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DEVELOPMENT OF TOOTH AND TONGUE

ODONTOGENESIS
INTRODUCTION
PRIMARY EPITHELIAL BAND FORMATION
DENTAL AND VESTIBULAR LAMINA FORMATION
MORPHOLOGIC STAGING
BUD STAGE
CAP STAGE
BELL STAGE
ROOT FORMATION
HISTOPHYSIOLOGICAL AND CLINICAL CONSIDERATIONS

DEVELOPMENT OF TONGUE
INTRODUCTION
BODY OF TONGUE
BASE OF TONGUE
MUSCULATURE AND CONNECTIVE TISSUE
PAPILLAE AND TASTE BUD
NERVE SUPPLY
BLOOD SUPPLY
LYMPHATICS
ANOMALIES AFFECTING TONGUE



INTRODUCTION


In Greek , ODONTO means TOOTH and GENESIS means
PRODUCTION i.e., the process of development of the teeth.

Humans have 2 generations of teeth, Deciduous and
Permanent.

Complete deciduous dentition has 20 teeth, 10 in each jaw
and permanent has 32 i.e; 16 in each jaw.


Tooth development is a continuous process that occurs as a
result of complex interaction between EPITHELIAL and
MESENCHYMAL tissues.

Tooth development is a continuous process where each and
every tooth pass though similar stages which has been divided
as MORPHOLOGIC and PHYSIOLOGIC stages.


MORPHOLOGIC STAGES
Bud stage
Cap stage
Bell stage

PHYSIOLOGIC STAGES
Initiation
Proliferation
Histodifferentiation
Morphodifferentiation
Apposition

When embryo is 3 weeks old , at anterior end of embryo ectoderm
invaginates to meet endoderm forming buccopharyngeal membrane
which forms primitive mouth which is lined by stratified squamous
epithelium beneath which ectomesenchymal cells also called neural crest
cells are present. The interaction between these layers of cells leads to
tooth development.



At about 27
th
day of
gestation, primitive oral
cavity (stomatodeum) is
lined by stratified
squamous epithelium
(oral ectoderm).

Separated from gut by a
thin membrane known as
buccopharyngeal
membrane.
Tooth Development
At about this time
primitive oral cavity
establishes
communication with
foregut.
Hence the
oral ectoderm ,
foregut endoderm and
nural crest mesenchyme
plays the role in tooth
initiation

The primitive oral cavity or stomatodeum at this stage
consist of :
Two or three layered epithelium
covering the embryonic connective tissue that
is of neural crest origin and which has migrated to
the jaws from the margins of the neural crest.

Primary epithelial band formation:
After about 37
th
days of gestation, continuous horse shoe
shaped bands are formed around mouth in presumptive
upper & lower jaw by thickening and invagination of oral
epithelium into mesenchyme known as primary epithelial
band.
The formation of these thickened epithelial bands is
result not so much of increased proliferation activity
within epithelium as of a change in orientation of
mitotic spindle & cleavage plane of dividing cells.

Dental lamina & Vestibular lamina formation:
Primary epithelial band quickly divides into:
Vestibular lamina or lip furrow band
Dental lamina
Vestibular lamina:

It proliferates into underlying mesenchyme.
The cells enlarge ,then degenerate centrally to form a cleft that
becomes vestibule between cheek & tooth bearing area.

Dental lamina :
Seen lingual to the vestibular
lamina.
Rapidly forms a horse shoe
shaped band which proliferates
in 10 different areas to initiate
tooth germ formation

Serves as primodium for
ectodermal component of
deciduous tooth.
Fate of dental lamina:

Total activity of dental lamina
extends over a period of 5 yrs.
After which it begins to
degenerate .

