GINGIVAL

EPITHELIUM
Aathira Vijayakumar
I MDS
CONTENTS

INTRODUCTION
ORAL MUCOUS MEMBRANE
GINGIVA
PARTS OF GINGIVA
GINGIVAL SULCUS
GINGIVAL EPITHELIUM
ORAL EPITHELIUM
KERATINOCYTES AND KERATINISATION
NON KERATINOCYTES
SULCULAR EPITHELIUM
JUNCTIONAL EPITHELIUM
RENEWAL OF GINGIVAL EPITHELIUM
INTEGRINS
CONCLUSION
INTRODUCTION The oral mucosa consists of the following three
zones:

1. MASTICATORY MUCOSA: The gingiva and the

covering of the hard palate
2. SPECIALIZED MUCOSA: The dorsum of the
tongue
3. LINING MUCOSA: The oral mucous membrane
lining the remainder of the oral cavity.

The periodontium (peri = around, odontos = tooth)

comprises the following tissues:
(1) gingiva,
(2) periodontal ligament
(3) root cementum
(4) alveolar bone proper
The periodontium is defined simply as “the tissues
investing and supporting the teeth”. Of these, only the
gingiva is visible clinically upon inspection of the healthy
oral cavity.

Masticatory mucosa (gingiva and hard palate):

Keratinized.
They have similarities in thickness and
keratinization of epithelium, density, and
firmness of lamina propria; and in being
immovably attached. However, there are
differences in their submucosa.
ORAL MUCOUS MEMBRANE:
Oral mucous membrane is the moist lining of oral cavity that communicates
with the exterior.
The oral mucosa is continuous with the skin of the lip through the vermilion
border. Posteriorly it is continuous with the mucosa of the pharynx.
FUNCTIONS:
1. Defense: The integrity of the oral epithelium is an effective barrier for the
entry of the microorganisms. The oral mucosa is impermeable to bacterial
toxins. It also secretes antibodies and has an efficient humoral and cell
mediated immunity.
2. Lubrication: The secretion of salivary glands keeps the oral cavity moist
and thus prevents the mucosa from drying and cracking thereby ensuring an
intact oral epithelium. A moist oral cavity helps in speech, mastication,
swallowing and in the perception of taste.
3. Sensory: The oral mucosa is sensitive
to touch, pressure, pain and temperature.
The sensitivity of these sensations vary in
different regions. The sensation of taste is
a unique sensation, felt only in the
anterior 2/3rd of the dorsum of the
tongue. Touch sensations in the soft palate
result in gag reflex.
4. Protection: The oral mucosa protects
the deeper tissues from mechanical forces
resulting from mastication and from
abrasive nature of foodstuffs.
• GINGIVA
The gingiva is the part of the oral
mucosa that covers the alveolar
processes of the jaws and surrounds
the neck of the teeth. (Carranza)
• The gingiva is that part of the
masticatory mucosa which covers
the alveolar process and surrounds
the cervical portion of the teeth.
(Lindhe).

• In an adult, normal gingiva covers

the alveolar bone and tooth root to
a level just coronal to the
cementoenamel junction.
• The gingiva is divided
anatomically into marginal,
attached, and interdental areas.
MARGINAL
GINGIVA
2 1.The marginal or unattached gingiva or
1
free gingiva is the terminal edge or border
of the gingiva that surrounds the teeth in
collar-like fashion.
2. It is demarcated from the adjacent
attached gingiva by a shallow linear
depression called the free gingival groove,
which is positioned at a level corresponding
to the level of the cementoenamel junction
(CEJ).
 The marginal gingiva is usually about 1 mm wide,
and it forms the soft-tissue wall of the gingival
sulcus. It may be separated from the tooth surface
with a periodontal probe.
 The most apical point of the marginal gingival
scallop is called the gingival zenith.
 Its apico-coronal and mesiodistal dimensions vary
between 0.06 and 0.96 mm.
After complete tooth eruption, the marginal gingival
margin is located on the enamel surface
approximately 1.5–2 mm coronal to the CEJ.
GINGIVAL SULCUS

• Space around the tooth bounded by the

surface of the tooth on one side and the • V-shaped and barely permits the entrance
epithelium lining the free margin of the of a periodontal probe. The clinical
gingiva on the other side. determination of the depth of the gingival
• Normal or clinically healthy gingiva there sulcus is an important diagnostic
is in fact no “gingival crevice” present, parameter.
but the gingiva is in close contact with the
enamel surface.
Under absolutely normal or ideal conditions, the depth of the gingival sulcus is 0
mm or close to 0 mm. These strict conditions of normalcy can be produced
experimentally only in germ-free animals or after intense and prolonged plaque
control.
The depth of this sulcus, as determined in
histologic sections, has been reported as 1.8
mm, with variations from 0 to 6 mm; other
studies have reported 1.5 mm and 0.69 mm
The clinical evaluation used to determine the
depth of the sulcus involves the introduction of
a metallic instrument (i.e., the periodontal
probe) and the estimation of the distance it
penetrates (i.e., the probing depth).
The histologic depth of a sulcus does not need to be exactly
equal to the depth of penetration of the probe
The so-called probing depth of a clinically normal gingival
sulcus in humans is 2 to 3 mm.
DEVELOPMENT OF GINGIVAL SULCUS
After enamel formation is complete, the enamel
is covered with reduced enamel epithelium
(REE), which is attached to the tooth by a basal
lamina and hemidesmosomes.

As the tooth penetrates the oral mucosa, the

REE unites with the oral epithelium and
transforms into the junctional epithelium.

As the tooth erupts, this united epithelium

condenses along the crown, and the
ameloblasts, which form the inner layer of the
REE, gradually become squamous epithelial
cells.
The transformation of the REE into a junctional
epithelium proceeds in an apical direction without
interrupting the attachment to the tooth  At that time, the
junctional
epithelium and the
The regenerating epithelial cells move toward the tooth REE form a broad
surface and along it in a coronal direction to the band that is
gingival sulcus, where they are shed. The migrating attached to the
daughter cells provide a continuous attachment to the tooth surface from
tooth surface. near the tip of the
crown to the
cementoenamel
junction.
The gingival sulcus is formed when the tooth erupts
into the oral cavity
The sulcus consists of the shallow space that is coronal
to the attachment of the junctional epithelium and
bounded by the tooth on one side and the sulcular
epithelium on the other. The coronal extent of the
gingival sulcus is the gingival margin.
ATTACHED GINGIVA

 The attached gingiva is continuous with

the marginal gingiva. It is firm, resilient,
and tightly bound to the underlying
periosteum of alveolar bone.
 The facial aspect of the attached gingiva
extends to the relatively loose and
movable alveolar mucosa; it is demarcated
by the mucogingival junction.
There is no mucogingival line present in the
palate since the hard palate and the
maxillary alveolar process are covered by
the same type of masticatory mucosa.
 Width of the attached gingiva

• It is the distance between the mucogingival junction and the projection

on the external surface of the bottom of the gingival sulcus or the
periodontal pocket.
• Greatest in the incisor region - Max incisor region- 3.5 to 4.5 mm
Mandibular incisor region-3.3 to 3.9 mm
Narrower in the posterior segments –Max first PM region-1.9 mm
Mandibular first premolars- 1.8 mm.
Because the mucogingival junction remains stationary throughout adult life, changes
in the width of the attached gingiva are caused by modifications in the position of its
coronal portion.

