in
at every stage. The migration of cell from the basal layer contrast to that of the attached gingiva, from which it
the epithelial cells.
•Lamina densa is the middle of the three to the surface is known as maturation, and the cells increase is demarcated by an indentation called free gingival
layers. in size and shape during this process. groove.
•Lamina fibroreticularis (sublamina densa)
masticatory mucosa, the epithelium of which
is orthokeratinized or parakeratinized. Junctional epithelium specialized epithelial
•In edentulous individuals, the chewing surfaces tissue which divides faster than any other
CYTOKERATINS of dental arches are covered by masticatory normal epithelium. The mean turnover
The cytoskeleton of all epithelial cells is made up of microfilaments, mucosa. The connective tissue contains time of junctional epithelium is 2–6 days.
microtubules and cytokeratins collagenous fibres which are thicker and more •External basal lamina: The basal cells
20 types of cytokeratin which are classified as type I (neutral or basic, 1–8) organized than those fibres in the lining rest on the external basal lamina that
and type II (acidic, 9–20). Cytokeratins have a high degree of tissue and mucosa. The connective tissue adheres firmly to interfaces with the connective tissue, as in
layer specificity. the underlying periosteum of the bone, making any other epithelium.
•The suprabasal cells of keratinized mucosa express CK1 and CK10 while the mucosa immobile. •Internal basal lamina: Suprabasal cells
the suprabasal cells of non-keratinized mucosa express CK4 and CK13. • have a similar appearance and maintain
Similarly, there is regional variation in the expression of cytokeratin. While actual attachment of gingiva to the tooth
the ventral surface of tongue expresses CK5, CK6 and CK14, the soft surface (enamel or cementum) by means
palate expresses CK7, CK8 and CK18. of the structural complex, internal basal
lamina. The internal basal lamina is
distinctive because it binds to calcified
surfaces rather than connective tissue
 Oral mucous membrane
hard palate is vaulted (concave); this space is mostly filled by tongue at rest. The anterior two-
third of the palate has a bony skeleton formed by the palatine processes of the maxilla and the
horizontal plates of the palatine bone.
•The incisive fossa is a depression in the midline of the bony palate posterior to the central
incisor teeth into which the incisive canals open. The mucosa of the hard palate is a masticatory
mucosa with ortho-or para-keratinized epithelium. The mean turnover time of hard palate cells
isa 24 days.
•The submucosa in the lateral regions of the anterior palate is composed of fatty tissue and that
in the posterior palate is composed of palatine glands. In the centre of the palate, there is no
submucosa and the connective tissue is directly adherent to the underlying periosteum of the
bone termed median raphae (

T a b l e Gingival Fibres

Fibres Origin Insertion Distribution

Cementum, Inserts into lamina Is grouped as superficial,

Dentogingival
Within free gingiva
coronal to the Inserts within
propria of free
the Extends long
middle anddistances,
deep;
Longitudinal

Within marginal gingiva into

Inserts Some
sometimes
cross interdentally
all over the
Circular
Crest
andof the Fanscementum
out into and/ Radiates
to joincoronally
the fibre group
Alveolo-
alveolar bone
Cementum Passes
overlying
over the
lamina Is distributed in labial and
Dentoperioste
Cementum of one Inserts into crest
alveolar Is distributed interdentally
lingual gingiva
Transseptal
Cementum
tooth near Crosses the free
cementum of the Is distributed over free
over the interdental
Semicircular
Cervical
the Inserts into marginal
gingiva margin, Reinforces circular and
gingival margin
Transgingival

Interdental/ cementum
Coronal portion of Inserts
gingiva
into buccal
of Runs
semicircular
in the buccolingual
fibres and

Vertical Alv Insert Runs

 Salivary Gland

Serous Cell Mucous Cell

Pyramidal or wedge Columnar cells

Large spherical Flattened nucleus basally located

Secretory granules— Secretory granules—mucinogen

Plasma membrane at Not seen in a mucous cell

Intercellular canaliculi Intercellular canaliculi absent

Serous acinus/serous Mucous acinus/secretory end pieces

•Saliva is the product of multiple salivary glands lying beneath the oral
mucosa. It is made up of 99.5% water and 0.5% solutes. Inorganic Organic Components
•Each day, the human salivary glands produce almost 1200 mL of Calcium Mucins
serous and mucinous saliva containing minerals, electrolytes, buffers, Phosphate Proline-rich proteins
enzymes and enzyme inhibitors, growth factors and cytokines,
immunoglobulins (e.g. secretory immunoglobulin A [sIgA]), mucins Bicarbonate Amylase
and other glycoproteins Fluoride Lipase
Thiocyanate Peroxidase
Sodium Lysozyme
Potassium Lactoferrin
Chloride IgA
Lead Histatins
AGE CHANGES Cadmium Statherin
•Decrease in the amount of salivary secretion (also because of
Copper Others: Blood group
the old age ailments and consequent drug therapy)
•Atrophy of acinar cells
•Fibrosis
•Gradual replacement of secretory components by adipose
tissue
•Increase in intercalated ducts
•Dilation of striated ducts
•Appearance of oncocytes (enlarged inactive cells with
pyknotic nucleus)
 Eruption

Eruptive movements
•Pre-eruptive tooth movements
Pre-eruptive movements are achieved by (i)
bodily movement of the tooth germs and (ii)
eccentric growth of the tooth germ.
•Eruptive tooth movements
•Post-eruptive tooth movements
Post-eruptive movements take place to
accommodate and compensate for (i) growth
of the jaw, (ii) proximal wearing away and (iii)
incisal/occlusal wearing away.