Remnants of dental lamina
persist as epithelial pearls or
islands within the jaw as well as
in gingiva (Epithelial rests of
serre).
STAGES OF DEVELOPMENT


As cell proliferation continues, each enamel organ increases
in size & change in shape. On the basis of change in shape
tooth development divided into following stages:
1. Bud Stage
2. Cap stage
3. Bell stage
STAGES OF DEVELOPMENT
BUD STAGE
Enamel organ differentiate
into round or ovoid
swelling called tooth bud.
Enamel organ at this stage
consists of:
1.Peripherally located low
columnar cells.
2.Centrally located
polygonal cells
Epithelium of dental
lamina is separated from
underlying mesenchyme
by a basement membrane.
Ectomesnchymal condensation occurs in relation to enamel
organ.
Ectomesnchymal condensation just below enamel organ is
known as dental papilla. It forms future dentin & pulp.
Ectomesnchymal condensation that surrounds tooth bud &
dental papilla is known as dental sac. It forms future
cementum & periodontal ligament.
Dental papilla & dental sac are not well defined in this
stage.
Molecular Basis:
Msx gene expression induces ectomesnchymal condensation .
BMP4
Induces ectomesnchymal condensation .
Induces Msx.
Induces BMP2 & Shh which helps in
transition from Bud to Cap stage.
CAP STAGE
As the tooth bud continues to proliferates, it does not expand
uniformly into a large sphere. Instead tooth bud leads to the cap
shape which is characterised by shallow invagination on deeper surface
of the bud.

At this stage , tooth germ consists of:
Outer Enamel epithelium
Inner enamel epithelium
Stellate Reticulum
Dental papilla
Dental sac
Outer Enamel epithelium cover convexity of
cap. These cells are cuboidal in shape. They
are separated from dental sac & inner
enamel epithelium from dental papilla by a
delicate basement membrane.

Inner enamel epithelium covers concavity &
are columnar in shape.

Stellate reticulum consists of polygonal
cells which separate from one another as
more & more intracellular fluid
accumulates
They give a cushioning consistency that
may support & protect delicate enamel
forming cells.
Enamel knot, Enamel cord & Enamel
Niche:
Late cap stage & very early bell stage.
Transient structures.
Not seen in every tooth germ.

Enamel knot & chord:

The cells in the center of enamel organ are
closely packed & form enamel knot.

This knot projects in part towards
underlying papilla .

A vertical enamel knot called
enamel chord.

These structures (enamel
knot & chord) represent
organisation center which
orchestrates cuspal
morphogenesis. Also they
may act as a reservoir of
dividing cells for growing
enamel organ.
Enamel Niche:

Apparent structure created
during histological preparation
due to the sheet like
structure of dental lamina.

Appears like a concavity filled
with connective
tissue and gives a impression
of that the tooth-germ has a
double attachment to the oral
epithelium


Dental papilla:
Under the influence of proliferating
epithelium of enamel organ,
ectomenchyme gets enclosed by
invaginated portion of inner enamel
epithelium & condense to form
dental papilla.
The papilla shows active budding of
capillaries & mitotic figures.
Dental sac :
Formed by ectomesnchymal
condensation surrounding enamel
organ & dental papilla.
Gradually this zone becomes dense
& more fibrous.
BELL STAGE
As the invagination of epithelium deepens & its margins
continue to grow ,enamel organ assumes bell shape .

Bell stage can be further divided into

Early Bell Stage
Advanced Bell Stage

Inner enamel epithelium
Outer enamel epithelium
Stratum Intermedium
Stellate reticulum
Cervical loop or zone of
reflexion
Dental Papilla
Dental Sac
Early Bell Stage:

Inner enamel epithelium:

Consists tall columnar cells
about 4 to 5 microns in diameter
& about 40 microns .
Contains nucleus away from
basement membrane.
Nucleus/cytoplasmic ratio is
high.
Characterised by high glycogen
content.
Attached to one another by
junctional complex & to stratum
intermedium by desmosomes.
Separated from dental papilla by
basement membrane.
Inner enamel epithelium
Stratum Intermedium:
A few layers of sqamous cells
form stratum intermedium
between inner enamel
epithelium & stellate reticulum.
These cells are closely attached
by desmosomes & gap junctions.
The well developed cytoplasmic
organelles, acid
mucopolysacharides,alkaline
phosphatase & glycogen
deposits indicate a high degree
of metabolic activity.
This layer seems to be essential
for enamel formation.