On the lingual aspect of the mandible, the attached gingiva terminates at the junction
of the lingual alveolar mucosa, which is continuous with the mucous membrane that
lines the floor of the mouth. The palatal surface of the attached gingiva in the
maxilla blends imperceptibly with the equally firm and resilient palatal mucosa
 SIGNIFICANCE OF ATTACHED GINGIVA
1. It gives support to the marginal gingiva.
2. It provides attachment or a solid base for the movable alveolar
mucosa for the action of lips,cheeks and tongue
3. It can withstand frictional and functional stresses of mastication and
toothbrushing.
4. It provides resistance to tensional stresses. Attached gingiva serves as
a buffer between the mobile free gingival margin and mobile alveolar
mucosa.
• For many  years the prevailing concept was that a narrow zone
of gingiva was insufficient
• (1) to protect the periodontium from injury caused by friction ADEQUATE OR
forces encountered during mastication and SUFFICIENT
• (2) to dissipate the pull on the gingival margin created by the DIMENSION OF
muscles of the adjacent alveolar mucosa (Friedman 1957;
Ochsenbein 1960). ATTACHED
GINGIVA?
• An “inadequate” zone of gingiva would
(1)facilitate subgingival plaque formation because of the improper
pocket closure resulting from the movability of the marginal
tissue (Friedman 1962) and
(2) favor attachment loss and soft tissue recession because of less
tissue resistance to apical spread of plaque‐associated gingival
lesions (Stern 1976; Ruben 1979).
(1)It was also considered that a narrow gingiva in combination
with a shallow vestibular fornix might LANG AND LOE
(a) favor the accumulation of food particles during mastication (1972)
 On dental students who
(b) impede proper oral hygiene measures. (Gottsegen 1954; had their teeth
Rosenberg 1960; Corn 1962; Carranza & Carraro 1970). professionally cleaned
once a day for 6 weeks.
• Bowers, 1963 <1 mm of gingiva may be  All buccal and lingual
sufficient. sites were examined for
plaque, gingival
• Corn, 1962 Apicocoronal height of keratinized conditions, and
tissue ought to exceed 3mm apicocoronal height of the
gingiva.

• Friedman 1962:

• An adequate amount of gingiva is any dimension that is

compatible with gingival health or prevents retraction of the
gingival margin during movements of the alveolar mucosa
• The results showed that despite the fact that the Wennström and Lindhe
tooth surfaces were free from plaque, all sites with (1983a, b) utilizing the
<2 mm of gingiva exhibited persisting clinical Beagle dog model.
signs of inflammation.
• Based on this observation, the authors suggested
that 2 mm of gingiva is an adequate width for
maintaining gingival health In these studies,
dentogingival units with
different clinical
characteristics were
Subsequent clinical trials (Grevers 1977; Miyasato experimentally
et al. 1977), however, failed to substantiate this established:
concept of a required minimum dimension of
gingiva. (1) units with only a
narrow and mobile zone
In fact, these clinical trials demonstrated that it is of keratinized tissue and
possible to maintain clinically healthy marginal
tissues even in areas with <1 mm of gingiva. (2) units with a wide,
firmly attached gingiva
 Conclusion that a
De Trey & Bernimoulin 1980;
minimal zone of
Hangorsky & Bissada 1980;
gingiva may not Lindhe & Nyman 1980;
compromise
periodontal health Schoo & van der Velden 1985;
is available from a Kisch et al. 1986;
number of other Wennström 1987;
longitudinal
Freedman et al. 1999).
clinical studies

Conclusion: Gingival health can be maintained independent of its dimensions.

Furthermore, there is evidence from both experimental and clinical studies that, in the
presence of plaque, areas with a narrow zone of gingiva possess a similar degree of
resistance” to continuous attachment loss as areas with a wide zone of gingiva. Hence, the
traditional dogma of the need for an “adequate” width (in millimeters) of gingiva, or an
attached portion of gingiva, for prevention of attachment loss is not scientifically
supported.
Interdental Gingiva: (the interdental papilla)

Shape of the gingiva in a given

Occupies the gingival embrasure, interdental space depends on the
which is the interproximal space presence or absence of a contact point
beneath the area of tooth contact. between the adjacent teeth, the distance
 Pyramidal: the tip of one papilla is between the contact point and the
located immediately beneath the osseous crest, and the presence or
contact point, or absence of some degree of recession.
 Col: shape presents a valley-like
depression that connects a facial
and lingual papilla and that
conforms to the shape of the
interproximal contact.
 Col is non-keratinizing epithelium, representing essentially the fusion of the
interproximal junctional epithelia of the two adjacent teeth.
 It is a structure that is particularly susceptible to noxious substances or
physical trauma and, as such, represents a most frequent site for the initiation
of the pathological breakdown of the tooth-supporting apparatus.
 Where adjacent teeth do not contact each other or when a tooth is missing
from the arch, keratinized attached gingiva courses uninterruptedly across the
alveolar ridge faciolingually; in such locations, interdental papillae and the
col are absent.

Hassell TM. Tissues and cells of the periodontium. Periodontol 2000. 1993 Oct;3:9-38. doi:
10.1111/j.1600-0757.1993.tb00230.x. PMID: 9673156.
Due to the presence of • The facial and lingual surfaces are tapered
interdental papillae, the free toward the interproximal contact area, whereas
gingival margin follows a the mesial and distal surfaces are slightly
more or less accentuated, concave.
scalloped course through the • The lateral borders and tips of the interdental
dentition papillae are formed by the marginal gingiva of
the adjoining teeth.
• The intervening portion consists of attached
gingiva. If a diastema is present, the gingiva is
firmly bound over the interdental bone to form
a smooth, rounded surface without interdental
papillae
MICROSCOPIC FEATURES
OF GINGIVA
 GINGIVAL EPITHELIUM

• Active role in innate host defense.

• Historically, the • The epithelium participates actively in
epithelial responding to infection, in signalling
compartment was further host reactions, and in
thought to provide integrating innate and acquired
only a physical barrier immune responses.
to infection and the
underlying gingival • The epithelial cells may respond to
attachment. bacteria by increased proliferation, the
alteration of cell-signaling events,
changes in differentiation and cell
death, and, ultimately, the alteration of
tissue homeostasis.
VARIANTS OF GINGIVAL EPITHELIUM:
 The gingival epithelium consists of a continuous lining of stratified squamous
epithelium. There are three different areas that can be defined from the
morphologic and functional points of view:
i. The oral or outer epithelium,
ii. The sulcular epithelium, and
iii.The junctional epithelium.
Oral (Outer) Epithelium:
 The oral or outer epithelium covers the crest and outer surface of the marginal
gingiva and the surface of the attached gingiva.
 On average, the oral epithelium is 0.2 to 0.3 mm in thickness. It is keratinized or
parakeratinized, or it may present various combinations of these conditions. The
prevalent surface, however, is parakeratinized.
 The oral epithelium is composed of four layers: stratum basale (basal layer),
stratum spinosum (prickle cell layer), stratum granulosum (granular layer), and
stratum corneum (cornified layer).
 STRUCTURAL AND METABOLIC CHARACTERISTICS OF
GINGIVAL EPITHELIUM

The oral epithelium is a keratinized,

stratified, squamous epithelium which, on
the basis of the degree to which the keratin‐
producing cells are differentiated, can be
divided into the following cell layers:
1. Basal layer (stratum basale or stratum
germinativum)
2. Prickle cell layer (stratum spinosum)
3. Granular cell layer (stratum granulosum)
4. Keratinized cell layer (stratum corneum).
STRATUM BASALE:
 The cells in the basal layer are either cylindric or
cuboid(mainly cuboidal), and are in contact with
the basement membrane that separates the
epithelium and the connective tissue.
 The basal cells possess the ability to divide, that is
undergo mitotic cell division.
 It is in the basal layer that the epithelium is
renewed. Therefore, this layer is also termed
stratum germinativum, and can be considered the
progenitor cell compartment of the epithelium.
 Attached to the underlying basal lamina by means
of hemidesmosomes. The basal cells are also
attached laterally to each other via both gap
junctions and hemidesmosomes.
Hassell TM. Tissues and cells of the periodontium. Periodontol
2000. 1993 Oct;3:9-38. doi: 10.1111/j.1600-
0757.1993.tb00230.x. PMID: 9673156
Some but not all cells of the stratum basale migrate
through the entire epithelial thickness and eventually
keratinize; these are known as keratinocytes

As with cells in other mammalian epithelia, following cell division

in the basal layer and the resultant birth of a new keratinocyte,
about 10 days are required for the new cell to traverse the
epithelium to reach the stratum corneum. This temporal interval is
known as the epithelial cell turnover time.

