Keratinization

Of Gingiva

Presented By :
Dr. Priya Patel

Guided By :
Dr. Hiral Parikh
Dr. Charu Agrawal
Dr. Shilpa Duseja
Dr. Mishal Shah

1
 2

INTRODUCTION
Oral Mucosa
Gingiva
Keratinization
GINGIVAL KERATINIZATION
Process
Control of keratinocyte differentiation
KERATINIZED Vs NON KERATINIZED EPITHELIA
CYTOKERATINS OF ORAL MUCOSA
IMMUNOHISTOCHEMISTRY
CONCLUSION
REFERENCES
3
 4
Masticatory Mucosa

Lining or Reflecting Specialized Mucosa

Mucosa
 5

Gingivais the part of the oral mucosa that

covers the alveolar processes of the jaws
and surrounds the neck of the teeth.
(Carranza 10th ed)

The fibrous investing tissue, covered by

keratinized epithelium, which immediately
surrounds a tooth and is contiguous with its
periodontal ligament and with the mucosal
tissues of the mouth.(AAP 1992)
 6

Anatomically
Free or Marginal Gingiva.
Attached Gingiva.
Interdental Gingiva.

(Carranza 10th ed)

 7

Keratinization can be defined as expression &

synthesis of keratin proteins in the basal layer
of cell,their chemical composition in the upper
layer & their interaction with keratohyalin
granules & formation of filamentous matrix
structure in the interior of corneocyte &
strenghtening of the envelope. Also called as
CORNIFICATION
(The process of keratinization of gingival
epithelium. ;The Journal of western society
of periodontology; 1979)
8
 9
PARAKERATINIZATION
 10
ORTHOKERATINIZATION
 11
NONKERATINIZATION
12
 13

Stratum Basale (st.germinativum)

Thebasal layer is made up of cells that synthesize
DNA and undergo mitosis, thus providing new cells.
Most of the new cells are generated in the basal
layer.

SERRATED
heavily packed
with
tonofilaments,
which are
adaptations for
attachment.
STEM CELLS
cell division, the
proliferative
compartment.
BASAL CELLS
14
 15
Basal lamina -
Electrolucent(40 nm) zone-
lamina lucida
Electrodense(40 nm) zone-
lamina dense
Anchoring fibrils project in a
fan shaped fashion into
connective tissue. Approx.
1m in length.
Hemidesmosome-
specialized structures abut
on basal lamina. These
consist of attachment
plaque, an adjacent plasma
membrane & an associated
extracellular structure that
appears to attach the
epithelium to the connective
tissue.
 16
Desmosome two
adjoining hemidesmosome
separated by a zone
containing electron dense
granulated material.
These have typical
structure consisting of
two dense attachment
plaques into tonofibrils
insert & an intermediate,
dense line in the
extracellular
compartment.
 17
Stratum Spinosum
The intercellular spaces - are large & distended;
thus desmosomes are made more prominent & these
cells are given a prickly appearance.
The spinous (prickle) cells resemble a cockleburr or sticker
that has each spine ending at a desomosome.
Spinous cells are the most active in protein synthesis.
Contains numerous dense granules keratinosome or
Odland bodies
 18
stratum spinosum dense granules, keratinosomes
or Odland bodies modified lysosomes.

Odland bodies(250nm) acid phosphatase

an enzyme involved in the destruction of organelle

membranes

Occurs between the granulosum and corneum strata

and during the intercellular cementation or cornified
cells.

Thus acid phosphatase is enzyme closely related to

the degree of keratinization
 19

Keratinized epithelium Non-Keratinized epithelium

Prickle cells
 20

Stratum Granulosum
Cells are larger and flatter.
Cells show increase in maturation.
Nuclei shows signs of degeneration
and pyknosis.
Cytoplasm is predominantly occupied by the
tonofilaments & tonofibrils.

Cells contain large nos of small granules

keratohyalin granules- these granules help to
form the matrix for the numerous keratin
fibers found in the superficial layers
 21
In the sudden transition to the
horny layer, the keratohylin
granules disappear
keratolinin and involucrin,

give rise to filaggrin-matrix of

the most differentiated which are precursors of a
epithelial cell, chemically resistant
structure (the envelope)

the corneocyte. located below the cell

membrane,

Thus, 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.
 22
BIOCHEMICAL PROPERTIES :

mitochondrial enzymes revealed a more active

tricarboxylic cycle in basal and parabasal cells, blood
supply facilitates aerobic glycolysis

enzymes of the pentose shunt (an alternative pathway

of glycolysis) increase their activity towards the surface.

produces a larger amount of intermediate products for

the production of ribonucleic acid (RNA),

synthesis of keratinization proteins

 23

Keratinized epithelium Non-Keratinized epithelium

Membrane coating granules

 24
Stratum Corneum
Cells are very flat ,devoid of nuclei, full
of keratin filaments surrounded by a
matrix may be termed epithelial
squamae & are dehydrated.
does not synthesize protein.
These cells are shed (the process of
desquamation), necessitating constant
turnover of epithelial cells.
Str corn. provides the mechanical
protective function to the mucosa.
25
 26
1.basal
Cuoidal ,columnar cells 1.basal
Bundles of tonofilaments Cuoidal ,columnar cells
Organelles,Site of cell division Separate tonofilaments
2.prickle
Organelles,Site of cell division
Large ovoid cells
2.prickle
Conspicous tonofilament
bundles,Organelles Large ovoid cells

