Oral histology, Sebha, 2010-2011

Tooth development:
Tooth development can be divided into three overlapping phases: initiation, morphogenesis and
histogenesis.

 During initiation, the sites of future teeth are established with the appearance of tooth
germs along an invagination of the oral epithelium.
 During morphogenesis, the shape of the tooth is determined by a combination of cell
proliferation and cell movement.
 During histogenesis, differentiation of cells proceeds to give rise to the fully formed dental
tissues.

1. Initiation of the tooth development:

Odontogenesis is first initiated by factors resident in the first arch epithelium influencing
ectomesenchyme. However, with time, this potential is assumed by the ectomesenchyme. The
expression pattern of transcription and growth factors in these tissues reflects this changing. Once
the ability to initiate tooth development has been acquired by ectomesenchyme, it is maintained by
dental papillary cells. Evidence to support the importance of epitheial-mesenchymal interactions in
initiating tooth development can be seen in transgenic mice where, for example, an absence of gene
Msx1 results in an arrest of tooth development.

2. Primary epithelial band:

By the six week of development, a continuous band of thickened epithelium forms around the mouth
in the presumptive upper and lower jaws and invaginates into the mesenchyme. These bands are
horseshoe shaped and correspond in position to the future dental arches. By the seven week, each
band of epithelium called the primary epithelial band gives rise to two subdivisions: the vestibular
lamina and the dental lamina.

[Link] lamina:
The vestibule between cheek or lips and teeth forms as a result of the proliferation of vestibular
lamina into the ectomesenchyme and the degeneration of its central cells to form the sulcus of the
vestibule.

[Link] lamina:
Further development of the dental lamina is characterized by an increase in length. By eight week of
development, a continued and localized proliferative activity leads to the formation of a series of
epithelial ingrowths into the ectomesenchyme at sites corresponding to the positions of the future
deciduous teeth. Each epithelial swelling called enamel organ or dental organ is almost completely
surrounded by a mesenchymal condensation. From this point, tooth development proceeds in three
stages: the bud, cap and bell stages. Leading up to the late bell stage, hard tissues are formed and
further growth of the tooth is related to tissue deposition.

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3. Bud stage
The enamel organ appears as a simple spherical to ovoid epithelial condensation that is poorly
morphodifferentiated and histodifferentiated. The epithelial component is separated from the
adjacent mesenchyme by a basement membrane. The successful development of the tooth germ
relies upon a complex interaction of the mesenchymal and epithelial components.

4. Cap stage
The epithelial bud continues to proliferate while ectomesenchyme shows an increasing cellular
density referred as a condensation of the ectomesenchyme. The epithelial dental organ in growth
resembles a cap sitting on a ball of condensed ectomesenchyme. The ball of condensed
ectomesenchymal cells is called the dental papilla. The dental organ and the dental papilla begin to
be encapsulated by a peripheral condensed ectomesenchymal cells called dental follicle. The dental
organ, dental papilla and dental follicle constitute the tooth germ.

5. Early Bell stage

Tooth germ continues growing and the dental organ comes to resemble a bell as the undersurface of
the dental organs deepens and maps out the occlusal morphology of the future tooth. It is supported
by a basal lamina around its periphery that separates it from the dental papilla.

5.1. Structure:
5.1.1Dental organ:
The cells are organized in several layers.

External/outer dental epithelium:

At the periphery of the dental organ, the cells assume a cuboidal shape and have a high
nuclear:cytoplasmic ratio.

Stellate reticulum:
The cells in the center of the dental organ become star shaped. They are attached to each other by
desmosomes at their cytoplasmic process but their bodies are separated from each other by ground
substance.

Internal dental epithelium

The cells bordering the dental papilla differentiate into internal dental epithelium. They have a
centrally placed nucleus with a free ribosome cytoplasm.

Stratum intermedium:
Between the internal dental epithelium and the newly differentiated stellate reticulum some
epithelial flattened cells differentiate into two or three layers of stratum intermedium. The internal
dental epithelium meets the external dental epithelium at the rim of the dental organ. This junctional
zone is known as the cervical loop.

5.1.2 Dental papilla :

The cells appear as undifferentiated mesenchymal cells. A few fine scattered collagen fibrils occupy
the extracellular spaces.

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5.1.3 Dental follicle:

It is more collagenous than the dental papilla. Its fibrils and fibroblasts are generally orientated in a
radial pattern around the dental organ and dental papilla.