Theories of Eruption
Causes for Delayed Tooth Eruption
Root formation theory •Gardener syndrome
•The root formation theory proposes that the tooth movement in the axial or •Down syndrome Premature Eruption
occlusal direction is mainly because of the formation of the root. The •Hypopituitarism
simultaneous occurrence of these two activities primarily gives the impression that •Vitamin D resistant rickets Dental open bite
root formation is an important prerequisite for the eruption of teeth. •Cleidocranial dysplasia
Obesity
Bone-remodelling theory •Sclerosteosis
•Bone-remodelling theory explains that the eruption takes place in a manner •HIV infection Diabetes
similar to the pre-eruptive movements. The resorption of the bone at the site of •Nutritional deficiency
pressure and the deposition of the bone at the site of tension may cause eruption. •Arch-length deficiency Increased adrenal
Vascular pressure theory •Genetic predisposition androgen secretion
•vascular pressure theory suggests that the change in the arterial pressure of the •Radiation damage
surrounding vessels could be responsible for the eruption. •Traumatic displacement of the secondary tooth germ
•Premature loss of the primary tooth
Ligament traction theory
•dental follicle–periodontal ligament complex pulls the tooth into the oral cavity, •Gingival hyperplasia
similar to traction.•This theory is the most accepted one. •Ankylosis
•Cysts and tumours
 Shedding
Shedding Pattern
Te physiologic process by which • pressure exerted by the growing and
erupting permanent teeth decides the
deciduous teeth are removed to allow the suc- pattern of resorption of deciduous
ceeding permanent teeth to take their functional teeth. developing teeth germs of the
position is known as shedding or exfoliation. permanent incisors and canines are
positioned lingual to their
corresponding deciduous teeth.

• During eruption, these permanent

teeth undergo physiologic movement
in occlusal and vestibular direction
initiating resorption of the roots of the
corresponding deciduous teeth on their
lingual surface
• eruptive movement of the permanent
teeth germs, which are then positioned
directly beneath the roots of decidu-
ous teeth, causes resorption,

Factors responsible for resorption of

deciduous teeth are
– Pressure from erupting permanent
successor
– Increased masticatory force
Ÿ The resorption of soft tissue such as the
periodontal ligament and pulp occurs by
Odontoclast apoptotic cell death.
• Odontoclasts are large, multinucleated cells
responsible for the resorption of dental hard
tissue. Histologically, they are similar to bone-
resorbing osteoclasts.
• They are derived from
tartrate-resistant acid phosphatase (TRAP)-
positive circulating monocytes and are present
within resorption bay (Howship’s lacunae).
• Odontoclasts have a vacuolated cytoplasm
and their cell membrane which is adjacent to the
resorbing hard tissue shows extensive folding
into a series of invaginations, 2–3 µm deep, called
the rufed border.
 Temporomandibular joint

•The TMJ is a type of synovial joint. It is also referred

as the ginglymoarthrodial joint because it has both the
ginglymus (a freely moving joint in which the bones
are so articulated as to allow extensive movement in
one plane) and the arthroidia (a hollow area onto
which the head of the other bone joins).

•The TMJ consists of the following hard-tissue and soft-tissue components:

•Bone/hard-tissue components
•Mandibular condyles
•Glenoid fossa of the temporal bone
•Articular eminence
•Soft-tissue components
•Articular capsule
•Articular disc
•Ligaments
•Muscles
•
The condyle is covered by a thin, fibrous layer which consists of poorly
vascularised, dense
connective tissue with few fibroblasts and chondrocytes. This layer is called
lamina splendens. Type I
collagen forms the major component of this layer. The condyle, in the
earlier stages, has a layer of
The articular disc/intra-articular disc is a roughly oval, firm, thick plate of dense, fibrous cartilage,
proliferating hyaline cartilage underlying its fibrous covering. The cartilage
located between the condyle and the articulating surface of the temporal bone. The disc divides the
acts as an active site of
joint cavity into two compartments—superior and inferior. Its viscoelasticity helps it to act as a
growth in the newborn and is later replaced by bone.
shock
absorber and stress distributor. The disc provides a gliding motion during the opening and closing of
the jaw. It is thick at its periphery and thin at the centre. The upper surface of the disc is
concavoconvex to fit the upper articular surface of the joint, and the lower surface is concave for the
head of the condyle to fit in. The articular disc is predominantly avascular; blood vessels are seen at
the margins of the disc.
The articular disc is divided into four parts:

1. Anterior band
2. Intermediate band
3. Posterior band
4. Bilaminar zone
 Maxillary sinus
The maxillary sinus (or antrum of Highmore) is a
paired pyramid-shaped paranasal sinus within the maxillary
bone which drains via the maxillary ostium into the
Relations infundibulum, then through hiatus semilunaris into the
Anterior: Facial surface of the maxilla middle meatus. It is the largest of the paranasal sinuses.
•Inferior: Alveolar and zygomatic processes of the maxilla
•Superior: Orbital surface of the maxilla
•Posterior: Infratemporal surface of the maxilla

The Schneiderian membrane, also called the

Schneiderian epithelium, is the lining of the paranasal
sinuses and nasal cavity. It’s unique in that the ciliated
columnar lining is ectodermally derived and features
goblet cells
Functions
•Warming of inspired air
•Humidification of dry air
•The structure and components of the sinus help in
creating appropriate resonance in the voice and thus play a
major role in speech
•Pneumatization of the sinus aids in lightening the weight
of the skull