Fig. PMCID: PMC1231826 PMID: 1254526 [PubMed - indexed for MEDLINE] MeSH Terms. The vermilion border (or margin, or zone) is usually defined as part of the skin. It has a rich blood supply and numerous elastic fibers within the lamina propria, but few dermal papillae and rete pegs. Unfortunately, parts of the skin and oral mucosa receive different names and are classified differently based on their location. Image credit: “Retrieval of the subepithelial connective tissue graft from the palate and placement at the recipient site” by DRosenbach is licensed under CC BY-SA 4.0. This procedure is very similar to different types of bone tissue grafts and is not limited in use to the gingiva—a video of a heart valve replacement using bovine pericardium can be viewed here We hope you appreciate the amount of histology and cell biology required to understand how pieces of cow hearts can be used to repair damaged gingiva. The mouth begins at the vermilion border of the lips. A free gingival graft may be done around dental implants, or used to repair gingival recession. Nicotinic stomatitis is a visible change to the hard palate. In subsequent chapters on the teeth, pay attention to how the lineage of tooth tissues is different from that of oral mucosa, as well as to how their basic pattern is similar. The border between the red area of the lip and the skin is called the vermilion border. It is thought that this condition might be triggered by overgrowth of certain oral fungi, possibly following the loss of competition with the use of certain antibiotics. Ultimately, the patient’s own epithelial stem cells migrate over the scaffold to regenerate the oral mucosa. If your patients smoke, these two nicotine-delivery methods are considerably safer for both the lungs and oral cavity, and can be helpful tools in smoking-cessation (nicotine is the addictive component of tobacco products). Until damage to the barrier is repaired, inflammation continues. Latham RA, Deaton TG. There are other pigments that cause color changes to the gingiva, and they are classified as either endogenous (produced by human cells) or exogenous (environmental). Image credit: "Lip (human), region between red zone (vermilion border) and mucosa inner surface" by Poels, Lambert G. is licensed under CC BY-NC-ND 3.0. It creates a space between the gingiva and tooth, named the gingival sulcus. In a healthy state, the distance from the marginal gingiva to the epithelial attachment should be between 1-3mm. A hair follicle is an invagination (an inward-folding) of the epidermis. Gingivitis also increases the risk of developing Alzheimer’s Disease and heart disease, making it all the more important to intervene as early as possible. Bundles of skeletal muscle fibers (musculus orbicularis oris), highly vascularized lamina propria. 4 Inside is a thick stratified squamous epithelium, with mucous glands in its lamina propria. Vermilion border The two images on the left show the oral mucosa lining the maxillary (above) and the mandibular (below) regions. Folic acid is required for cell division, low levels during pregnancy can lead to congenital malformations of the neural tube (spina bifida). Because the junctional epithelium is more permeable than other regions of the oral mucosa, white blood cells come into contact with this bacterial population and trigger inflammation. It is where lipstick is sometimes applied. Marginal gingiva is similar to the attached gingiva. Endogenous pigments commonly found in the gingiva, besides melanin, include hemoglobin and breakdown products of hemoglobin. Vermilion: The red part of the lips (Fig. It represents the change in the epidermis from highly keratinized external skin to less keratinized internal skin. It is composed in part of a layer of dense irregular CT, the old-fashioned name for which is the reticular layer of the dermis. Poor oral hygiene, however, can lead to increased levels of oral bacteria within the periodontal pockets. After synthesizing melanin, melanocytes transfer it to keratinocytes inside of vesicles (melanosomes). This is because stem cells generally halt progression through the cell cycle until the inflammatory process removes the source of the stress. It has no sebaceous glands, sweat glands, or facial hair. It has no sebaceous glands, sweat glands, or facial hair. A 49-year-old woman, presented with an asymptomatic, 1-cm-diameter, erythematous, telangiectatic and crusted nodule on the upper lip evolving for 9 months and having once interested the vermilion border. Tobacco smoke creates numerous free radicals that can be absorbed by epithelial cells, thus increased melanin production helps protect the oral mucosa. / Arrows added. Similar signals govern the spacing of the teeth. Instead, sebum accumulates in the cytoplasm and is secreted by destruction of the cell. The reason the filiform papillae appear hair-like is that both filiform papillae and hairs are composed predominantly of dead keratinized epithelial cells. The areas devoid of hairs are lips (vermilion border), palms & soles, palmar surface of fingers & plantar surface of toes, glans penis, inner surface of prepuce, & inner surface of anus. Table 3.4: Turnover time of the various regions of oral mucosa and skin. The epithelium is thin and therefore the blood vessels are closer to the surface. Why we study Oral Histology : •To understand the structures and functions of oral tissues. It has no sebaceous glands, sweat glands, or facial hair. Winter 1987;11(2):158-63. Contrasts for the rates of growth were assessed with t tests for correlated measures. The underlying causes of geographic tongue are unknown. We cover adverse effects of nicotine when we discuss PDL loss in chapter 11. Figure 3.3: Histology of focal melanin in a melanocytic nevus (mole). The vermilion border of the lips (lip for short) is the only part on the face where the oral mucosa is persistently exposed to the outside. Like edema, gingival hyperplasia may be caused by poor oral hygiene. Figure 3.40: Bleeding on probing (BoP). The epidermis of the skin is highly keratinized. Under the microscope, the absence of dermal papillae and rete pegs indicates this tissue gets very little abrasion. Similarly, the patient’s mesenchymal stem cells migrate through the scaffold and replace the transplanted collagen, regenerating the lamina propria and sub-mucosa. It is not caused by nicotine, which is an addictive substance but mostly non-toxic, despite what many otherwise reliable resources suggest. It is special in that its apical surface attaches to the tooth by way of hemi-desmosomes. Image credit: “Pitting edema” by James Heilman, MD is licensed under CC BY-SA 3.0. The depth of a periodontal pocket can be measured using a calibrated probe. Figure 3.22: Illustration of the histology of the tongue. [9], A vermilionectomy (sometimes spelled vermillionectomy) is the surgical removal of the vermilion border. 3.9 illustrates a lining mucosa. Gingival hyperplasia is an abnormal growth of gingival tissue. It was intended to replace Nomina Histologica.The Nomina Histologica was introduced in 1977, with the fourth edition of Nomina … A third function of melanin is its ability to bind free radicals. One unfortunate difference is the names we use for the skin are not the same names we use for oral mucosa. Tetracycline antibiotics bind to melanin, which triggers melanocytes to up-regulate melanin synthesis. As you should see, the oral epithelium grows quickly, which means it can regenerate quickly following injury. Epithelial stem cells in the basal layer of the epidermis give rise to new keratinocytes, and as keratinocytes mature, they are pushed towards the apical surface. Environmental changes trigger melanocytes to changes the levels of melanin they produce, and these changes illustrate several functions of melanin. If the increase in keratinization is localized, it is referred to as leukoplakia. The vermilion border of neonatal lips. It represents the change in the epidermis from highly keratinized external skin to less keratinized internal skin. Consideration should be given to the way the question is asked, since the patient may be sensitive about this facial difference. Without stem cells generating new cells, chronic stress allows everyday wear on a tissue to accumulate. Sheldahl's histology, embryology, anatomy and physiology. First, stratified squamous epithelium and underlying areolar connective tissue are lumped together and called the oral mucosa. The epithelial cells make a large protein called keratin (or more accurately, keratins, as there are over 50 genes for slightly different keratin molecules), which is similar to collagen, except keratin is not secreted. These microorganisms come into contact with the bloodstream with disruption to the epithelial barrier. First, the connective tissue that surrounds a cow or pig heart (the pericardium) is harvested and stripped of any pig or cow cells. Sulcular epithelium (or crevicular epithelium) is lined by either a non-keratinized or para-keratinized stratified squamous epithelium. Similar to the sub-epithelial graft, the free gingival graft harvests healthy tissue from the donor, only in this case epithelial cells from the oral mucosa are also transplanted. Chronic inflammation of the gingiva can lead to gingival recession, exposing deeper tissues of the tooth, which in turn may make teeth more susceptible to tooth decay. Image credit: leukoplakia by dozenist is licensed CC BY 3.0. Keratinized regions of oral epithelium are located where there is a lot of abrasion. Some regions of the oral cavity won’t require such a strong connection, and the rete pegs and dermal papillae are smaller or absent. Unlike tanning, which represents a change in melanocyte activity in response to UV damage to keratinocytes, melanin in the gingiva rarely represents a homeostatic change (hence, not a pathological change). Image credit: Really bad gingivitis by D. Rosenbach, is licensed CC BY 3.0. Junctional epithelium (JE) is a non-keratinized stratified squamous epithelium. The amount of keratinization of the oral mucosa reflects the amount of stress or abrasion that region