It has been proposed that these cells play a pivotal early role
in the host response to microbiological insult at the gingival
margin
The cells of the basal layer of gingival epithelium are
responsible for the important functions of protecting
underlying structures and producing new epithelial cells; in
addition, these cells synthesize and secrete the macromolecules
that constitute the basal lamina that separates the stratum
basale from underlying connective tissue.
Nutritive supply for and disposal of metabolic by-products of gingival
epithelial cells are provided via capillary loops within connective tissue rete
that project into the basal surface of the epithelial layer.
 STRATUM SPINOSUM

Stratum spinosum consists of 10–20 layers of

relatively large, polyhedral cells, equipped with
short cytoplasmic processes resembling spines.
The cytoplasmic processes occur at regular
intervals and give the cells a prickly
appearance.
 Together with intercellular protein–
carbohydrate complexes, cohesion between
the cells is provided by numerous
“desmosomes” (pairs of hemidesmosomes)
which are located between the cytoplasmic
processes of adjacent cells.
 ODLAND BODIES: The uppermost cells of the stratum spinosum contain
numerous dense granules called keratinosomes or Odland bodies, which are
modified lysosomes. They contain a large amount of acid phosphatase, an
enzyme involved in the destruction of organelle membranes, which occurs
suddenly between the granulosum and corneum strata and during the
intercellular cementation of cornified cells.
 Cells that no longer synthesize basal lamina constituents and that contain an
elevated quantity of cytoplasmic filaments. This epithelial layer is
characterized at the light microscopic level by apparent “bridges” between
adjacent cells.

Hassell TM. Tissues and cells of the periodontium. Periodontol

2000. 1993 Oct;3:9-38. doi: 10.1111/j.1600-
0757.1993.tb00230.x. PMID: 9673156
 STRATUM GRANULOSUM

 Keratohyalin granules are seen in the stratum

granulosum. There is an abrupt transition of the
cells from the stratum granulosum to the stratum
corneum.
 This is indicative of a very sudden keratinization of
the cytoplasm of the keratinocyte and its
conversion into a horny squame.
 In the stratum granulosum, electron‐ dense
keratohyalin bodies (K) and clusters of glycogen‐
containing granules start to appear. Such granules
are believed to be related to the synthesis of
keratin.
 Flattened cellular elements containing keratohyaline granules and enzyme-containing
Odland bodies with desmosomal junctions among cells of the granular layer are more
frequently observed than in subjacent layers, along with elongated gap junctions.

Hassell TM. Tissues and cells of the periodontium. Periodontol 2000. 1993 Oct;3:9-38.
doi: 10.1111/j.1600-0757.1993.tb00230.x. PMID: 9673156
 STRATUM CORNEUM:
 As cells approach the outermost layer of oral epithelium, the stratum corneum, the
intracellular process of keratinization nears completion as the cells are transformed
into corneocytes, which appear compressed flatly parallel to the surface of the
gingiva and lack any nuclei at all.
 In addition, most of the intracellular synthetic and respiratory machinery (such as
Golgi bodies, mitochondria and endoplasmic reticulum) is lost, resulting in a
keratin-filled superficial oral epithelial cell.
 However, despite the rather abrupt and distinct intracellular and extracellular
alterations in cellular contour and configuration that would appear to reflect
cellular degradation, the cell-cell attachments remain for the most part intact in the
stratum corneum.

Tissues and cells of the Periodontium THOMAS M.

HASSELL(1993)
 The cytoplasm of the cells in the stratum
corneum (SC) is filled with keratin and the
entire apparatus for protein synthesis and
energy production, that is the nucleus, the
mitochondria, the endoplasmic reticulum,
and the Golgi complex, is lost.
K1 keratin polypeptide (68 kD) is
 In a parakeratinized epithelium, however, the
the main component of the stratum
cells of the stratum corneum contain
corneum
remnants of nuclei.
From the basal layer (stratum basale) to the
granular layer (stratum granulosum) both the
number of tonofilaments in the cytoplasm and
the number of desmosomes increase.
KERATINOCYTES

The principal cell type of the gingival epithelium—as well as of

other stratified squamous epithelia—is the keratinocyte.
90% of the total cell population.
They originate from the ectodermal germ layer.
Structurally they are like any other cells having cell organelles
like nucleus, cytosol , ribosomes , and golgi appparatus.
Possess melanosomes, which are the pigment bearing granules
present within these cells only and not in the other cells of the
periodontium.
The main function of the gingival epithelium ie, protection and
barrier against the oral environment is achieved by the
proliferation and differentiation of the keratinocytes (Hefti AF
1993)
 CYTOKERATIN/KERATIN

There are two types of cytokeratins: the

Cytokeratins are intermediate filaments low weight or the acidic type I
containing keratin usually found in the cytokeratins and the high weight or
intracytoplasmic cytoskeleton of epithelial basic or neutral type II cytokeratins.
tissue. The term cytokeratin was derived in the The high‑molecular‑weight
1970s when the proteins in the intermediate cytokeratins or basic or neutral
filament were identified. However, the cytokeratins comprise numerous
terminology was modified as keratins in the subtypes, namely CK1, CK2, CK3,
new systemic nomenclature in 2006. CK4, CK5, CK6, CK7, CK8, and CK9.
The low‑molecular‑weight cytokeratins
or acidic cytokeratins comprise CK10,
CK12, CK13, CK14, CK16, CK17,
CK18, CK19, and CK20.
The molecular weight decreases as the number
advances and thus cytokeratin 1 has the highest
molecular weight, while cytokeratin 19 has the
lowest molecular weight.
Two dimers of cytokeratin group into a keratin
tetramer by anti‑parallel binding. This
cytokeratin tetramer is considered to be the
main building block of the cytokeratin chain.
By head‑to‑tail linking of the cytokeratin
tetramers, the protofilaments are originated,
which in turn intertwine in pairs to form
protofibrils. Four protofibrils give place to one
cytokeratin filament
• The type II keratin K5 and the type I keratin K14 form
the primary keratin pair of the keratinocytes of stratified
squamous epithelia, including the epidermis as well as
mucosal nonkeratinizing stratified squamous epithelia
• They are strongly expressed in the undifferentiated basal
cell layer containing the stem cells and are
downregulated in the differentiating suprabasal cell
layers K5 and K14 which are uniformly expressed
throughout all layers.
• Ultrastructurally, K5/K14 keratin filaments are bundled
as tonofilaments and attached to desmosomes and
hemidesmosome.
KERATINISATION:

 Keratinization of the oral mucosa varies in different areas in

the following order: palate (most keratinized), gingiva, ventral
aspect of the tongue, and cheek (least keratinized).
 The degree of gingival keratinization diminishes with age and
the onset of menopause, but it is not necessarily related to the
different phases of the menstrual cycle.
The main function of the gingival epithelium is to protect the
deep structures while allowing for a selective interchange with
the oral environment. This is achieved via the proliferation and
differentiation of the keratinocytes
 The proliferation of keratinocytes takes place by mitosis in the basal
layer and less frequently in the supra-basal layers, in which a small
proportion of cells remain as a proliferative compartment while a larger
number begin to migrate to the surface.