Stratum
Intermedium
Stellate reticulum
Inner enamel
epithelium
Dental Papilla
Stellate reticulum :
Expand further mainly by an
increase in amount of
intracellular fluid.
Cells are star shaped&
attached to one another & to
outer enamel epithelium and
stratum intermedium by
desmosomes.
Contains sparsely distributed
organelle in cytoplasm.


Outer enamel epithelium:
Consists of low cuboidal
epithelial cells.
Supported by basement
membrane around its
periphery.
Rich glycogen and
cytoplasmic organelle.
High nuclear cytoplasmic
ratio.
Join to adjacent cells by
means of Junctional
complexes & to stratum
reticulum by desmosmes.
Dental Papilla:
Dental papilla consists of undifferentiated mesenchymal
cells & fine scattered collagen fibrils scattered
throughout extracellular space.
Ramifying nerves & vessels are also seen.
It is separated from dental organ by a basement
membrane.

Dental Sac:
Consists of undifferentiated mesenchymal cells &
circularly arranged collagen fibrils around enamel organ
& dental papilla.
Collagen fibrils are more in dental sac than dental
papilla.
Ramifying nerves & vessels are also seen.

Cervical loop or zone of reflexion :
Consists of only outer & inner enamel epithelium.
This is the point where cells continue to divide until
tooth attains its full size & which after crown formation
gives rise to epithelial component of root formation.
Advanced Bell Stage:
Separation of tooth germ from Dental Lamina.

Hard tissue formation.

Morphogenesis of crown.

Separation of tooth germ
from Dental Lamina:

Dental lamina joining
tooth germ to oral
epithelium breaks into
discrete islands of
epithelial cells, thus
separating developing
tooth germ from oral
epithelium.
Hard tissue formation:
At the site of future
cusp tips, where a layer
of dentin first appears,
mitotic activity ceases &
short columnar cells of
inner enamel
epithelium elongate
&reverse their polarity,
becoming taller with
their nuclei adjacent to
stratum intermedium
and golgi complex
facing dental papilla.



Under organizing effect of inner enamel epithelium
undifferentiated ectomesenchyme increases in size &
ultimately differentiate into odontoblasts, dentin forming
cells which eliminate acellular zone between dental papilla
& dental epithelium. First they assume cuboidal form, later
they assume a columnar form & acquire the specific
potential to produce dentin matrix which ultimately
mineralizes.

Once mineralized dental papilla is known as dental pulp. As
organic matrix is deposited ,the odontoblasts move towards
center of papilla leaving a cytoplasmic extension around
which dentin is formed.

Shortly after dentin formation initiates, inner enamel
epithelium differentiates into ameloblasts that produce
organic matrix against newly formed dentinal surface which
ultimately undergoes mineralization.

Before first dentin formation, enamel organ receives nourishment from
two sources:
1.Blood vessels located in dental papilla
2. Vessels located along the periphery of outer enamel epithelium.

When dentin is formed there is drastic reduction in nutrients reaching
enamel organ.. The demand is fulfilled by collapse of stellate reticulum
& invagination of outer enamel epithelium by blood vessels outside.

