25 March 2010

Oral Cavity



Oral Cavity
By:Robert Scranton© 2008

The Tissues
Lining Mucosa
Masticatory Mucosa
* NKSS (nonkeratinized stratified squamous)
* Lamina Propria- loose CT w/ collagen bundles
o Mucous and serous glands
o Fordyce Spots
* Location?
* KSS/PKSS (keratinized/parakeratinized stratified squamous)
* Variable Lamina Propria
* Location?

Lining Mucosa
Don’t forget the soft palate
Diagrams are important

Identify:
* vermillion zone
* Hair follicle
* Epithelium, what type?
* Skeletal muscle
o what is the name?

Special Mucosa
* Filiform
o Most abundant
o Dorsal surface
* Fungiform
o Occasional tasebuds, CN-VII
* Vallate
o 8-12 along sulcus terminalis
o Crypt
o Serous glands of Von Ebner
o CN- IX, taste buds
* Foliate
o Dorsolateral surfaces, taste buds?

Identify filiform and fungiform
Vallate/ circumvallate

Teeth
* We origionally have __ baby (________) teeth. Adults have ___ teeth.
* What are the three cell types that form the teeth and what parts do they form?
* What do dentin and enamel have in common?
* Which is acellular?

Mesenchymal CT pulp cavity
Odontoblasts (mesenchyme) Dentin
ameloblasts (ectoderm) Enamel
Avascular
Ca2+ Hydroxyapatite (calcified organic Matrix
Enamel
Teeth
* The little tubules in the teeth, what is their story?
* Damage to What three things can lead to loss of a tooth?
* Dentinal tubules- the tubule that the cytoplasmic process of odontoblasts extend through for nociception
* Canaliculi- the tubules that cementocytes use to maintain cementum
* Bony Socket
* Peridontal ligament
* Cementum

Identify:
* Alveolar Bone
* Free Gingiva
* Attached Gingiva
* Alveolar Mucosa
* Gingival Ligament
* Gingival Sulcus
* Alveolar Bone
* Dentin
* Peridontal ligament
* Pulp Cavity
* Gingiva
* Odontoblasts
* Predentin
* Dentin
* Cementocytes
* Peridontal Ligament

Salivary Glands
Intrinsic
Extrinsic
* AKA minor
* Serous
* Mucous
* Mixed
* Means w/in lamina propria
* AKA Major
* Serous
* Serousmucous
* Outside oral cavity
* Has large ducts

Important words
* Serous amylase
* Serous demilunes bacteriolytic lysozyme
* IgA bacteriostatic, resistant to degradation
* Nasopharynx Respiratory Epithelium
* Oropharynx lining mucosa, NKSS
* Laryngopharynx transitional zone so KSS, NKSS

Oral Cavity.ppt

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Chemical composition and functions of saliva



Chemical composition and functions of saliva
By:Dennis E. Lopatin, Ph.D.

Chronology of defining salivary components and functions
* Beginning in 1950’s whole saliva evaluated (antimicrobial properties, role in microbial attachment, mineralization, taste, lubrication)
* Secretions of major glands (parotid and submandibular/sublingual)
* In 1970’s individual components isolated and biochemically characterized
* In mid-1980’s beginning to map functional domains (peptide synthesis and recombinant approaches)

Major salivary components
Mucin 1 (MG1)
sIgA
Mucin 2 (MG2)
Lactoferrin
Peroxidases
Amylases
Carbonic anhydrases
Proline-rich proteins
Lysozyme
Statherins
Histatins

Current concepts regarding the functional features of salivary macromolecules
* Recent structure/function studies have identified general principles regarding function
* Based on in vitro studies of purified molecules
* Additional studies required to evaluate concepts in situ

Conformational requirements
* Conformation or shape of a molecule is critical for its biological function
* Examples
o Proline-rich proteins interact with A. viscosus and St. gordonii only when adsorbed onto mineralized surface
o Statherins and histatins require -helical conformation
o Human salivary amylase require 5 inter-chain disulfide bonds

