Orbans Oral Histology And Embryology 15th Edition G S Kumar

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ORBAN’S ORAL HISTOLOGY AND EMBRYOLOGY

FIFTEENTH EDITION

G S Kumar, BDS, MDS (Oral Path)

Principal, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, INDIA

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Preface to the fifteenth edition

Preface to the fourteenth edition

Lymphoid tissue and lymphatics of orofacial region

Age changes in oral tissues

Study of oral tissues

2 Development of face and oral cavity

Origin of facial tissues

Development of facial prominences

Final differentiation of facial tissues

Clinical considerations

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Age changes in periodontal ligament

Unique features of periodontal ligament

Development of alveolar process

Structure of the alveolar bone

Internal reconstruction of alveolar bone

10 Oral mucous membrane

Classification of oral mucosa

Functions of oral mucosa

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Definitions and general considerations (flowchart 10.1)

Structure of the oral epithelium

Subdivisions of oral mucosa

Gingival sulcus and dentogingival junction

Development of oral mucosa

Age changes in oral mucosa

Structure of terminal secretory units (acini)

Classification and structure of human salivary glands

Development and growth

Control of secretion

Composition of saliva

Functions of saliva

Types of lymphoid tissues

Development of lymph nodes and lymphatics

Functions of the lymphatic system

Lymph nodes

Lymphatic vessels and capillaries

Blood vessels of lymph nodes

Clinical significance of lymph nodes

Lymph

Tonsils

Lymphatic drainage of head and neck

Summary

Pattern of tooth movement

Histology of tooth movement

Mechanism of tooth movement (theories of tooth eruption)

Development of the joint

Developmental anomalies

Structure and variations

Microscopic features (box 16.2)

Age changes in enamel

Age and functional changes in dentin

Age changes in pulp

Age changes in periodontium

Changes in periodontal ligament

Age changes in cementum

Age changes in alveolar bone

Change in dental arch shape

Age changes in temporomandibular joint

Age changes in oral mucosa

Salivary gland function and aging

18 An Outline of histochemistry of oral tissues

Special considerations in histochemical techniques

Histochemical study of oral connective tissue

Histochemical study of oral epithelial tissues and derivatives

Important histochemical techniques

Immunohistochemistry

Clinical considerations

Summary

Review questions

Suggested reading

References

19 Preparation of specimens for histologic study

Preparation of sections of paraffin-embedded specimens

Preparation of sections of parlodion-embedded specimens

Preparation of ground sections of teeth or bone

Preparation of frozen sections

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Orban’s Oral Histology and Embryology, 11e, S N Bhaskar

Copyright © 1991 by Mosby Inc, Eleventh edition

All rights reserved

ISBN: 978-0-8016-0239-9

This adaptation of Orban’s Oral Histology and Embryology, 11e by S

N Bhaskar was undertaken by RELX India Private Limited and ispublished by arrangement with Elsevier Inc

Orban’s Oral Histology and Embryology, 15e

Adaptation Editor: G S Kumar

Copyright © 2019 by RELX India Pvt Ltd

Adaptation ISBN: 978-81-312-5481-3

E ISBN: 978-81-312-5482-0

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Previous editions copyrighted, 2015, 2013, 2011, 2008

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The adaptation has been undertaken by RELX India Pvt Ltd at itssole responsibility Practitioners and researchers must always rely ontheir own experience and knowledge in evaluating and using anyinformation, methods, compounds or experiments described herein.Because of rapid advances in the medical sciences, in particular,

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To

My Teachers Who Have Guided Me

My Students Who Have Inspired Me

My Family Who Have Encouraged Me

My Associates Who Have Supported Me

List of contributors

Amsavardani S Tayaar, Formerly Professor and Head, Department

of Oral Pathology and Microbiology, SDM College of Dental Sciences,Dharwad

Chapters 3 and 18-online resource

Arun V Kulkarni, Formerly Professor of Anatomy, SDM College ofDental Sciences, Dharwad

Chapter 13

Pushparaja Shetty, Professor and Head, Department of Oral

Pathology, AB Shetty Memorial Institute of Dental Sciences, NitteUniversity, Mangalore