5.1.4 Dental transient structures:

During the stages of tooth development some transient structures occur that are not necessarily
present in every tooth germ or at the same time.

The enamel knot:

It is a localized thickening in the internal dental epithelium at the center of the tooth germ. It plays a
role in the patterning of the crown.

The enamel cord:

It is a strand of cells running from the knot to the external dental epithelium dividing the dental
organ in two parts.

The enamel niche:

It is an apparent structure in histologic sections when the section is realized through the concavity of
the sheet of dental lamina filled with connective tissue creating the impression that the tooth germ
has a double attachement to the oral epithelium by several separate strands.

5.2. Events occurring during the bell stage:

5.2.1 Breakup of the dental lamina:
The dental lamina joining the tooth germ to the oral epithelium breaks up into discrete islands of
epithelial cells. The developing tooth is separated from the oral epithelium and dental lamina
between tooth germs also degenerates. Remnants of the dental lamina called epithelial pearls of
Serres could form cysts.

5.2.2 Crown pattern determination:

The internal dental epithelium folds making it possible to recognize the shape of the future crown
pattern of the tooth. As stellate reticulum cells are separated by ground substance, a pressure is
exerting on both the internal and the external dental epithelia. The growing dental papilla also grows
and the internal dental epithelium lies between two opposing pressures. In the internal dental
epithelium, differential rates of mitotic division occur. Cell division ceases when they begin to
differentiate. This occurs at the site of future cusp and incisal margins development and evaluate
laterally to the junctional zone that remains mitotically active.

6. Late bell stage= appositional stage (Hard tissue formation)

6.1 Crown stage:
The formation of dentin, a specialized hard connective tissue forming the bulk of the tooth, always
precedes the enamel formation, the hardest tissue in the organism that covers the tooth crown.
Dentin appears at the top of the cusps after the differentiation of the cells called in regard in the
dental papilla. After the first dentin has been formed, the epithelial cells lining the dentin
differentiate and produce the enamel at its surface. Considering the limit between the dental organ
and dental papilla, dentin is elaborated from the outside to inside while enamel is produced from

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inside to outside. This hard tissue formation begins at the top of the cusps and progress laterally to
the cervical portions to cover the entire crown. The dental papilla that is surrounded by dentin is
called now pulp and the dental papilla that is not yet surrounded by dentin is called apical papilla.

6.2 Root formation:

The root of the tooth consists of dentin. Epithelial cells are also required to initiate the differentiation
of mesenchymal cells at the periphery of the dental papilla to give radicular dentin. When the crown
is formed, epithelial cells of the external and internal dental epithelium proliferate from the cervical
loop of the dental organ to form a double layer of cells known as Hertwig’s epithelial root sheath.
This sheath of epithelial cells grows around the dental papilla between the papilla and the dental
follicle. Epithelial diaphragm encloses the primary apical foramen. Once the root sheath forms, it
rapidly initiates root formation and then becomes fragmented without formation of enamel on the
surface of the roots. This fragmentation forms a fenestrated network around the root. In longitudinal
section this fenestration network is seen as a discrete cluster of epithelial cells called epithelial cell
rests of Malassez. These cell rests persist next to the root surface after tooth development. For a long
time, they were incriminated in the development of radicular cysts, but recent studies demonstrated
that they play an important role as a space maintainer to preserve the integrity of the periodontal
space.

Two-rooted teeth are formed when epithelial cells proliferate and form two tongues of epithelium
growing toward each other inside the dental papilla. Dental papilla is divided and apical foramen is
converted into two secondary apical foramina. If three tongues of epithelium grow, three secondary
apical foramina arise and three roots develop.

7. Formation of the primary and permanent dentition:

The permanent dentition also arises from the dental lamina that shows a further proliferative
activity. This leads to the formation of another epithelial cap on the lingual aspect of the deciduous
tooth germs. The permanent molars have no deciduous predecessors, so their tooth germs originate
by a posterior proliferation of the dental lamina beneath the lining epithelium of the oral mucosa.
This backward extension gives rise to the tooth germs of the first, the second and the third molar.

The entire primary dentition is initiated between the sixth and eight weeks of embryonic
development, the successional permanent teeth between the twentieth week in utero and the tenth
month after birth and the permanent molars between the twentieth week in utero and the fifth year
of life.

Further reading:

 Oral Histology, development, structure and function. Ten Cate, Mosby edition
 Oral anatomy, histology and embryology. Berkovitz BKB, Holland GR, Moxham BJ. Mosby
edition