 The main morphologic changes include the following:

(1) the progressive flattening of the cell with an increasing
prevalence of tonofilaments;
(2) the couple of intercellular junctions with the production of
keratohyalin granules; and
(3) the disappearance of the nucleus.
A complete keratinization process leads to the production of an
ortho-keratinized superficial horny layer similar to that of the
skin, with no nuclei in the stratum corneum and a well-defined
stratum granulosum.
Only some areas of the outer gingival epithelium are
orthokeratinized; the other gingival areas are covered by
parakeratinized or nonkeratinized epithelium and are considered
to be at intermediate stages of keratinization

In parakeratinized epithelia, the stratum

corneum retains pyknotic nuclei, and the
keratohyalin granules are dispersed.
• Proteins unrelated to keratins are synthesized during the maturation
process.
• The most extensively studied are keratolinin and involucrin, which are
precursors of a chemically resistant structure (the envelope) located
below the cell membrane, and filaggrin, which has precursors that are
packed into the keratohyalin granules.
• At the sudden transition to the horny layer, the keratohyalin granules
disappear and give rise to filaggrin, which forms the matrix of the most
differentiated epithelial cell, the corneocyte.
• Thus, in the fully differentiated state, the corneocytes are mainly formed
by bundles of keratin tonofilaments embedded in an amorphous matrix
of filaggrin and surrounded by a resistant envelope under the cell
membrane.
• The immunohistochemical patterns of the different keratin types,
envelope proteins, and filaggrin change under normal or pathologic
stimuli, thereby modifying the keratinization process.

• Cytoplasmic organelle concentration varies among different epithelial

strata. Mitochondria are more numerous in deeper strata and decrease
toward the surface of the cell
Electron microscopy reveals that keratinocytes are interconnected by structures
on the cell periphery called desmosomes.
NON KERATINOCYTES

10% of the cell population

in the oral epithelium.
In addition to the keratin‐producing cells
which comprise about 90% of the total
These cell types are often stellate and
cell population the oral epithelium
have cytoplasmic extensions of various
contains the following types
size and appearance. They are also called
of cell: “clear cells” since in histologic sections,
• Melanocytes the zone around their nuclei appears
• Langerhans cells lighter than that in the surrounding
keratin‐producing cells
• Merkel’s cells
• Inflammatory cells
Clear cells are located in or near the stratum
basale of the oral epithelium.

With the exception of the Merkels cells, these

“clear cells”, which do not produce keratin, lack
desmosomal attachment to adjacent cells.

 None of these cells contains the large

numbers of tonofilaments and desmosomes
seen in epithelial keratinocytes, and none
participates in the process of maturation seen
in oral epithelia; therefore, they often are
called collectively nonkeratinocytes.
MELANOCYTES

 Melanin is elaborated by specific cells,

melanocytes, residing in the basal layer.  Melanin pigment dispersed
The melanocytes are derived from the in the connective tissue
embryologic neural crest and migrate will be phagocytosed by
into the epithelium. the macrophages. These
 Each melanocyte establishes contact macrophages termed
with about 30–40 keratinocytes through melanophages.
their dendritic processes.  Silver stains reveal a spider
Melanin produced by the melanocytes are like (dendritic) appearance.
transferred through their dendritic process Thus melanocytes are
to the adjacent basal cell keratinocytes referred to as clear cells or
which store the pigment in the form of dendritic cells.
melanosomes
 The process of pigmentation consists of three phases :
I) Activation of melanocytes.
II) Synthesis of melanin.
III) Expression of melanin.

The activation phase occurs when the melanocytes are stimulated by

factors like stress hormones, sunlight etc. leading to production of chemical
messengers like melanocyte stimulating hormone.
II) In synthesis phase, melanocytes make granules called melanosomes.
This process occurs when the enzyme tyrosinase converts amino acid
tyrosine into a molecule called dihydroxyphenylalanine (DOPA). Tyrosinase
then converts DOPA into secondary chemical dopaquinone. After a series of
reactions, dopaquinone is converted into either dark melanin (eumelanin)
or light melanin (pheo-melanin).
III) In expression phase, melanosomes are transferred from the
melanocytes to the keratinocytes which are the skin cells located above
melanocytes in the epidermis. After this, melanin color eventually
becomes visible on the surface of skin.

The degree of clinical melanin pigmentation in human epidermis and in

the epithelium of oral mucosa is related to the amount of melanin i.e.
the maturation of melanosomes, the number of keratinocytes containing
melanosomes and the distribution of melanin loaded keratinocytes
throughout the epithelium. (Rehab A. Abdel Moneim et al 2017)
LANGERHANS CELL

 The Langerhans cell is another clear cell or

dendritic cell found in the upper layers of the
skin and the mucosal epithelium.
 The cell has a convoluted nucleus and
characteristic rod-like granules in the
cytoplasm, termed Birbeck granules.
 This cell is free of melanin .
 The Langerhans cell is a cell of
hematopoietic origin.
Langerhans cells penetrate the epithelium from
lamina propria. It has vimentin-type
intermediate filaments.
Langerhans cells are involved in the immune response. In
the presence of antigenic challenge by bacterial plaque
Langerhans cells migrate into the gingiva. They also
migrate into the epithelium in response to chemotactic
factors released by the keratinocytes to the surface
receptors of Langerhans cells. They contain HLA antigens,
which they present to primed T cells (thymocytes).
They may function, as do macrophages, by picking up antigen and presenting it to
lymphocytes, either locally or at lymph nodes. Langerhans cells present the
antigen to specific helper T cells.
Langerhans cells with HLADR and T6 antigens also interact with lymphocytes but
do so differently from keratinocytes. The interleukin-1 secreted by the
keratinocytes induces the T cells to produce interleukin-2, which binds to
responsive T cells, causing them to proliferate.

Another factor with common biochemical and biophysical properties to

interleukin-1 is epidermal cell derived thyrocyte-activating factor (ETAF), which
apparently is produced by a subset of keratinocytes. It plays important role in
contact hypersensitivity, in anti-tumor immunity and in graft rejection. They
shuttle between epithelium and regional lymph nodes.
MERKEL CELL:
 Merkel cells are found among the basal cells.
 It has nerve tissue immediately subjacent and is
presumed to be a specialized neural pressure-sensitive
receptor cell.
 It responds to touch sensation. They are commonly seen
in masticatory mucosa, but are usually absent in lining
mucosa.
 Merkel cells differ from other nonkeratinocyte in that
they are not dendritic.
 Ultrastructurally, the nucleus shows a deep invagination
and characteristic rodlet. They contain numerous
characteristic electron-dense granules that are located
almost exclusively at the side of cytoplasm in contact
with axon terminals.
 The characteristic feature of Merkel cells is the small membrane bound vesicles in
the cytoplasm, sometimes situated adjacent to a nerve fiber associated with the cell.

 These granules may liberate a transmitter substance across the synapse-like

junction between the Merkel cell and the nerve fiber and thus trigger an impulse.
This arrangement is in accord with neurophysiologic evidence suggesting that
Merkel cells are sensory and respond to touch.

• Merkel cells migrate from the neural crest.