A Ravi Prakash, Professor and Head, Department of Oral

Pathology, G Pulla Reddy Dental College, Kurnool

Chapter 5

Sharada P, Professor and Head, Department of Oral and

Maxillofacial Pathology, AECS Maaruti College of Dental Sciences,Bangalore

Chapters 7, 8 and 9

Shreenivas Kallianpur, Professor and Head, Department of oralpathology and Microbiology, Century International Institute of DentalSciences and Research Centre, Kasaragod

Chapter 17

G S Kumar, Principal and Professor of Oral Pathology, KSR

Institute of Dental Science and Research, Tiruchengode

Chapters 1, 18 and 19, Summary of all Chapters, & Multiple choice

questions

Preface to the fifteenth edition

This edition has many features to meet the persistent demand of

undergraduate students to make the subject easier for their

comprehension

Audiovisual presentation of Oral Histology slides, which are

usually shown in their practical classes, is attempted for a better

correlation with the textual matter on microscopic appearance of thevarious structures Clinical photographs of the oral cavity is anotherattempt to provide clinical correlation with histological appearances

of oral structures

Subject matter is more simplified than in the previous edition Thechapter on Histochemistry is completely rewritten keeping in mindthe requirements of undergraduate students Additional text boxes,flowcharts and tables will be useful for a quick review before theory

or viva- voce examinations Multiple-choice questions based on

difficulty index to test the learned concepts are provided, as a appraisal exercise

self-For students seeking more information on various aspects of oralhistology, online resources provided with this text should be

consulted Detailed references are also available as online resource on

www.medenact.com

Needless to say, our refinement in making this text relevant anduseful to undergraduate students comes from the valuable feedbackreceived, not only from undergraduate students but also as criticalappraisal from the teachers of this subject We eagerly look forwardfor your valuable suggestions to make this edition retain its

popularity, as ever before

G S Kumar

Preface to the fourteenth edition

We, the editorial team, constantly strive to improve this book by

incorporating not only additional information that we may have

gathered, but also our readers’ valuable suggestions Our contributorsare dedicated to this cause and hence, within just three years, we havecome up with the next edition of this book

A salient feature of this edition is the inclusion of Summary andReview Questions at the end of every chapter ‘Appendix’ section hasbeen removed and all chapters have been renumbered to give theirdue identity The redrawn diagrams and change in the style and

format of presentation are bound to be more appealing than before.However, the most important change is the addition of a new chapter

‘Lymphoid Tissue and Lymphatics in Orofacial Region’ We haveincluded this chapter because we believe that this topic is not givenenough importance in General Histology lectures

I hope to receive feedback from all our readers to aid further

improvement of this book

G S Kumar

List of videos

 Dev of tooth.mp4 Chapter 3 - Page 30- s0105 subheading - Advanced bell stage  Enamel full.mp4 Video for full Chapter 4 - Enamel

 Dentin full.mp4 Video for full Chapter 5 - Dentin

 Pulp and alveolar

 Oral mucous

membrane.mp4

Video for full Chapter 10 - Oral mucous membrane  Maxillary sinus.mp4 Video for full Chapter 16 - Maxillary sinus

Brief contents

List of Contributors vii

Preface to the Fifteenth Edition ix

Preface to the Fourteenth Edition xi

List of Videos xiii

1 An Overview of Oral Tissues 1

2 Development of Face and Oral Cavity 5

3 Development and Growth of Teeth 21

17 Age Changes in Oral Tissues 315

18 An Outline of Histochemistry of Oral Tissues 329

19 Preparation of Specimens for Histologic Study 337

Index

C H A P T E R 1

An overview of oral tissues

Lymphoid Tissue and Lymphatics of Orofacial Region  4

Age Changes in Oral Tissues  4

Study of Oral Tissues  4

The oral cavity contains a variety of hard tissues and soft tissues Thehard tissues are the bones of the jaws and the teeth The soft tissuesinclude the lining mucosa of the mouth and the salivary glands