Multifunctionality
Salivary
Families
Anti-Bacterial
Buffering
Digestion
Mineralization
Lubrication &Viscoelasticity
Tissue
Coating
Anti-Fungal
Anti-Viral
Carbonic anhydrases,
Histatins
Amylases,
Mucins, Lipase
Cystatins,
Histatins, Proline rich proteins,
Statherins
Mucins, Statherins
Amylases,
Cystatins, Mucins,
Proline-rich proteins, Statherins
Histatins
Cystatins,
Mucins
Amylases, Cystatins,
Histatins, Mucins,
Peroxidases
Redundancy
* Saliva has built-in redundancy in regard to its protective functions.
* Example - Many salivary molecules can inhibit the precipitation of calcium phosphate salts.
o strong inhibitors such as statherin and acidic proline-rich proteins
o moderate inhibitors such as histatins and cystatins
o weak inhibitors such as mucins and amylase

Amphifunctionality
* A molecule may have both protective and detrimental properties - “double-edged sword”.
* May depend on molecule’s location or site of action
o Amylases
+ In solution, they facilitate clearance of viridans streptococci
+ Adsorbed to tooth surface, they can promote adherence of these bacteria and digest starch to dietary maltose and production of acid
o Statherin and acidic proline-rich proteins
+ At enamel surface, they play an important role in mineralization by inhibiting the formation of primary and secondary calcium phosphate salts. When adsorbed to the enamel surface, they promote attachment of cariogenic microorganisms.

Complexing
* Functional relationships exist between different molecules in saliva
* Two types of complexing (covalent and non-covalent)
o homotypic (between similar molecules)
o heterotypic (between different molecules)
* Example: Mucins
o homotypic complexes necessary for lubrication and viscoelastic properties
o heterotypic complexes with sIgA, lysozyme and cystatins concentrate these anti-microbials at tissue interfaces
Salivary Protein Functions
Mucins
* Lack precise folded structure of globular proteins
* Asymmetrical molecules with open, randomly organized structure
* Polypeptide backbone (apomucin) with CHO side-chains
* Side-chains may end in negatively charged groups, such as sialic acid and bound sulfate
* Hydrophillic, entraining water (resists dehydration)
* Unique rheological properties (e.g., high elasticity, adhesiveness, and low solubility)
* Two major mucins (MG1 and MG2)

Mucin Functions
* Tissue Coating
o Protective coating about hard and soft tissues
o Primary role in formation of acquired pellicle
o Concentrates anti-microbial molecules at mucosal interface
* Lubrication
o Align themselves with direction of flow (characteristic of asymmetric molecules)
o Increases lubricating qualities (film strength)
o Film strength determines how effectively opposed moving surfaces are kept apart
* Aggregation of bacterial cells
o Bacterial adhere to mucins may result in surface attachment, or
o Mucin-coated bacteria may be unable to attach to surface
* Bacterial adhesion
o Mucin oligosaccharides mimic those on mucosal cell surface
o React with bacterial adhesins, thereby blocking them

Amylases
* Calcium metalloenzyme
* Hydrolyzes (1-4) bonds of starches such as amylose and amylopectin
* Several salivary isoenzymes
* Maltose is the major end-product (20% is glucose)
* “Appears” to have digestive function
* Why is it also present in tears, serum, bronchial, and male and female urogenital secretions?
* A role in modulating bacterial adherence?

Lingual Lipase
* Secreted by von Ebner’s glands of tongue
* Involved in first phase of fat digestion
* Hydrolyzes medium- to long-chain triglycerides
* Important in digestion of milk fat in new-born
* Unlike other mammalian lipases, it is highly hydrophobic and readily enters fat globules

Statherins
* Calcium phosphate salts of dental enamel are soluble under typical conditions of pH and ionic strength
* Supersaturation of calcium phosphates maintain enamel integrity
* Statherins prevent precipitation or crystallization of supersaturated calcium phosphate in ductal saliva and oral fluid
* Produced by acinar cells in salivary glands
* Also an effective lubricant

Proline-rich Proteins (PRPs)
* Like statherin, PRPs are also highly asymmetrical
* Inhibitors of calcium phosphate crystal growth
* Inhibition due to first 30 residues of negatively-charged amino-terminal end
* Present in the initially formed enamel pellicle and in “mature” pellicles

Role of PRPs in enamel pellicle formation
* Acquired enamel pellicle is 0.1-1.0 µm thick layer of macromolecular material on the dental mineral surface
* Pellicle is formed by selective adsorption of hydroxyapatite-reactive salivary proteins, serum proteins and microbial products such as glucans and glucosyl-transferase
* Pellicle acts as a diffusion barrier, slowing both attacks by bacterial acids and loss of dissolved calcium and phosphate ions