Once enamel formation completes, ameloblast layer and rest of the
enamel organ regresses and together constitute the reduced enamel
epithelium.
Morphogenesis of crown:
When tooth germ is growing rapidly during cap
to bell stage ,cell division occurs throughout inner enamel epithelium. As
division continues, division ceases at a particular point because cells are
beginning to differentiate & assume their eventual functioning of
producing enamel.
The point at which inner enamel epithelium differentiation
occurs first represent the site of future cusp or growth center.
Because inner enamel epithelium is constrained between cervical loop &
cusp tips ,continued proliferation causes the inner dental epithelium to
buckle & form cuspal outline. Thus future cusp is pushed towards outer
dental epithelium.
Thus inner dental epithelium completes its foldings making it possible to
recognise shape of future crown pattern of tooth.
Eventually differentiation of inner enamel epithelium & dental papilla seeps
down & is followed by dentin & enamel formation.
It begins after enamel &
dentin formation has reached
cemento enamel junction.
The enamel organ plays
important role by forming
Hertwigs epithelial root
sheath.
It is formed by proliferation of
cervical loop cells .
It consists of only inner &
outer enamel epithelium.
It molds the shape of root &
initiate radicular dentin
formation.
Root Formation
When dentin is formed ,it
looses its structural integrity
& its close relation with root
surface.
This loss of structural
integrity is as a result of
invasion of surrounding
connective tissue of dental
sac.
The epithelium is moved
away from surface of dentin
so that connective tissue cells
come into contact with outer
surface dentin & differentiate
into cementblasts that
deposite a layer of cementum
onto surface of dentin.

Remnants of Hertwigs
epithelial root sheath are
found in periodontal
ligament & are called rests
of Malassez .



Prior to the beginning of root formation ,epithelial root
sheath forms epithelial diaphragm by bending at future
cemento enamel junction into horizontal plane ,narrowing
the wide cervical opening of tooth.

Proliferation of cells of epithelial diaphragm is accompanied
by ectomesenchymal cell proliferation ,adjacent to
diaphragm.
In last stages of root development ,the proliferation of
epithelium in diaphragm lags behind that of pulpal
connective tissue.

Thus wide apical foramen is first reduced to width of
diaphragmatic opening itself , later by apposition of
dentin & cementum at the apex of root.
In case of multirooted
teeth, there is differential
growth of epithelial
diaphragm in the form of
tongue like extensions
which grow towards each
other & fuse causing
division of trunk into two or
three roots.
Histophysiological & Clinical
Considerations
1. Initiation
2. Proliferation
3. Histo differentiation
4. Morpho differentiation
5. Apposition
Initiation:
A lack of initiation results in absence of either single
tooth or multiple teeth.
Most frequently the permanent upper lateral incisor,
third molar, and lower second premolars.
Abnormal initiation may result in development of single
or multiple supernumerary teeth.

Histodifferentiation:
This phase reaches its peak in the Bell stage, just before
hard tissue formation.
In vitamin deficiency ameloblasts fail to differentiate ,as
a result of which adjacent mesenchyme fails to
differentiate & a atypical dentin known as osteodentin is
formed
Morphodifferentiation:
Disturbance in this phase may result in
supernumerary cusps or roots
or suppression of parts may be there( loss of cusps or
roots)
or may result in peg or malformed teeth( e.g.,
Hutchinsons incisors) with normal enamel & dentin.

Apposition:
Genetic & environmental factors may disturb the normal
synthesis & secretion of organic matrix of enamel
leading to condition called enamel hypoplasia.
If organic matter is defective, then enamel or dentin is
said to be hypocalcified or hypomineralised.
Histophysiological & Clinical Considerations related root
formation
If the epithelial root sheath remains adherent to the dentin surface
,they may differentiate into ameloblasts and produce enamel. Such
droplets of enamel called enamel pearls are seen sometimes in
furcation area of permanent molars.
If continuity of root sheath is broken prior to dentin formation, a
defect in dentinal wall results. Such defects are commonly found in
furcation area. This accounts for the development of accessory root
canals opening on the periodontal surface of root.