The tooth consists of crown and root The visible part of the tooth in

the mouth is called clinical crown, the extent of which increases withage and disease The root portion of the tooth is not visible in themouth of a person with healthy gums The tooth is suspended in thesockets of the alveolar bone by the periodontal ligament The

anatomical crown is covered by enamel and the root by the

cementum Periodontium is the term given to supporting tissues ofthe tooth They include the cementum, periodontal ligament, and thealveolar bone The innermost portion of the crown and root is

occupied by soft tissue, the pulp The dentin occupies the regionbetween the pulp and enamel in the crown, and between pulp andcementum in the root

Development of tooth

The tooth is formed from the ectoderm and ectomesenchyme Theenamel is derived from the enamel organ which is differentiated fromthe primitive oral epithelium lining the stomodeum (primitive oralcavity) Epithelial mesenchymal interactions take place to determinethe shape of the tooth and the differentiation of the formative cells ofthe tooth, and the timing of their secretion The ectomesenchymal cellswhich are closer to the inner margins of the enamel organ differentiateinto dental papilla and the ectomesenchymal cells closer to the outermargins of the enamel organ become dental follicles Dentin and pulpare derivatives of dental papilla while cementum, periodontal

ligament, and alveolar bone are all derivatives of dental follicle Thecells that form these tissues have their names ending with “blast.”Thus, ameloblast produces enamel, odontoblast produces dentin,

cementoblast produces cementum, and osteoblast produces bone.These synthesizing cells have all the features of a protein-secreting cell

—well-developed ribosomes and a rough endoplasmic reticulum (ER),Golgi apparatus, mitochondria, and a vesicular nucleus, which is

often polarized The cells that resorb the tissues have their names

ending with “clast.” Thus, osteoclast resorbs bone, cementoclast

resorbs cementum, and odontoclast resorbs all the dental tissues The

“clast” cells have a similar morphology in being multinucleated giantcells Their ultrastructural features include numerous lysosomes andingested vacuoles

Dentin is the first hard tissue of the tooth to form Enamel starts itsformation after the first layer of dentin has formed The enamel

formation is from its junction with dentin outward, first in the

cuspal/incisal and later in the cervical regions Dentin formation issimilar, but from the dentinoenamel junction, the formation is towardthe pulp Cementum formation occurs after the form, size, shape andnumber of roots is outlined by the epithelial root sheath and dentin islaid down in these regions Formation of enamel, dentin, and

cementum takes place as a daily event in phases or in increments, and

hence they show incremental lines In dentin and cementum

formation, a layer of uncalcified matrix forms first, followed by itsmineralization While in enamel formation, enamel matrix is calcified,its maturation or complete mineralization occurs as a secondary event.Mineralization occurs as a result of supersaturation of calcium andphosphorus in the tissue fluid The formative cells concentrate theminerals from calcium phosphate (apatite) and secrete them into theorganic matrix, in relation to specific substances like collagen, whichact as attractants or nucleators for mineralization The mechanism ofmineralization is quite similar in all the hard tissues of tooth and inbone (Fig 1.1)

FIGURE 1.1 Diagrammatic representation of tooth in situ.

The enamel is the hardest tissue in the human body It is the onlyectodermal derivative of the tooth Inorganic constituents account for96% by weight and they are mainly calcium phosphate in the form ofhydroxyapatite crystals These apatite crystals are arranged in theform of rods All other hard tissues of the body, dentin, cementum,and bone also have hydroxyapatite as the principal inorganic

constituent Hydroxyapatite crystals differ in size and shape; those ofthe enamel are hexagonal and longest Enamel is the only hard tissuewhich does not have collagen in its organic matrix The enamel

present in the fully formed crown has no viable cells, as the cells

forming it—the ameloblast—degenerates, once enamel formation isover Therefore, all the enamel is formed before eruption This is ofclinical importance as enamel lost, after tooth has erupted, due towear and tear or due to dental caries, cannot be formed again Enamellacks not only formative cells but also blood vessels and nerves