Remineralization of enamel and calcium phosphate inhibitors
* Early caries are repaired despite presence of mineralization inhibitors in saliva
* Sound surface layer of early carious lesion forms impermeable barrier to diffusion of high mol.wt. inhibitors.
* Still permeable to calcium and phosphate ions
* Inhibitors may encourage mineralization by preventing crystal growth on the surface of lesion by keeping pores open

Calculus formation and calcium phosphate inhibitors
* Calculus forms in plaque despite inhibitory action of statherin and PRPs in saliva
* May be due to failure to diffuse into calcifying plaque
* Proteolytic enzymes of oral bacteria or lysed leukocytes may destroy inhibitory proteins
* Plaque bacteria may produce their own inhibitors

Calcium phosphate precipitation inhibitors and plaque
* Statherin and PRPs might be expected to occur in plaque, have not been detected
* Plaque bacteria produce calcium phosphate inhibitors
* Might be necessary to prevent calcification of bacteria -- happens with dead cells
* Immobilized crystal growth inhibitors can function as nucleators of crystal growth
* Immobilization may occur in plaque, encouraging calculus formation

Interaction of oral bacteria with PRPs and other pellicle proteins
* Several salivary proteins appear to be involved in preventing or promoting bacterial adhesion to oral soft and hard tissues
* PRPs are strong promoters of bacterial adhesion
o Amino terminal: control calcium phosphate chemistry
o Carboxy terminal: interaction with oral bacteria
* Interactions are highly specific
o Depends on proline-glutamine carboxy-terminal dipeptide
o PRPs in solution do not inhibit adhesion of bacteria

These anti-microbial proteins will be discussed in a later lecture
* Secretory Immunoglobulins
* Lactoferrin
* Lysozyme
* Sialoperoxidase
* Cystatins
* Histatins

Summary - Clinical Highlights
* Understanding of salivary mechanisms at fundamental level a prerequisite for
o effective treatment of salivary gland dysfunctions
o modulation of bacterial colonization
o development of artificial saliva other “cutting edge” approaches to salivary dysfunctions and diseases

Chemical composition and functions of saliva.ppt

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Salivary Glands



Salivary Glands

Major glands
* Parotid: so-called watery serous saliva rich in amylase, proline-rich proteins
o Stenson’s duct
* Submandibular gland: more mucinous
o Wharton’s duct
* Sublingual: viscous saliva
o ducts of Rivinus; duct of Bartholin

Minor glands
* Minor salivary glands are not found within gingiva and anterior part of the hard palate
* Serous minor glands=von Ebner below the sulci of the circumvallate and folliate papillae of the tongue
* Glands of Blandin-Nuhn: ventral tongue
* Palatine, glossopalatine glands are pure mucus
* Weber glands

Functions
* Protection
o lubricant (glycoprotein)
o barrier against noxious stimuli; microbial toxins and minor traumas
o washing non-adherent and acellular debris
o formation of salivary pellicle
+ calcium-binding proteins: tooth protection; plaque
* Buffering (phosphate ions and bicarbonate)
o bacteria require specific pH conditions
o plaque microorganisms produce acids from sugars

Functions

* Digestion
o neutralizes esophageal contents
o dilutes gastric chyme
o forms food bolus
o brakes starch
* Antimicrobial
o lysozyme hydrolyzes cell walls of some bacteria
o lactoferrin binds free iron and deprives bacteria of this essential element
o IgA agglutinates microorganisms
* Maintenance of tooth integrity
o calcium and phosphate ions
+ ionic exchange with tooth surface
* Tissue repair
o bleeding time of oral tissues shorter than other tissues
o resulting clot less solid than normal
o remineralization
* Taste
o solubilizing of food substances that can be sensed by receptors
o trophic effect on receptors

Embryonic development
* The parotid: ectoderm (4-6 weeks of embryonic life)
* The sublingual-submandibular glands: endoderm
* The submandibular gland around the 6th week
* The sublingual and the minor glands develop around the 8-12 week
* Differentiation of the ectomesenchyme
* Development of fibrous capsule
* Formation of septa that divide the gland into lobes and lobules