 
INFLAMMATORY CELLS:
 When sections of epithelium taken from clinically normal areas of
mucosa are examined microscopically, a number of inflammatory
cells often can be seen in the nucleated cell layers.
 These cells are transient and do not reproduce themselves in the
epithelium as the other non-keratinocytes do.
 The cell most frequently seen is the lymphocyte, although the
presence of polymorphonuclear leukocytes and mast cells is not
uncommon.
 Lymphocytes often are associated with Langerhans cells, which
are able to activate T lymphocytes.
 A few inflammatory cells are common place in the oral epithelium
and can be regarded as a normal component of the nonkeratinocyte
population.
NON KERATINISED EPITHELIUM

 Nonkeratinizing epithelia differ from

keratinizing epithelia primarily because
they do not produce a cornified surface
layer, but there are other differences as
well.
 The layers in nonkeratinizing epithelium
are referred to as basal, intermediate, and
superficial (stratum basale, stratum
intermedium, stratum superficiale).
 Thus there are only three layers in the nonkeratinized epithelium. The
basal cells of both types are similar.
 The cells of the stratum intermedium are larger than cells of the stratum
spinosum. The intercellular space is not obvious or distended and hence
the cells do not have a prickly appearance. These cells do contain some
intermediate keratin filaments, but they differ biochemically from those in
keratinizing epithelia and are sparsely distributed within the cells.
The cells of the stratum intermedium are attached by desmosomes and other
junctions, and their cell surfaces are more closely applied than are spinous
cells
 There is no stratum granulosum (although incomplete
or vestigial granules may form), nor is there a stratum
corneum.
 Stratum superficiale contains nucleated cells. They
contain less number of tonofilaments and lack
keratohyaline granules. These cells ultimately
desquamate, as do the cornified squamae.
In general, nonkeratinizing oral mucosa have higher rates
of mitoses than do the keratinizing oral mucosa. Tissues
that are not keratinized at one stage of development may
keratinize at another
 Similarly, tissues may be modulated from keratinized-parakeratinized
and nonkeratinized variants in pathologic states. Although the terms
‘keratinized’ and ‘parakeratinized’ may be used interchangeably with
the terms ‘parakeratosis’ and ‘keratosis,’ the former terms refer to
physiologic and the latter terms refer to pathologic stages. When
keratinization occurs in a normally nonkeratinized tissue, it is referred
to as keratosis. When normally keratinizing tissue such as the
epidermis becomes parakeratinized, it is referred to as parakeratosis
• The boundary between the oral epithelium (OE) and underlying connective
tissue(CT) has a wavy course.
• The connective tissue portions which project into the epithelium are called
connective tissue papillae (CTP) and are separated from each other by epithelial
ridges – so‐called rete pegs (ER).
 Sulcular Epithelium

 The sulcular epithelium lines the gingival sulcus.

 It is a thin, nonkeratinized stratified squamous
epithelium without rete pegs, and it extends from the
coronal limit of the junctional epithelium to the crest
of the gingival margin. It usually shows many cells
with hydropic degeneration.
 Despite these morphologic and chemical
characteristics, the sulcular epithelium has the
potential to keratinize if it is reflected and exposed
to the oral cavity.
• The oral sulcular epithelium is the extension of the oral gingival
epithelium into the gingival sulcus.
• Its coronal most boundary is therefore the height of the free
marginal gingiva and its apical most boundary is the sloughing
surface of the junctional epithelium.
• Thus, the oral sulcular epithelium forms one lateral wall of the
gingival sulcus. The oral sulcular epithelium exhibits the same 4
epithelial strata as oral gingival epithelium, but a definitive and
continuous cornified layer is absent. Although the surface of the oral
sulcular epithelium may sometimes exhibit a degree of
parakeratinization, a primary distinguishing feature between it and
the oral gingival epithelium is that the oral sulcular epithelium does
not keratinize.
 The oral sulcular epithelium can be sharply demarcated visually from the adjacent
junctional epithelium because the cells of the oral sulcular epithelium appear much
darker due to elevated basophilicity of the cells.
 Transmigrating leukocytes are only seldom observed in the oral sulcular epithelium
owing to its lack of permeability (vis-A-vis the junctional epithelium).
 It has been speculated that the lack of keratinization of the oral sulcular epithelium
may play a role in rendering the gingival sulcus more susceptible to attack by
pathogenic periodontal microorganisms, and some reports have demonstrated
keratinization of the oral sulcular epithelium in response to physical stimulation
(such as sulcular brushing), but a keratinized inner surface of the oral sulcular
epithelium should be viewed as a pathological change without favorable
consequences in terms of gingival health.
 The sulcular epithelium is extremely important; it may act as a semipermeable
membrane through which injurious bacterial products pass into the gingiva and
through which tissue fluid from the gingiva seeps into the sulcus.
 Unlike the junctional epithelium, however, the sulcular epithelium is not heavily
infiltrated by polymorphonuclear neutrophil leukocytes, and it appears to be less
permeable.
 The nonkeratinized epithelium (although cytokeratins are the major component, as
in all epithelia) has neither granulosum nor corneum strata, whereas superficial
cells have viable nuclei.
 As with other nonkeratinized epithelia, the sulcular epithelium lacks granulosum
and corneum strata and K1, K2, and K10 through K12 cytokeratins, but it contains
K4 and K13, the so-called oesophageal type cytokeratins. It also expresses K19,
and it normally does not contain Merkel cells.
Junctional Epithelium or epithelial attachment apparatus

COMPOSITION, DIMENSION
 The junctional epithelium consists of a collar-like band of stratified
squamous nonkeratinizing epithelium. It is 3 to 4 layers thick in early
life, but that number increases with age to 10 or even 20 layers.
 The junctional epithelium tapers from its coronal end, which may be
10 to 29 cells wide to 1 or 2 cells wide at its apical termination,
which is located at the cementoenamel junction in healthy tissue.
These cells can be grouped in two strata: the basal layer that faces
the connective tissue and the suprabasal layer that extends to the
tooth surface.
 The length of the junctional epithelium ranges from 0.25 to 1.35 mm.
 
IMPORTANCE
 First, junctional epithelium is firmly attached to the tooth
and thus forms an epithelial barrier against the plaque
bacteria
 Second, it allows the access of GCF, inflammatory cells
and components of the immunological host defense to the
gingival margin.
 Third, junctional epithelial cells exhibit rapid turnover,
which contributes to the host–parasite equilibrium and
rapid repair of damaged tissue.

Pöllänen MT, Salonen JI, Uitto VJ. Structure and function of the tooth-epithelial interface in
health and disease. Periodontol 2000. 2003;31:12-31. doi: 10.1034/j.1600-
0757.2003.03102.x. PMID: 12656993.
Interdentally, the junctional epithelia of adjacent teeth fuse
coronally to form the lining of the interdental col.
In humans, this collar is about 2 mm in height and up to 100
micrometre thick. It tapers in an apical direction
FORMATION AND DEVELOPMENT

• The junctional epithelium is formed during

the phases of tooth eruption.
• As the tooth erupts into the oral cavity, the
flattened cuboidal cells cover the newly
formed crown to the level of the
cementoenamel junction. The epithelial
layers covering the tooth crown fuse with the
oral epithelium.
• Following this, the crown becomes exposed
to the oral cavity and the developing tooth
now becomes fully transgingival.
Bartold PM, Walsh LJ, Narayanan AS. Molecular and cell biology
of the gingiva. Periodontol 2000. 2000 Oct;24:28-55. doi:
10.1034/j.1600-0757.2000.2240103.x. PMID: 11276872.
• At this stage, the first evidence of formation of the junctional
epithelium is seen.
• The newly breeched oral epithelium appears to have fused to the
epithelial covering of the enamel organ and forms a continuum
of epithelial tissue apically along the crown surface to the level
of the cementoenamel junction.
• At this stage the bulk of the crown is still submerged and
remains covered by its reduced enamel epithelium.
• With continuing tooth eruption, the conversion of the reduced
enamel epithelium into junctional epithelium continues, and the
formation of the gingival sulcus begins to become apparent.
• Because the post-secretory ameloblasts of the reduced enamel
epithelium are terminally differentiated, they have no capacity to
divide and thus do not contribute to future generations of junctional
epithelium cells.
• However, the other cellular components of the reduced enamel
epithelium, those of the stratum intermedium of the enamel organ,
retain their ability to proliferate and provide the parent source of
future generations of junctional epithelial cells.
• These cells form the basal cells of the junctional epithelium and give
rise to cells which migrate coronally towards the gingival sulcus and
exfoliate. This continual renewal process maintains the junctional
epithelium’s structure and relationship to the tooth surface.
ATTACHMENTS:
 However, the other 3 normal epithelial strata (spinosum, granulosum and
corneum) are absent from the junctional epithelium; rather, all of the
intervening junctional epithelial cells may be considered simply as a
suprabasal cell layer.
 The suprabasal layer consists of cells that are more flattened and elongated,
with their long axes oriented in a corono-apical plane, which would appear to
facilitate cell migration in a coronal direction.
 The suprabasal cells and all cells along the internal basal lamina are in
constant coronal migration toward the base of the gingival sulcus, where they
are sloughed at the coronal most surface of the junctional epithelium. Basal
cells are somewhat cuboidal and suprabasal cells extremely flattened,
elongated and oriented parallel to the tooth surface.

