ORAL HISTOLOGY

Lec. (1) ‫مصطفى هادي اخلياط‬.‫د‬

Development and Growth

of the Teeth
The primitive oral cavity, or stomodeum, is lined by stratified squamous epithelium
called the oral ectoderm or primitive oral epithelium. Most of the connective tissue cells
underlying the oral ectoderm are of neural crest or ectomesenchyme in origin. Neural crest
cells induce the overlying ectoderm to start tooth development, which begins in the
anterior portion of what will be the future maxilla and mandible and proceeds posteriorly.

Primary epithelial band:

When the embryo is about 6 weeks old, certain areas
of oral ectoderm proliferate more rapidly than do the cells
of the adjacent areas. This leads to the formation of the
primary epithelial band which is a band of thickened
epithelium that invades the underlying ectomesenchyme
along each of the horseshoe-shaped future dental arches.

At about 7th week, the primary epithelial

band divides into an inner (lingual) process
called Dental lamina and an outer (buccal)
process called Vestibular lamina.

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  Dental lamina
The neural crest cells induce the oral epithelium to proliferate and form the dental
lamina, which is the first sign of tooth development. The epithelium of the dental lamina is
separated from the underlying ectomesenchyme by a basement membrane. Along the
dental lamina, continued and localized proliferative activity leads to the formation of 20
epithelial outgrowths into the mesenchyme which are the forming buds of the 20 deciduous
teeth. Ectomesenchymal cells accumulate around these outgrowths.
The lamina continues to develop the 32 permanent tooth buds which develop from a
lingual position to their deciduous predecessors. Later, during the development of the jaws,
the permanent molars arise directly from a distal extension of the dental lamina. The distal
proliferation of the dental lamina is responsible for the location of the germs of the
permanent molars in the ramus of the mandible and the tuberosity of the maxilla.
The development of the first permanent molar is initiated at the fourth month in
utero. The second molar is initiated at about the first year after birth, the third molar at the
fourth or fifth years; therefore, the total activity of the dental lamina extends over a period
of at least 5 years. As the teeth continue to develop, they lose their connection with the
dental lamina and later break up by mesenchymal invasion. Remnants of the dental lamina
persist as epithelial pearls or islands within the jaw as well as in the gingiva. These are
referred to as cell rest of Serres.

 Vestibular lamina
Labial and buccal to the dental lamina in each dental arch, another epithelial thickening
develops independently, it is the vestibular lamina. The vestibule forms as a result of the
proliferation of the vestibular lamina into the underlying ectomesenchyme soon after
formation of the dental lamina. The cells of the vestibular lamina rapidly enlarge and then
degenerate to form a cleft that becomes the vestibule or sulcus between the cheek and the
tooth-bearing area.

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Morphological Stages of Tooth Development
On the anterior aspect of the dental lamina, continued and localized proliferative
activity leads to the formation of a series of epithelial outgrowths into the surrounding
ectomesenchyme. Each of these little outgrowths from the dental lamina represents the
beginning of the enamel organ of the tooth bud of a deciduous tooth. Ectomesenchymal
cells accumulate around these outgrowths. From this point, tooth development proceeds in
three stages: the bud, cap, and bell.

1. Bud stage
Round or ovoid swellings arise from dental lamina at 10
different points in each jaw and grow into the underlying
ectomesenchyme, corresponding to the future position of
deciduous teeth; these are the tooth buds. Since the main
function of certain epithelial cells of the tooth bud is to
form the enamel of the tooth, these cells constitute the
enamel organ, which is critical to normal tooth
development.
In the bud stage, the enamel organ consists of peripherally located low columnar cells
and centrally located polygonal cells. Many cells of the tooth bud and the surrounding
mesenchyme undergo mitosis. As a result of the increased mitotic activity and the migration
of neural crest cells into the area, the ectomesenchymal cells surrounding the tooth bud
condense. The area of ectomesenchymal condensation immediately subjacent to the
enamel organ is the dental papilla. The condensed ectomesenchyme that surrounds the
enamel organ and the dental papilla is the dental sac or dental follicle. The enamel organ,
dental papilla, and dental follicle together constitute the tooth germ. The enamel is formed
from the enamel organ, the dentin and pulp from the dental papilla and the supporting
tissues namely the cementum, periodontal ligament and the alveolar bone from the dental
follicle.

2. Cap stage
As the tooth bud continues to proliferate unequally
into the ectomesenchyme, the deeper surface of the
enamel organ invaginates to form a cap-shaped structure.
The peripheral cells of the cap stage are cuboidal, cover the
convexity of the cap, and are called the outer enamel
epithelium. The cells in the concavity of the cap become

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tall, columnar cells and represent
the inner enamel epithelium.
Polygonal cells located in the center
of the enamel organ, between the
outer and inner enamel epithelia
are separated and become star
shaped but maintain contact with
each other by their cytoplasmic
process. As these star- shaped cells
form a cellular network, they are
called the stellate reticulum. This
gives the stellate reticulum a
cushion like consistency and acts as
a shock absorber that may support
and protect the delicate enamel-
forming cells.
The adjacent ectomesenchymal cells are continue to proliferate and surround the
enamel organ. The part of the ectomesenchyme lying beneath the inner enamel epithelium
is called dental papilla. The ectomesenchymal tissue surrounding both enamel organ and
dental papilla is called dental sac or dental follicle.
The cells in the center of the enamel organ are densely packed and form the enamel
knot. At the same time a vertical extension of the enamel knot, called the enamel cord
occurs. When the enamel cord extends to meet the outer enamel epithelium it is termed as
enamel septum, for it would divide the stellate reticulum into two parts. These are
temporary structures (transitory structures) that disappear before enamel formation
begins. The function of the enamel knot and cord may act as a reservoir of dividing cells for
the growing enamel organ.