Serous cells
* Seromucus cells=secrete also polysaccharides
* They have all the features of a cell specialized for the synthesis, storage, and secretion of protein
o Rough endoplasmic reticulum (ribosomal sites-->cisternae)
o Prominent Golgi-->carbohydrate moieties are added
Secretory granules-->exocytosis
* The secretory process is continuous but cyclic
* There are complex foldings of cytoplasmic membrane
* The junctional complex consists of:
o Tight junctions (zonula occludens)-->fusion of outer cell layer
o Intermediate junction (zonula adherens)-->intercellular communication
o Desmosomes-->firm adhesion

Mucous cells
* Production, storage, and secretion of proteinaceous material; smaller enzymatic component
-more carbohydrates-->mucins=more prominent Golgi
-less prominent (conspicuous) rough endoplasmic reticulum, mitochondria
-less interdigitations

Formation and Secretion of Saliva
* Primary saliva
o Serous and mucous cells
o Intercalated ducts
* Modified saliva
o Striated and terminal ducts
o End product is hypotonic

Macromolecular component
* Synthesis of proteins
* RER, Golgi apparatus
* Ribosomes RER posttranslational modification (N- & O-linked glycosylation) Golgi apparatus Secretory granules
* Exocytosis
* Endocytosis of the granule membrane

Fluid and Electrolytes
* Parasympathetic innervation
* Binding of acetylcholine to muscarinic receptors
o Activation of phospholipase IP3 release of Ca2+ opening of channels K+, Cl- Na+ in
o K+ and Cl- in
o Also another electrolyte transport mechanism through HCO3-
* Noepinephrine via alpha-adrenergic receptors
o Substance P activates the Ca2+

Myoepithelial cells
* One, two or even three myoepithelial cells in each salivary and piece body
* Four to eight processes
* Desmosomes between myoepithelial cells and secretory cells
* Myofilaments frequently aggregated to form dark bodies along the course of the process

Myoepithelial cells
* The myoepithelial cells of the intercalated ducts are more spindled-shaped and fewer processes
* Ultrastructurally very similar to that of smooth muscle cells
* Functions of myoepithelial cells
o Support secretory cells
o Contract and widen the diameter of the intercalated ducts
o Contraction may aid in the rupture of acinar cells of epithelial origin

Intercalated Ducts
* Small diameter
* Lined by small cuboidal cells
* Nucleus located in the center
* Well-developed RER, Golgi apparatus, occasionally secretory granules, few microvilli
* Myoepithelial cells are also present
* Intercalated ducts are prominent in salivary glands having a watery secretion (parotid).

Striated Ducts
* Columnar cells
* Centrally located nucleus
* Eosinophilic cytoplasm
* Prominenty striations
o Indentations of the cytoplasmic membrane with many mitochondria present between the folds
* Some RER and some Golgi, short microvilli
* Modify the secretion
o Hypotonic solution=low sodium and chloride and high potassium
* Basal cells

Terminal excretory ducts
* Near the striated ducts they have the same histology as the striated ducts
* As the duct reaches the oral mucosa the lining becomes stratified
* Goblet cells, basal cells, clear cells.
* Alter the electrolyte concentration and add mucoid substance.

Ductal modification
* Autonomic nervous system
* Striated and terminal ducts
* Modofication via reabsorption and secretion of electrolytes
* Final product is hypotonic
* Rate of salivary flow
o High: Sodium and chlorine up; potassium down

Connective tissue
* Fibroblasts
* Inflammatory cells
* Mast cells
* Adipose cells
* Extracellular matrix
o Glycoproteins and proteoglycans
* Collagen and oxytalan fibers
* Blood supply

Nerve supply
* No direct inhibitory innervation
* Parasympathetic and sympathetic impulses
* Parasympathetic are more prevalent.
* Parasympathetic impulses may occur in isolation, evoke most of the fluid to be excreted, cause exocytosis, induce contraction of myoepithelial cells (sympathetic too) and cause vasodilatation.
* There are two types of innervation: Epilemmal and hypolemmal
* beta-adrenergic receptors that induce protein secretion
* L-adrenergic and cholinergic receptors that induce water and electrolyte secretion

Hormones can influence the function of the salivary glands. They modify the salivary content but cannot iniate salivary flow.

Age changes
* Fibrosis and fatty degenerative changes
* Presence of oncocytes (eosinophilic cells containing many mitochondria)

Clinical Considerations
* Obstruction
* Role of drugs
* Systemic disorders
* Bacterial or viral infections
* Therapeutic radiation
* Formation of plaque and calculus

Salivary Glands.ppt

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