 Schroeder HE, Listgarten MA. The gingival tissues: the architecture of periodontal protection.
Periodontol 2000. 1997 Feb;13:91-120. doi: 10.1111/j.1600-0757.1997.tb00097.x. PMID: 9567925.
The junctional epithelium is, therefore, a highly specialized
structure. It is a fully mature, functional, highly dynamic
epithelial tissue composed of only 2 cell layers.(hasell)

 The junctional epithelium is attached to the tooth surface

(epithelial attachment) by means of an internal basal
lamina.
 It is attached to the gingival connective tissue by an
external basal lamina that has the same structure as other
epithelial–connective tissue attachments elsewhere in the
body.
• The internal basal lamina consists of a lamina densa (adjacent to the
enamel) and a lamina lucida to which hemidesmosomes are
attached.
• Hemidesmosomes have a decisive role in the firm attachment of the
cells to the internal basal lamina on the tooth surface.
• Data suggest that the hemidesmosomes may also act as specific sites
of signal transduction and thus may participate in the regulation of
gene expression, cell proliferation, and cell differentiation
 Organic strands from the enamel appear to extend into the lamina densa.
The junctional epithelium attaches to afibrillar cementum that is present
on the crown (usually restricted to an area within 1 mm of the
cementoenamel junction) and root cementum in a similar manner.
 The internal basal lamina is approximately three times thicker than the
external basal lamina. It contains laminin and proteoglycans.
 Cells in contact with the internal basal lamina express the a6b4 integrin,
a laminin receptor. The cells in contact with the internal basal lamina
contain a relatively well-developed rough endoplasmic reticulum, and
numerous Golgi components.

Cho MI, Garant PR. Development and general structure of the

periodontium. Periodontol 2000. 2000 Oct;24:9-27. doi:
10.1034/j.1600-0757.2000.2240102.x. PMID: 11276876. 
 LAMININ

(The extracellular matrix of the periodontium: dynamic and interactive

tissues ANGELO MARIOT)
• Laminin appears to be ubiquitous in basement membranes and, in conjunction
with nidogen (entactin), forms an important complex within the matrix.
• At least seven different forms of laminin, which have selective distributions
and functions, have been described.
• Laminin is composed of three polypeptide chains which aggregate in a
crucifix-like structure. (glycoprotein)
• With nidogen acting as an intermediary agent, laminin is able to interact with
type IV collagen and contribute to the sieve-like network organization of
basement membranes.
• In addition to its interaction with nidogen and type IV collagen, laminin
mediates cell adhesion through cell surface integrins and may also play a
regulatory role in cell proliferation and migration of epithelial cells.
• Immunolocalization studies have shown the laminin to be uniformly
distributed in the basement membrane of gingival epithelia, with both laminin-
1 and laminin-5 being identified in these tissues.
• Laminins are comprised of a number of tissue-specific and
cell-specific isotypes.
• The laminin molecule is comprised of domains for the
attachment of prokaryotic and eukaryotic cells ,heparin, elastin,
type IV collagen, nidogedentactin and galactoside-binding
lectins.
• In embryonic tissues, laminin is the first extracellular protein
detected, and in mature tissues it is universally found as the
major non-collagen component in basement membranes.
 The attachment of the junctional epithelium to the tooth is
mediated through an ultramicroscopic mechanism defined as
the epithelial attachment apparatus.
 It consists of hemidesmosomes at the plasma membrane of the
cells directly attached to the tooth (DAT cells).

Pöllänen MT, Salonen JI, Uitto VJ. Structure and function of the tooth-epithelial
interface in health and disease. Periodontol 2000. 2003;31:12-31. doi: 10.1034/j.1600-
0757.2003.03102.x. PMID: 12656993.
DAT cells
 The innermost suprabasal cells (facing the tooth surface) are called DAT cells (=
directly attached to the tooth) (Salonen et al, 1989).
Functions of DAT cells
 Form and maintain the 'internal basal lamina' that faces the tooth surface.
 Capable of synthesizing DNA.
 Express a high density of transferrin receptors which supports high turnover.
 Important role in tissue dynamics and reparative capacity of the junctional
epithelium.
The mechanism of DAT cell turnover
•DAT cells are able to divide and migrate, three possible mechanisms
(1) daughter cells produced by dividing DAT cells replace degenerating cells on the
tooth surface,
2) daughter cells migrate coronally to eventually break off into the
sulcus,

3) epithelial cells move in the coronal direction along the tooth

surface and are replaced by basal cells migrating round the apical
termination of the junctional epithelium.

Features:
1.Junctional epithelium is firmly attached to the tooth and thus forms
an epithelial barrier against the plaque bacteria
2.Allows the access of GCF, inflammatory cells and components of
the immunological host defense to the gingival margin.
3.Exhibit rapid turnover, which contributes to the host–parasite
equilibrium and rapid repair of damaged tissue.
• The cells of the stratum basale proliferate rapidly, while those of
the suprabasale layer have no mitotic capacity.
• The epithelial connective tissue interface is not characterized by
rete ridges and tends to be straight with only mild undulations
apparent in the more coronal portions.
• Within the junctional epithelium, the gaps between cells appear
to be larger than in either the oral gingival epithelium of sulcular
epithelium. Indeed, the so called ‘‘wider’’ intercellular spaces of
the junctional epithelium have always been considered a ‘‘weak
link’’ allowing permeation of bacterial products into the gingival
connective tissue and initiating an inflammatory response.
• Throughout the junctional epithelium, numerous migrating
polymorphonuclear leukocytes are evident.
• These migrating leukocytes are present in health but
dramatically increase in number with the accumulation of dental
plaque and are closely associated with the development of
gingival inflammation.
• Lymphocytes (particularly T lymphocytes) are also found with
an intraepithelial distribution in the junctional epithelium.
 Data also have shown that the basal lamina of the junctional epithelium
resembles that of endothelial and epithelial cells in its laminin content but
differs in its internal basal lamina, which has no type IV collagen. These
findings indicate that the cells of the junctional epithelium are involved in
the production of laminin and play a key role in the adhesion mechanism.
 Internal basal lamina proteins include laminin and type VIII collagen.
 Laminin, identified as type 5, is localized mainly to the optically
electrondense part of the internal basal lamina and it seems to be associated
with hemidesmosomes. Characteristically, the internal basal lamina lacks
laminin-1 and type IV collagen, which are components of true basement
membranes.

 Pöllänen MT, Salonen JI, Uitto VJ. Structure and function of the tooth-epithelial interface in health
and disease. Periodontol 2000. 2003;31:12-31. doi: 10.1034/j.1600-0757.2003.03102.x. PMID:
12656993
 The attachment of the junctional
epithelium to the tooth is reinforced by
the gingival fibres, which brace the
marginal gingiva against the tooth
surface. For this reason, the junctional
epithelium and the gingival fibers are
considered together as a functional
unit referred to as the dentogingival
unit.
 
 In healthy teeth, the junctional epithelium (epithelial
attachment) ends at the cementoenamel junction. Densely
packed collagen bundles are anchored to the acellular
extrinsic fiber cementum just below the terminal point of the
junctional epithelium.
 These collagen bundles form the connective tissue
attachment. The stability of this connective tissue attachment
is a key factor in limiting the migration of the junctional
epithelium.