experiences. Medical Mcqs Medical Mcqs for Exams preparation of Medical Students and professionals. They may have higher levels of elastic fibers within the lamina propria. The vermilion border requires frequent moistening because_____? HISTOLOGY OF THE MUCO-CUTANEOUS JUNCTION AT THE CORNER OF THE HUMAN MOUTH 783 Mast cells In infants, the mean mast-cell counts varied from 91 to 95 per mm2 (Table 4) in the three zones, but in adults there were approximately 25 per cent fewer mast cells in mucosa than in skin or vermilion border (61, 81 and 84 per mm2). The stem cells in the basal layer of the hair bulb divide, differentiate into keratinocytes, and die to form the hair itself. Since it is no longer attached to the tooth, the probe can likely be inserted over 3mm. The Terminologia Histologica (TH) is the controlled vocabulary for use in cytology and histology. The vermilion border (sometimes spelled vermillion border), also called margin or zone, is the normally sharp demarcation between the lip and the adjacent normal skin. The vermilion border of neonatal lips J Pedod. For instance, dental offices in Ethiopia and surrounding areas may offer ethnobotanical tattooing of the maxillary gingiva to add a blue-ish or grey-ish coloration to the gingiva, masking pinkish regions. Filiform papillae contain an ortho-keratinized or para-keratinized epithelial layer. The pattern of keratinized versus partially-keratinized papillae changes over weeks. Histology Learning System [ Digestive System: Oral Cavity and Teeth, lip, vermilion border] There are 3 major pigments (a molecule that absorbs certain frequencies of visible light) that contribute to skin color, listed in Table 3.1. At this point, the pocket is said to be lined with pocket epithelium. A second risk with migration of the epithelial attachment is that acid-producing bacteria now come into contact with softer cementum, leading to root caries. Figure 3.30: Gingival hyperplasia. We start this chapter reviewing the histology of the skin. Figure 3.33: Smokers melanosis. Since it is only notch in the vermilion border of the lip, this will not affect treatment. Image credit: “Lip (human), region between red zone (vermilion border) and mucosa inner surface” by Poels, Lambert G. is licensed under CC BY-NC-ND 3.0. A reddish lesion caused by hemoglobin or its breakdown products is a sign of damage to capillaries (bruising). • The vermilion border is red because the epithelium layer is thin and there are connective tissue papillae projecting into the epithelium, which are loaded with blood vessels and nerve endings. Surgeries and treatments to remove gingival pigment exist, often advertising what is found in textbooks: healthy gingiva should be pinkish or whitish in color (try a google search for gingival hyperpigmentation if you are skeptical). Based on the 3 major embryonic tissues, the layers of the skin are divided appropriately, but the oral mucosa is divided incorrectly. It therefore has the appearance of a sharp line between the coloured edge of the lip and adjoining skin. Vermilion borderMucous Skin side side lip 29. Similar to increased levels of keratin in the attached gingiva, increased levels of melanin may obscure underlying healthy level of hemoglobin. Higher-than-normal levels of keratinization are clinically relevant when they indicate bruxism, tobacco use, or other health-related issues. Nevertheless, it might be a good idea to keep scientific developments in the hair-loss treatment industry somewhere on your radar, advances there may have applications in some future tooth-growth industry. Mucosa exude more liquid into an area as a part of the inflammatory process, known as edema, making that region of the oral mucosa larger and paler when inflamed. In April 2011, Terminologia Histologica was published online by the Federative International Programme on Anatomical Terminologies (FIPAT), the successor of FCAT. Melanin levels vary naturally in the skin. This allows white blood cells from the underlying vascular sub-mucosa to migrate through junctional epithelium and enter the gingival sulcus. The most obvious function of melanin is to absorb UV light. Related Content: GIT Development Lecture | GIT Development Practical | Salivary Gland Development Vermilion border and skin specimens of cattle, rats and humans were processed under standardized conditions for light microscopic observation. Yellow-white, asymptomatic, floral appearing 1 - 3 mm papules that remain constant throughout life May be hyperplastic and nodular … These papillae function for providing friction only, their mucosa contain no taste buds. Skin around my lip brighter than anatomy of the ageing lip pmfa dry lips with scaling and crusting why lip injections look fake and how. Even so-called “good bacteria” trigger inflammation when they move inside the body. Figure 3.17: Interdental gingiva. With chronic inflammation comes a loss of junctional epithelium, which can reduce the thickness of the junctional epithelium further, potentially causing the loss of the epithelial attachment. Image credit: Gingiva