DEVELOPMENT OF TONGUE
DEVELOPMENT OF TONGUE
Tongue arises from the ventromedial wall of the
primitive oropharynx from the inner lining of the first
four branchial arches.
Development of tongue can be studied under the
following headings
Anterior 2/3
rd
(or the body of tongue)
Posterior 1/3
rd
(base of the tongue)
Musculature and connective tissue
Papillae and taste buds.
The nerve supply

Anterior 2/3
rd
of the tongue
During the 4
th
week of IUL, paired lateral swellings appear on
the internal aspect of the 1
st
brachial arches
Tuberculum impar is a median eminence whose caudal end
has a pit called the foremen caecum
These lateral swellings rapidly enlarge, merge with each other
and overgrow the tuberculum impar to form the body of the
tongue
A U shaped sulcus, the linguogingival groove develops in front
of the oral part, which allows it to be free and highly mobile
except at the region of the lingual frenum where its attached
to the floor of the mouth
Posterior 1/3
rd
of the tongue
The base of the tongue is initially indicated by two midline
elevations that develop caudal to the foremen caecum
The copula
The hypo brachial eminence
As the tongue develops, the hypobranchial eminence
overgrows the second branchial arch to become continous
with the body of the tongue. The site of union b/w the the
body and base of the tongue is delineated by a V shaped
groove, called the SULCUS TERMINALIS

Musculature and connective tissue
Branchial arch mesenchyme forms the connective tissue and the
lymphatic and the blood vessels of the tongue
Tongue musculature
During the 5
th
to 7
th

week of the IUL, 3-4
occipital myotomes,
migrate anteriorly to
form the musculature of
the tongue.
Papillae of the tongue
Papillae are projections of mucous
membrane on the dorsum of the
tongue.

Circumvalate papillae
Fungiform papillae
Filliform papillae
Foliate papillae
Taste buds
Taste buds are located on the dorsum of the tongue and are
associated with the papillae
Taste buds appear around 8
th
week of IUL.
Taste buds arise by inductive interaction b/w the epithelial cells and
the invading gustatory nerve cells
Nerve supply of the tongue
Development of tongue from the branchial arch explains its nerve supply
Sensory supply
Ant 2/3
rd
-Lingual nerve for general sensation.
chorda tympani for the special sensation
Post 1/3
r
Glossopharyngeal nerve
Posterior most part - vagus nerve
Motor supply
All the intrinsic and extrinsic muscles except the palatoglossus are supplied by the
hypoglossal nerve.
Palatoglossus pharyngeal plexus
Arterial supply
It is chiefly derived from the lingual artery a branch of
external carotid artery. The root of the tongue is also
supplied by tonsillar and ascending pharyngeal artery.
Venous drainage:
The deep lingual vein is the principal vein of the tongue.
Lymphatic drainage:
The tip of the tongue drains into submental nodes. The
remaining part of the anterior 2/3
rd
drains into the
submandibular nodes. The posterior 1/3
rd
of the tongue
drains into jugulo-omohyoid nodes.
LYMPHATIC
DRAINAGE
Structure of the tongue
The bulk of the tongue is
made of muscles.
Intrinsic muscles
Extrinsic muscles
The ORAL PART of dorsum of
the tongue has numerous
papillae associated with the
taste buds.
The PHARYNGEAL PART of
the dorsum of the tongue is
rich in lymphoid follicles that
is collectively called the
lingual tonsil. Mucous glands
are also present.
The inferior surface of the
tongue shows the frenulum
linguae,deep lingual veins
and the plica fimbriata.
The entire tongue is in the mouth at birth .Its post. 1/3
rd
desends into
the pharynx by the age of 4yrs. The tongue normally doubles in
length,breadth and thickness from birth to adolesence reaching
maximal size at about 8yrs.
ANOMILIES OF THE TONGUE
Aglossia
Microglossia
Macroglossia
Bifid tongue
Ankyloglossia
Lingual thyroid
Fissured tongue
Median rhomboid glossitis
ANKYLOGLOSSIA
LINGUAL THYROID
FISSURED TONGUE
MEDIAN RHOMBOID GLOSSITIS





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