Dentistry Department; 2nd grade Dijlah University College

Oral Histology
Lec.2 Lab. 2 Dr. Munir Nasr
Development and growth of the teeth
The development of tooth involves many complex biological processes, including
epithelial mesenchymal interaction, morphogenesis and mineralization. In human
beings, 20 deciduous and 32 permanent teeth develop from the interaction
between the oral epithelium cells and mesenchymal cells Fig (1). The basic
developmental process is similar for all teeth but each developing tooth develops
as an anatomically distinct unit. Vitamins, minerals and hormones affect tooth
development. Vitamin A is important for epithelial growth, vitamin C for
connective tissue development and vitamin D is essential for calcification.

Tooth formation begins in the 6th week of intrauterine life(IUL) with the
formation of a continuous horseshoe-band of thickened epithelium in the location
of the upper and lower jaws called the primary epithelial band Fig. (2), at about
7th week the primary epithelial band divides into a lingual process called dental
lamina & a buccal process called vestibular lamina Fig. (3) All deciduous teeth
arise from dental lamina at the 8th week of fetal life, later the permanent
successors arise from its lingual extension which is called successional lamina
& permanent molars from its distal extension.

Fig.1 Primary epithelial band and the mesenchymal cell.

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Maxillary primary epithelial band

Mandibular primary epithelial band

Fig.2 early oral cavity.

Dental Lamina

The dental lamina begins to function at the 6th week of gestation period, this
lamina invaginates as a sheet of epithelial cells to underlying mesenchyme cells
around the perimeter of both the maxillary and mandibular jaws. Along the
leading edges of the lamina, 20 areas of enlargement which are forming the buds
of 20 primary teeth. Which then develop into primary teeth and the leading edge
of the lamina continues to develop the 32 permanent tooth buds.

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Fig.3. Each band of epithelium will give rise to 2 sub divisions: Dental lamina and
vestibular lamina

The initiation of the permanent 1st molar occurs at the 4th month of intrauterine
life, the 2nd molar one year after birth and the 3rd molar five years after birth.
Successional lamina is responsible for the development of permanent incisors,
canine and premolars. The successional lamina is active from the 5th month in
utero (permanent central incisor) to the 10th month of age (second premolar).

Fate of dental lamina

The total activity of dental lamina extends over a period of at least 5 years. As the
teeth continue to develop, they lose their connection with dental lamina. They
later break by mesenchymal invasion of the jaw. Remnants of dental lamina
persist as epithelial islands within jaw and gingiva. In the incisors area the dental
lamina is first to appear and disappear after initiation of tooth development, and
in the third molar area it is the last to appear and disappear.

Vestibular lamina

Facial (labial &buccal) to dental lamina another thick band of epithelium

develops in the maxillary and mandibular dental arches. It is called the vestibular
lamina or the lip furrow band. It later hollows out and forms the oral vestibule
between the alveolar portions of the jaws and the lips and cheeks. The oral

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 Dentistry Department; 2nd grade Dijlah University College

epithelium in the lower jaw forms an epithelial invagination separating the tongue
from the developing alveolar process termed the linguoalveolar sulcus.

Stages of tooth development

Tooth formation is a continuous process by a series of stages. Each tooth

develops through successive bud, cap and bell stages. During these stages, the
tooth germs grow and develop into specialized cells which form the enamel,
dentin and the cementum. Dental lamina plays an important role in the
development of teeth. At certain points along the dental lamina each representing
the location of one of the 10 mandibular & 10 maxillary teeth, ectodermal cells
multiply rapidly & little knobs that grow into the underlying mesenchyme. Each
of this little down growths from the dental lamina represents the beginning of the
enamel organ of the tooth bud of a deciduous tooth. First to appear are those of
anterior mandibular region. As the cell proliferation occurs each enamel organ
takes a shape that resembles a cap.

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On the inside of the cap, the ectomesenchymal cells increase in number. The
tissue appears denser than the surrounding mesenchyme and represents the
beginning of the dental papilla. Surrounding the combined enamel organ or
dental papilla, the third part of the tooth bud forms. It is known as dental
sac/follicle and it consists of ectomesenchymal cells and fibers that surround the
dental papilla and the enamel organ. Thus the tooth germ consists of ectodermal
component- the enamel organ, the ectomesenchymal components- the dental
papilla & the dental follicle. The enamel is formed from the enamel organ, the
dentin and the pulp from the dental papilla and the supporting tissues namely
the cementum, periodontal ligament & the alveolar bone from the dental
follicle. During & after these developments the shape of the enamel organ
continues to change. The depression occupied by the dental papilla deepens until
the enamel organ assumes a shape resembling a bell. The dental lamina becomes
longer, thinner & finally loses its connection with the epithelium of the primitive
oral cavity.

Tooth development is a continuous process, however can be divided into 3 stages:

1.Bud Stage: Initiation
2.Cap Stage: Proliferation
3. Bell Stage: (a) Early- Histodifferentiatin
(b) Advanced- Morfodifferentiation

The name of the stages is based on the shape of epithelial part of the tooth germ
which is the enamel organ.

Bud stage (1st stage):

This is the initial stage of tooth formation where enamel organ resembles a small
bud. It is rounded localized growth of the epithelial cells; it consists of
peripherally located columnar cells and centrally located polygonal cells. Many
cells of the tooth and surrounding mesenchyme undergo mitosis. As a result of
the increased mitotic activity and the migration of neural crest cells into the area,
the ecto-mesenchymal cells surrounding the tooth bud condense. The condensed

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area immediately adjacent to the enamel organ called dental papilla. The
condensed ecto-mesenchyme surrounds the tooth bud and dental papilla called
dental sac.

The cells of the dental papilla will form tooth pulp and dentin. The cells of
dental sac will form cementum and periodontal ligament.