Therefore, no blood oozes out or pain is felt when enamel is drilledwhile making a cavity for filling Although enamel is not a viabletissue, it is permeable, so exchange of ions between tooth and salivatakes place This property enables fluoride ions from a toothpaste to

be incorporated in the enamel, making it harder and resistant to

dental caries

junction The junction between enamel and dentin is scalloped to givemechanical retention to the enamel Dentin is avascular Nerves arepresent in the inner dentin only Therefore, when dentin is exposed,

by loss of enamel and stimulated, a pain-like sensation called

sensitivity is experienced The dentin forms throughout life withoutany stimulation or as a reaction to an irritant The cells that form thedentin—the odontoblast lies in the pulp, near its border with dentin.Thus, dentin protects the pulp and the pulp nourishes the dentin.Though dentin and pulp are different tissues, they function as oneunit

The pulp, the only soft tissue of the tooth, is a loose connective tissueenclosed by the dentin The pulp responds to any stimuli by pain.Pulp contains the odontoblast Odontoblasts are terminally

differentiated cells, and in the event of their injury and death, they arereplaced from the pool of undifferentiated ectomesenchymal cells inthe pulp The pulp is continuous with the periodontal ligament

through the apical foramen or through the lateral canals in the root.Pulp also contains defense cells The average volume of the pulp isabout 0.02 cm3

Cementum forms throughout life to keep the tooth in functional

position Cementum also forms as a repair tissue and in excessiveamounts due to low-grade irritants

The cells that form the cementum the cementoblasts, line the

cemental surface Uncalcified cementum is usually seen as the mostsuperficial layer of cementum The cells within the cementum, calledthe cementocytes are enclosed in a lacuna and its process in the

canaliculi, similar to that seen in bone, but in a far less complex

network Cementocyte presence is limited to certain regions The

regions of cementum containing cells are called cellular cementumand the regions without it are known as the acellular cementum Theacellular cementum is concerned with the function of anchorage to theteeth and the cellular cementum is concerned with adaptation, i.e., tokeep the tooth in the functional position Like dentin, cementum

forms throughout life, and is also avascular and noninnervated

Periodontal ligament

The periodontal ligament is a fibrous connective tissue, which anchorsthe tooth to the alveolar bone The collagen fibers of the periodontalligament penetrate the alveolar bone and cementum They have awavy course The periodontal ligament has the formative cells of boneand cementum, i.e., osteoblast and cementoblast in addition to

fibroblast and resorptive cells—the osteoclast Cementoclasts are veryrarely seen, as cemental resorption is not seen in health Fibroblastalso functions as a resorptive cell Thus, with the presence of bothformative and resorptive cells of bone, cementum and connectivetissue, and along with the wavy nature of the fibers, the periodontalligament is able to adjust itself to the constant change in the position

of teeth, and also maintains its width The periodontal fibers connectall the teeth in the arch to keep them together and also attach the

gingiva to the tooth The periodontal ligament nourishes the

cementum The presence of proprioceptive nerve endings providesthe tactile sensation to the tooth and excessive pressure on the tooth isprevented by pain originating from the pain receptors in the

periodontal ligament

Alveolar bone

Alveolar bone is the alveolar process of the jaws that forms and

supports the sockets for the teeth They develop during the eruption

of the teeth and disappear after the tooth is extracted or lost The basicstructure of the alveolar bone is very similar to the bone found

elsewhere, except for the presence of immature bundle bone amidstthe compact bone lining the sockets for the teeth The buccal and

lingual plates of compact bone enclose the cancellous bone The

arrangement and the density of the cancellous bone vary in the upperand lower jaws and are related to the masticatory load the tooth

receives The ability of bone, but not cementum, to form under tensionand resorb under pressure makes orthodontic treatment possible

Temporomandibular joint

This only movable bilateral joint of the skull has a movable fibrousarticular disk separating the joint cavity The fibrous layer that linesthe articular surface is continuous with the periosteum of the bones.The fibrous capsule, which covers the joint, is lined by the synovialmembrane The joint movement is intimately related to the presence

or absence of teeth and to their function

Maxillary sinus

The maxillary posterior teeth are related to the maxillary sinus in thatthey have a common nerve supply and that their roots are often

separated by a thin plate of bone Injuries to the lining and extension

of infection from the apex of roots are often encountered in clinicalpractice Developing maxillary canine teeth are found close to thesinus Pseudostratified ciliated columnar epithelium lines the

maxillary sinus