Cho MI, Garant PR. Development and general structure of the periodontium.
Periodontol 2000. 2000 Oct;24:9-27. doi: 10.1034/j.1600-0757.2000.2240102.x.
PMID: 11276876. 
While cell mitosis occurs in the basal Since the surface area occupied by the basal
and possibly also in some DAT cells cells is much greater than that of the sulcus
(Salonen, 1994), exfoliation of bottom, exfoliation must occur at an
daughter cells takes place at the free extremely high rate (Löe and Karring, 1969;
surface of the junctional epithelium Listgarten, 1972).
(i.e., at the bottom of the sulcus and The DAT cells are said to migrate toward
the interdental col). Thus, junctional the sulcus bottom. Since the DAT cells are
epithelial cells migrate in the coronal connected to the basal lamina via
direction toward the free surface, hemidesmosomes, a remodeling of the
where they desquamate. epithelial attachment must occur. Thus, the
epithelial attachment normally is not static
but dynamic.
 Schroeder HE, Listgarten MA. The gingival tissues: the
architecture of periodontal protection. Periodontol 2000.
1997 Feb;13:91-120. doi: 10.1111/j.1600-
0757.1997.tb00097.x. PMID: 9567925.
Mast cells, plasmablasts and even Langerhans cells are
encountered in junctional epithelium, although the latter
are not always present.
The highest concentration of leukocytes is found beneath
the sulcus bottom, in the most coronal part of the
junctional epithelium, and decreases apically.
Inside the junctional epithelium, the ratio of neutrophilic
granulocytes to mononuclear leukocytes is, on average,
1:3.6, instead of 95:5 as reported in sulcular washings.

Schroeder HE, Listgarten MA. The gingival tissues: the

architecture of periodontal protection. Periodontol 2000.
1997 Feb;13:91-120. doi: 10.1111/j.1600-
0757.1997.tb00097.x. PMID: 9567925.
KERATINS EXPRESSED
• Junctional epithelium expresses K19, which is absent from keratinized
epithelia, and the stratification-specific cytokeratins K5 and K14.
• Morgan and colleagues reported that reactions to demonstrate K4 or K13
reveal a sudden change between sulcular and junctional epithelia; the
junctional area is the only stratified nonkeratinized epithelium in the oral
cavity that does not synthesize these specific polypeptides.
• Another particular behaviour of junctional epithelium is the lack of
expression of K6 and K16, which is usually linked to highly proliferative
epithelia, although the turnover of the cells is very high.
• Cell layers that are not juxtaposed to the tooth exhibit numerous
free ribosomes, prominent membrane-bound structures (e.g.,
Golgi complexes), and cytoplasmic vacuoles that are presumably
phagocytic.
• Lysosome-like bodies also are present, but the absence of
keratinosomes (Odland bodies) and histochemically
demonstrable acid phosphatase, which are correlated with the
low degree of differentiation, may reflect a low-defense power
against microbial plaque accumulation in the gingival sulcus.
 In addition, all junctional epithelial cells express N-acetyl-
lactosamine, epidermal growth factor and the intercellular
adhesion molecules ICAM- 1 and LFA-3 on their surface.
 Lysosomal bodies are encountered in cells facing the tooth
surface and those near the sulcus bottom.
 Membrane-coating granules are absent, an observation
suggesting that the junctional epithelium lacks a diffusion
barrier.

 
 TURNOVER
• The turnover rate of junctional epithelium is exceptionally rapid.
In nonhuman primates it is about 5 days and approximately twice
the rate of the oral gingival epithelium.
• Previously it was thought that only epithelial cells facing the
external basal lamina were rapidly dividing. However, recent
evidence indicates that a significant number of the DAT cells are,
like the basal cells along the connective tissue, capable of
synthesizing DNA, which demonstrates their mitotic activity.
Pöllänen MT, Salonen JI, Uitto VJ. Structure and function of the
tooth-epithelial interface in health and disease. Periodontol
2000. 2003;31:12-31. doi: 10.1034/j.1600-0757.2003.03102.x.
PMID: 12656993.
• At the coronal part of the junctional
epithelium, the DAT cells typically express a
high density of transferrin receptors, which
supports the idea of their active metabolism
and high turnover. The findings suggest that
the DAT cells have a more important role in Schroeder HE, Listgarten MA. The
tissue dynamics and reparative capacity of gingival tissues: the architecture of
periodontal protection. Periodontol
the junctional epithelium than has previously 2000. 1997 Feb;13:91-120. doi:
been thought. 10.1111/j.1600-
• The existence of a dividing population of 0757.1997.tb00097.x. PMID:
9567925.
epithelial cells (DAT cells) in a suprabasal
location, several layers from the connective
tissue, is a unique feature of the junctional
epithelium and that this activity might be
protective in nature.
 The junctional epithelium is completely restored
within about 5 days in primates. The high rates of
cell migration and exfoliation are facilitated by the
relatively small number of desmosomes and gap
junctions that connect junctional epithelial cells.

 Schroeder HE, Listgarten MA. The gingival tissues: the architecture

of periodontal protection. Periodontol 2000. 1997 Feb;13:91-120.
doi: 10.1111/j.1600-0757.1997.tb00097.x. PMID: 9567925.
 ANTIMICROBIAL DEFENSE

 Junctional epithelium consists of active populations of cells and

antimicrobial functions, which together form the first line of
defense against microbial invasion into tissue
 Even though junctional epithelial cell layers provide a barrier
against bacteria many bacterial substances, such as
lipopolysaccharide, pass easily through the epithelium but have
only limited access through the external basal lamina into the
connective tissue.
 Both the internal and external basal laminas act as barriers against
infective agents. Many epithelial cell types, including junctional
epithelium, have been found to contain enzyme-rich lysosomes.
 The junctional epithelial cells lateral to DAT cells produce
matrilysin.
• Leukocytes, especially the polymorphonuclear leukocytes that migrate
through the junctional epithelium, comprise probably the most
important defense mechanism at the gingival margin.
• The cell surface carbohydrates expressed by the junctional epithelial
cells are thought to respond to extracellular molecular changes in a
manner which allows the cells to communicate with their environment.
• The cells respond actively to bacterial infection by producing cell
adhesion molecules (intercellular adhesion molecule1) and chemotactic
substances (chemokines such as C5a, leukotriene B4, lymphocyte
function-associated antigen-3 and interleukin-8) that facilitate the
migration of leukocytes through the junctional epithelium.
REGENERATION
 That cells other than the embryologically reduced
ameloblasts and stratum intermedium cells can differentiate
into junctional epithelial cells has been demonstrated by
complete surgical removal of all marginal gingival tissue,
including the entire junctional epithelium, in animals.
 A new junctional epithelium forms during the wound-healing
process and its appearance is identical to a post-eruptive
junctional epithelium.
 

Hassell TM. Tissues and cells of the periodontium. Periodontol

2000. 1993 Oct;3:9-38. doi: 10.1111/j.1600-
0757.1993.tb00230.x. PMID: 9673156
 The cells of such newly formed junctional epithelia take their
origins from basal cells of the remaining oral epithelium or the
oral sulcular epithelium.
 In periodontal therapy, post-surgical regeneration of an
elongated junctional epithelium is now recognized as an
undesirable sequela, because it appears to prevent the
formation of new cementum and the subsequent new
attachment of connective tissue fibers to the denuded tooth
surface.
 The oral sulcular epithelial cells do have the capacity to
differentiate into junctional epithelial cells if the latter are
severely compromised by disease or lost entirely.
PATHWAY OF EXUDATION AND CELLULAR EMIGRATION:

 Preferential pathway for the inflammatory exudate, since

neither the oral sulcular epithelium nor the oral gingival
epithelium serve that purpose.
 Gingival fluid as well as neutrophilic granulocytes originate
from the vessels of the gingival plexus.
 Gingival fluid is of an exudative nature and is absent when the
gingiva is virtually free of inflammation, as is the case in
experimentally induced norma1 gingiva.