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Bud stage
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Cap stage (2nd stage):

As tooth bud continues to proliferate, it gains shallow invagination on the surface

of the bud.

The peripheral cells of the cap stage are cuboidal, the cells that cover the
convexity of the cap are called the outer enamel epithelium (O.E.E). The cells
in the concavity of the cap are columnar and called the inner enamel epithelium
(I.E.E.)

The O.E.E is separated from the dental sac and the I.E.E from the dental papilla
by a delicate basement membrane.

2. Cap stage

Cap stage

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Dentistry Department; 2nd grade Dijlah University College

Cap stage

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 Dentistry Department; 2nd grade Dijlah University College

Stellate Reticulum

Polygonal cells located in the centre of the epithelial organ, between the outer and
inner enamel epithelia, begin to separate as more intercellular fluid is produced
and form a cellular network called stellate reticulum; this spaces in this networks
are filled with a mucoid fluid rich with albumin, which give the stellate reticulum
a cushion like consistency that may support and protect the enamel forming cells.

Enamel knot and enamel cord

The cells in the centre of the enamel organ are densely packed and form enamel
knot. This knot projects in part toward the underlying dental papilla (exact role
not known, but currently believed to be the organizational center for cusp
development).

At the same time there arises in the increasingly high enamel organ a vertical
extension of the enamel knot, called enamel cord. It has been speculated that the
function of the enamel knot and cord maybe to act as a reservoir of dividing cells
for the growing enamel organ. Both are temporary structures that disappear
before enamel formation begins.

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1) Inner enamel ep. 2) Outer enamel ep. 3) Cervical loop 4) Stellate reticulum 5)
Enamel knot 6) Enamel cord 7) Enamel navel

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 Dentistry Department; 2nd grade Dijlah University College

Process of cap stage

Bell stage (3rd stage)

Early bell stage: (Histodifferentiation stage)

Due to continued uneven growth of the enamel organ it acquires a bell shape. In
bell stage crown shape is determined. It was thought that the shape of the crown
is due to pressure exerted by the growing dental papilla cells on the inner enamel
epithelium. This pressure however was shown to be opposed equally by the
pressure exerted by fluid present in the stellate reticulum.

The folding of enamel organ to cause different crown shapes is shown to be due
to different rates of mitosis & difference in cell differentiation time.

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 Dentistry Department; 2nd grade Dijlah University College

The bell stage is characterized by the following four layers of epithelial cells:
a. Inner enamel epithelium
b. Stratum intermedium
c. Stellate reticulum
d. Outer enamel epithelium

Inner enamel epithelium:

 The inner enamel epithelium consists of a single layer of cells that
differentiate prior to amelogenesis into tall columnar cells called
ameloblasts
 These elongated cells are attached to one another by junctional complexes
laterally & to cells in the stratum intermedium by desmosomes
 The cells of the inner enamel epithelium exert a strong influence on the
underlying mesenchymal cells of the dental papilla, which later
differentiate into odontoblasts.

Stratum intermedium
A few layers of squamous cells form the stratum intermedium , between the inner
enamel epithelium & the stellate reticulum. These cells are closely attached by
desmosomes & gap junctions. This layer seems to be essential to enamel
formation.
Stellate reticulum
The stellate reticulum expands further due to continued accumulation of intra-
cellular fluid. These star shaped cells, having large processes anastomose with
those of adjacent cells. As the enamel formation starts. The Stellate reticulum
collapses to a narrow zone thereby reducing the distance between the outer &
inner enamel epithelium

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Outer enamel epithelium

The cells of the outer enamel epithelium flatten to form low cuboidal cells

The outer enamel epithelium is thrown into folds which are rich in capillary
network; this provides a source of nutrition for the enamel organ

Before the inner enamel epithelium begins to produce enamel. Peripheral

cells of the dental papilla differentiate into odontoblasts

These cuboidal cells later assumes a columnar form & produce dentin

Dental sac

The dental sac exhibits a circular arrangement of fibres & resembles a

capsule around the enamel organ. The fibres of the dental sac form the
periodontal ligament fibres that span between the root & the bone. The
junction between the inner enamel epithelium & odontoblasts outlines the
future dentino-enamel junction.

Advanced bell stage / Morphodifferentiation

 Characterized by the commencement of mineralization & root

formation.
 The boundary between the inner enamel epithelium & odontoblasts
outline the future dentinoenamel junction.
 Formation of dentin occurs first as a layer along the future
dentinoenamel junction in the region of future cusps & proceeds
pulpally & apically.
 After the first layer of dentin is formed, the ameloblasts lay down
enamel over the dentin in the future incisal & cuspal areas.
 The enamel formation then proceeds coronally & cervically in all the
regions from the dentinoenamel junction toward the surface.
 The cervical portion of enamel organ gives rise to Hertwig Epithelial
Root Sheath (HERS).
 This HERS outlines the future root & thus responsible for the size,
shape, length & number of roots.

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Advanced (early) bell stage

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C. Early bell stage. D. Advanced bell stage

Formation of enamel & dentin matrix (apposition ):

1. Apposition is the deposition of the matrix of the hard enamel structures.

2. Appositional growth of the enamel & dentin is a layer like deposition of an

extracellular matrix. This type of growth is therefore additive.

3. Appositional growth is characterized by regular & rhythmic deposition of

the extracellular matrix, which is of itself incapable of further growth

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 Dentistry Department; 2nd grade Dijlah University College

Life cycle of a tooth. A. Initiation (bud stage).B. Proliferation (Cap stage). C.

Histodifferentriation, morphodefrentiation (bell stage). D. Apposition. E.
Before eruption. F. After eruption. G. & H. Attrition, recession of pulp. I.
Weakening & loss of periodontal support leading to exfoliation.

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