of the human mouth by John Crawford is licensed CC BY 3.0 / arrows added. The accessory (or minor) salivary glands are seromucous. Image credit: “7x speed timelapse video of fish melanophores responding to 200uM adrenaline” by Zephyris is licensed under CC BY-SA 3.0 / converted to gif. Figure 3.14: Example of healthy human gingival coloration. The other part of the dermis is a layer of areolar CT, which has an old-fashioned name, too the papillary layer of the dermis. The use of lasers can reduce bleeding and pain by cauterizing damaged blood vessels and ablating nerve endings. The soft palate is lined by a non-keratinized stratified squamous epithelium, with a very thin layer of sub-mucosa deep to it. After being transferred to keratinocytes, melanin binds to toxic free radicals, and as keratinocytes are exfoliated removes free radicals from the body. VERMILLION transitional zone. Where and when hair follicles invaginate from the surface epidermis is regulated by Planar Cell Polarity signals, which ensure more-or-less even spacing between follicles. Image credit: “Lip (human), region between red zone (vermilion border) and mucosa inner surface” by Poels, Lambert G. is licensed under CC BY-NC-ND 3.0. A. Figure 3.25: Nicotinic stomatitis, an example of hyper-keratosis. Masticatory mucosa is found in regions of high abrasion caused by mastication, such as the attached gingiva. Congenital Considered benign sebaceous hamartomas Clinical features. The vermilion border (or margin, or zone) is usually defined as part of the skin. Epidermis includes the following layers: 8. But this also increases the potential for oral cavity bacteria to do the same in reverse, especially if the epithelial attachment is lost. This can be explained because of two more functions of the molecule melanin. Histology is the study of what tissues look like under a microscope. Vermilion Border: The rim of paler skin that demarcates the vermilion … Figure 3.24: Leukoplakia, and example of hyper-keratosis. There are a few small differences. Attached gingiva is a type of masticatory mucosa, lined with a para-keratinized stratified squamous epithelium. Chronic inflammation within the pockets leads to damage to nearby tissue, such as alveolar bone. A tissue that has undergone hyperplasia is not as squishy as a tissue with edema. Lip -Arrow shows: Hair follicles. The vermilion zone and oral mucosa contain few or no sebaceous glands, but when sebaceous glands are present in these regions, they form benign whitish spots known as Fordyce Spots. at the University of Kentucky College of Medicine. Deep to the oral mucosa, the layer of dense irregular connective tissue is called the sub-mucosa, which is the homologue of the reticular layer of the dermis in the skin. GI Histology Lab 1 Prepared by: Zeina Kalaji . Mucograft – acquired by Geistlich biomaterials, Table 3.5: Further reading about currently available dental biomaterials. Figure 3.21; Junctional epithelium (red bracket). Chapter 2 * Table of Contents * Chapter 4, For further reading on dental biomaterials, “7x speed timelapse video of fish melanophores responding to 200uM adrenaline”, “Lentigo simplex or simple lentigo or lentiginous melanocytic naevus”, “Lip (human), region between red zone (vermilion border) and mucosa inner surface”, “Preoperative picture of 25-year-old female complaining of black-colored gums”, “Dermal perivascular lymphoeosinophilic infiltrate – very low mag”, half of American adults over the age of 30 suffer from periodontal disease, Gingival enlargement due to S – amlodipine, “Pre-operative view and Maxillary pigmentation removal using scalpel surgical technique”, “Smoker’s melanosis in oral mucosa with brown black pigmentation”, Class II gingival recession on the left maxillary canine and lateral incisor, “Retrieval of the subepithelial connective tissue graft from the palate and placement at the recipient site”, “Intraoperative view showing hand sewn polytetrafluoroethylene bicuspid pulmonary valve in situ with transannular pericardial patch being sutured”, Free gingival graft placed around the implants. Vermilion border 34. This is similar to the formation of a callus on the hands or feet. Excess gingival tissue can be removed using a scalpel or a laser tool. Alveolar mucosa is lined by a non-keratinized stratified squamous epithelium. The connective tissue provides a scaffold which epithelial stem cells are attracted to and migrate over. It is often caused by occlusal trauma. Geographic tongue is a condition where filiform papillae on the dorsal surface of the tongue become non-uniformly hyper-keratinized, giving some filiform papillae a more white-ish appearance. Image credit: Ventral tongue by the NIH is in the Public Domain CC 0. FORDYCE'S SPOTS AND MONTGOMERY'S TUBERCLES Groups of tiny white or yellow discrete papules (Fig. Vitamin A deficiency can lead to generalized hyper-keratosis. Image credit: “Esthetic crown lengthening” by Shanmukha Srinivas Manikanta Kumar Tirumalasetty et al is licensed under CC BY-NC 4.0. 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