3. Bell stage
As the invagination of the epithelium deepens and its
margins continue to grow, the enamel organ assumes a
bell shape. During this stage, a tooth crown assumes its
final shape (morphodifferentiation) and the cells that will
be making the hard tissues of the crown (ameloblasts and
odontoblasts) acquire their distinctive phenotype
(histodifferentiation).

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 A// Early bell stage:
Four different types of epithelial cells can be distinguished on light microscopic
examination of the bell stage of the enamel organ. The cells form the inner enamel
epithelium, the stratum intermedium, the stellate reticulum, and the outer enamel
epithelium. The junction between inner and outer enamel epithelium is called cervical loop
and it is an area of intense mitotic activity.

 Inner enamel epithelium:

It consists of a single layer of cells that differentiate prior to amelogenesis into tall
columnar cells called ameloblasts. These cells are 4 to 5 μm in diameter and about 40 μm
high. The inner enamel epithelium is separated from the peripheral cells of dental papilla by
a basement membrane and cell free zone. The cells of this layer exert an organizing
influence on the underlying ectomesenchymal celIs of the dental papilla, which later
differentiate into odontoblasts.

 Stratum intermedium:
A few layers of flattened squamous cells form the stratum intermedium, between the
inner enamel epithelium and the stellate reticulum. This layer seems to be essential to
enamel formation. It is absent in the part of the tooth germ that outlines the root portions
of the tooth which does not form enamel.

 Stellate reticulum:
The stellate reticulum expands further, mainly by an increase in the amount of
intercellular fluid. The cells are star shaped, with long processes that anastomose with
those of adjacent cells. Before enamel formation begins, the stellate reticulum collapses,
reducing the distance between the ameloblasts and the nutrient capillaries near the outer
enamel epithelium.

 Outer enamel epithelium:

The cells of the outer enamel epithelium flatten to a low cuboidal form. At the end of
the bell stage and during the formation of enamel, the formerly smooth surface of the
outer enamel epithelium is laid in folds. Between the folds the adjacent mesenchyme of the
dental sac forms papillae that contain capillary loops and thus provide a rich nutritional
supply for the intense metabolic activity of the avascular enamel organ. This would
adequately compensate the loss of nutritional supply from dental papilla owing to the
formation of mineralized dentin.

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Dental papilla
The dental papilla is
enclosed in the invaginated
portion of the enamel organ.
Before the inner enamel
epithelium differentiate into
ameloblast to produce
enamel, the peripheral cells
of the ectomesenchymal
dental papilla differentiate
into odontoblasts under the
organizing influence of the
inner enamel epithelium.
First, they assume a cuboidal form; later they assume a columnar form and acquire the
specific potential to produce dentin.

Dental sac
Before formation of dental tissues begins, the dental sac shows a circular arrangement
of its fibers and resembles a capsular structure. With the development of the root, the
fibers of the dental sac differentiate into the periodontal fibers that become embedded in
the developing cementum and alveolar bone.

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 B// Advanced (late) bell stage or appositional stage:

This stage of tooth development is

associated with the formation of the
dental hard tissues. During the advanced
bell stage, the boundary between inner
enamel epithelium and odontoblasts
outlines the future dentinoenamel
junction (DEJ).
The formation of dentin occurs first
as a layer along the future
dentinoenamel junction in the region of
future cusps tips and incisal ridges and
proceeds pulpally and apically. After the
first layer of dentin is formed, the
ameloblast which has already
differentiated from inner enamel epithelial cells lay down enamel over the dentin in the
future incisal and cuspal areas. The enamel formation then proceeds coronally and
cervically in all regions from the dentinoenamel junction towards the surface. The cervical
portion of the enamel organ gives rise to the Hertwig’s epithelial root sheath (HERS) which
outlines the future root and it is responsible for the shape, length, size and number of roots.

Disturbance of teeth development

A) Malformation of teeth related to variation in size, shape, number or in structure:

1. Macrodontia (enlarge tooth)
2. Microdontia (small size tooth)
3. Gemination (partial cleavage of tooth germ)
4. Fusion (union of two adjacent teeth)
5. Hyperdontia (increase in number of teeth)
6. Hypodontia (reduction in number of teeth)
7. Anadontia (complete absence of teeth)
8. Dens in dente (tooth within tooth)

B) Malformation of teeth related to the development of specific dental tissue:

1. Amelogenesis imperfecta
2. Dentinogenesis imperfecta
3. Trauma of deciduous teeth may cause malformation in permanent teeth.