The gingival tissues: the architecture of periodontal protection

HUBERT E. SCHROEDER & MAxA. LISTGARTEN 1997
 Within the junctional epithelium, gingival fluid passes
through the intercellular spaces that can be distended to
variable degrees. In a slightly inflamed gingiva, fluid may
accumulate in the enlarged spaces.
 Ultrastructurally, enlarged intercellular spaces have been
shown to be filled with electron-dense material, probably
serum proteins . Such enlargements occur mainly in the
coronal half of the junctional epithelium, particularly in its
central portion.
Neutrophilic granulocytes passing through the
junctional epithelium carry normal receptors for
C3b and the Fc region of IgG and kill
microorganisms effectively. These observations
support the statement that neutrophilic
granulocytes kill bacteria with almost equal
efficiency under aerobic or anaerobic
conditions.
 EPITHELIAL MIGRATION WITH
MONONUCLEAR LEUKOCYTES:
 The junctional epithelium serves not only as a
pathway for the transmigration of neutrophilic
granulocytes and for gingival fluid exudation but
also as a compartment that accommodates
mononuclear leukocytes.
 Based on electron microscopic observations, this
population of mononuclear leukocytes consists of
small lymphocytes, T and B-lymphoblasts, as well
as monocytes/macrophages and, rarely, mast
cells.The exact proportion of each cell class is
unknown and appears to vary unpredictably over
time.
RENEWAL OF GINGIVAL EPITHELIUM
 The oral epithelium undergoes continuous renewal. Its thickness is
maintained by a balance between new cell formation in the basal
and spinous layers and the shedding of old cells at the surface.
 The mitotic activity exhibits a 24-hour periodicity, with the highest
and lowest rates occurring in the morning and evening,
respectively.The mitotic rate is higher in nonkeratinized areas and
increased in gingivitis, without significant gender differences.
 A significant number of the cells (e.g., the basal cells along the
connective tissue) are capable of synthesizing deoxyribonucleic acid
(DNA), thereby demonstrating their mitotic activity.
 The rapid shedding of cells effectively removes bacteria that adhere
to the epithelial cells and therefore is an important part of the
antimicrobial defense mechanisms at the dentogingival junction.
 The mitotic rate in experimental animals varies among different areas of the oral
epithelium in descending order: buccal mucosa, hard palate, sulcular epithelium,
junctional epithelium, outer surface of the marginal gingiva, and attached gingiva.
 The following have been reported as turnover times for different areas of the oral
epithelium in experimental animals: palate, tongue, and cheek, 5 to 6 days; gingiva, 10
to 12 days, with the same or more time required with age; and junctional epithelium, 1
to 6 days.
 When two daughter cells (D) have been formed by cell
division, an adjacent “older” basal cell (OB) is pushed into
the spinous cell layer and starts, as a keratinocyte, to traverse
the epithelium.It takes approximately 1 month for a
keratinocyte to reach the outer epithelial surface, where it is
shed from the stratum corneum. Within a given time, the
number of cells which divide in the basal layer equals the
number of cells which are shed from the surface. Thus,
under normal conditions there is equilibrium between cell
renewal and cell loss so that the epithelium maintains a
constant thickness. As the basal cell migrates through the
epithelium, it becomes flattened with its long axis parallel to
the epithelial surface.
 
INTEGRINS:
(Expression of Integrins in Human Gingiva M. HORMIA et al 1990)
• The interaction of cells with each other and with the surrounding extracellular matrix
is a central phenomenon in a wide variety of biological processes, including tissue
morphogenesis, remodelling, repair, guided cell migration, and formation of
epithelial barriers (Hay, 1983; Ekblom et al, 1986).
• The nature of the membrane receptors involved in cell-cell and cell matrix
interactions has recently been studied widely. A family of proteins, designated
integrins, has been attributed to pericellular matrix receptors (Hynes, 1987; Ruoslahti
and Giancotti, 1989).
• The integrins are heterodimeric transmembrane glycoproteins composed of non-
covalently-linked alpha and beta subunits (Hynes, 1986). Each integrin is, therefore,
defined by its subunits.
• On the basis of their chains, integrins have commonly been
divided into three main subfamilies, the beta1,beta2, and beta3
integrins (Buck and Horwitz, 1987; Hemler et al., 1987a; Hynes,
1987; Gehlsen et al., 1988; Ruoslahti, 1988; Kajiji et al, 1989;
Ruoslahti and Giancotti, 1989).
• Members of the beta-1 integrin family contain one of at least six
unique but related alpha subunits, complexed with the common
Beta subunit.
DISTRIBUTION
• An overall cell membrane immunoreactivity for the a2 and a3 subunits was
shown in basal cells of gingival epithelium and in cells of JE, corresponding to
the epithelial localization of the b1 subunit.
• The a6 subunit was polarized to the basal aspects of basal epithelial cells, but
was also present in an overall cell surface distribution in basal cells and in cells
of JE.
• The b4 integrin subunit was mainly expressed at the basal aspects of basal cells
in gingival epithelium and JE. The results indicate that the a2/b1, a3/b1 a6/b1,
and a6/b4 integrins are all expressed in human gingival epithelium.
• Of these, the a6/b4 integrin complex is the major candidate for mediation of the
attachment of epithelial cells to the basement membrane facing the connective
tissue and probably also the tooth.
BIOLOGY OF SOFT TISSUE REPAIR: GINGIVAL EPITHELIUM IN WOUND HEALING AND
ATTACHMENT TO THE TOOTH AND ABUTMENT SURFACE S. Gibbs1,2,*, S. Roffel2 , M. Meyer3
and A. Gasse 2019
BIOLOGY OF SOFT TISSUE REPAIR: GINGIVAL EPITHELIUM IN WOUND HEALING AND
ATTACHMENT TO THE TOOTH AND ABUTMENT SURFACE S. Gibbs1,2,*, S. Roffel2 , M. Meyer3
and A. Gasse 2019
CONCLUSION

The gingival tissues, with their specialized relation- ship to

the tooth surface, constitute the major peripheral defense
against microbial infections that may lead to periodontal
disease. Both the epithelial and connective tissue
components play major roles in this defense. Although the
keratinized oral gingival epithelium provides effective
protection against both mechanical trauma and bacterial
invasion, the nonkeratinized junctional epithelium is only
partly effective in its protective role, because its attachment
function to the tooth is incompatible with good resistance to
trauma
 REFERENCES

Hassell TM. Tissues and cells of the periodontium. Periodontol 2000. 1993 Oct;3:9-38. doi:
10.1111/j.1600-0757.1993.tb00230.x. PMID: 9673156
Pöllänen MT, Salonen JI, Uitto VJ. Structure and function of the tooth-epithelial interface in health and
disease. Periodontol 2000. 2003;31:12-31. doi: 10.1034/j.1600-0757.2003.03102.x. PMID: 12656993.
Schroeder HE, Listgarten MA. The gingival tissues: the architecture of periodontal protection. Periodontol
2000. 1997 Feb;13:91-120. doi: 10.1111/j.1600-0757.1997.tb00097.x. PMID: 9567925.
Cho MI, Garant PR. Development and general structure of the periodontium. Periodontol 2000. 2000
Oct;24:9-27. doi: 10.1034/j.1600-0757.2000.2240102.x. PMID: 11276876. 
Bartold PM, Walsh LJ, Narayanan AS. Molecular and cell biology of the gingiva. Periodontol 2000.
2000 Oct;24:28-55. doi: 10.1034/j.1600-0757.2000.2240103.x. PMID: 11276872.

Carranza 13th edition

Lindhe 6th edition