Membrane coated granules- Dispersed tonofilaments

upper layers,filaments Organelles
3.granular
Membrane coated granules-
flattened cells-contain
upper layers
keratohyalin granules
filaments
Thickening of cell membrane
granule fuse with cell 3.intermediate.
membrane Sligtly flattened cells
4. corneum
Dispersed tonofilaments &
Flattened &Dehydrated cells
glycogen
All organelles are lost
4.Superficial
Packed with fibrillar material
Same as intermediate layer
Nuceus if present-pyknotic
Nuclei are persistant

Non keratinized Keratinized

 27
IMMUNOHISTOCHEMISTRY
Immunohistochemistry, gel electrophoresis, and immunoblot
techniques suggest that, keratin proteins are composed of
different polypeptide subunits characterized by their
isoelectric points and molecular weights.
Numbered their molecular weights.

basal cells begin

synthesizing Eg; such as K19 and
lower molecular 40kd
weight keratins

higher Eg;K1 keratin

molecular polypeptide of 68kd
weight keratins is the main
as they migrate component of
to the surface. stratum corneum.
 28

Cytokeratin proteins( CK )
They are composed of different polypeptide subunits &
numbered in a sequence contrary to their molecular weights.
eg. K19- mol wt. 40 kDa present at basal cells
20 types of cytokeratins recognised of which 8 are Type I
(basic) & 12 are Type II (acidic)

Cytokeratins always occurs in pairs, without pairing they are

unstable & degradable.
Seen not only in epithelial cells but also in cell contact areas
like desmosomes.
Also termed intermediate filaments as their diameter (7
11nm) is intermediate between larger microtubules (25nm) &
smaller microfilaments (4 6nm).
 29

DISTRIBUTION OF CYTOKERATINS
Type I acidic Type II basic
Low molecular wt High molecular wt.
Suprabasal, keratinized 1,2 & 3 10 & 11
stratified squamous
epithelium
Cornea 3 12
Suprabasal, non 4 13
keratinized stratified
sqamous epithelium
Basal keratinocytes 5 14
Hyperproliferative 6 16
epithelia
Simple epithelia 8 18
Basal cell carcinomas - 17
Basal keratinocytes in non - 19
keratinized stratified
squamous epithelium
30
 31

EPIDERMAL GROWTH FACTOR & TRANSFORMING GROWTH

FACTOR

EGF & TGF

Receptors on basal cells of oral mucosa

Increased production of apoptosis supressor gene & bcl-xl

Increasing keratinocyte survival & growth

 32

KERATINOCYTE GROWTH FACTOR

KGF

IL 6 & IL 1 increase Glucocorticoids supress

Receptors are present on oral mucosa keratinocytes

Increased proliferation
 33

RETINOIC ACID

Retinoic acid

Bind to nuclear retinoic receptors of oral SSE

Which in turn control mRNA trancription into keratin form.

Inreased K1,K10,K5,K14,K16, involucrin & filaggrin

Increased proliferation
 34

CALCIUM

K1,K10 & differentiation

calcium
loricin of keratinocytes
 35
Conclusion

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
Keratinization of gingiva is indespensable to maintain its state
of health.
Expression of cytokeratins is tissue specific and even strata
specific & any alteration in this suspects breach from its state
of normalcy.
It is desirable to define these molecular changes that would
allow pathologists to identify the highest risk lesions & thus it
holds promising future in diagnosis.
 36
REFERENCES:
1. Clinical peridontology 10th edition Carranza F.A., Michael G. Newman.
2. Oral Histology, Development, structure and function A.R. Tencate, 5th
edition
3. Orbans Oral Histology and Embryology S.N. Bhaskar, 10th edition.
4. Clinical Periodontology and Implant Dentistry Jan Lindhe, 4th edition.
5. Relation between width of attached gingiva & health. JP 1972
6. Oral cells & tissues .Garant 1st edition
7. Comparison of Keratinocyte Proliferation in Diabetic and Non-Diabetic
Inflamed Gingiva ;JP July 2004, Vol. 75, No. 7, Pages 989-994
8. Hereditary mucoepithelial dysplasia. Case report and review of the literature
J Am Acad Dermatol. 1989 Aug;21(2 Pt 2):351-7
9. Patterns of cytokeratin expression in the epithelia of inflamed human gingiva
and periodontal pockets J Periodontal Res. 1993 Jan;28(1):49-59
10. Keratins (K16 and K17) as markers of keratinocyte hyperproliferation in
psoriasis in vivo and in vitro Br J Dermatol. 1995 Oct;133(4):501-11
11. Gene expression of differentiation-specific keratins (K4, K13, K1 and K10) in
oral non-dysplastic keratoses and lichen planus J Oral Pathol Med. 2000
Sep;29(8):376-84
12. The process of keratinization of gingival epithelium. The Journal of western
society of periodontology; vol 27; no.3 pg: 72-85 1979
37