they migrate to the surface from the stratum basale where the progenitor cells are located to the superficial surface. Unlike keratinized epithelium, nonkeratinized epithelium normally has no superficial layers showing keratinization. Nonkeratinized epithelium may, however, readily transform into a keratinizing type in response to frictional or chemical trauma, in which case it undergoes hyperkeratinization. This change to hyperkeratinization commonly occurs on the usually nonkeratinized buccal mucosa when the linea alba forms, a white ridge of calloused tissue that extends horizontally at the level where the maxillary and mandibular teeth come together and occlude. Histologically, an excess amount of keratin is noted on the surface of the tissue, and the tissue has all the layers of an orthokeratinized tissue with its granular and keratin layers. In patients who have habits such as clenching or grinding (bruxism) their teeth, a larger area of the buccal mucosa than just the linea alba becomes hyperkeratinized. This larger white, rough, raised lesion needs to be recorded so that changes may be made in the dental treatment plan regarding the patient’s parafunctional habits. Even keratinized tissue can undergo further level of hyperkeratinization; an increase in the amount of keratin is produced as a result of chronic physical trauma to the region. Changes such as hyperkeratinization are reversible if the source of the injury is removed, but it takes time for the keratin to be shed or lost by the tissue. Thus, to check for malignant changes, a baseline biopsy and microscopic study of any whitened tissue may be indicated, especially if in a high-risk cancer category, such with a history of tobacco or alcohol use or are HPV positive. Hyperkeratinized tissue is also associated with the heat from smoking or hot fluids on the hard palate in the form of nicotinic stomatitis. The lamina propria is a fibrous connective tissue layer that consists of a network of type I and III collagen and elastin fibers in some regions. The main cells of the lamina propria are the fibroblasts, which are responsible for the production of the fibers as well as the extracellular matrix. The lamina propria, like all forms of connective tissue proper, has two layers: papillary and dense. The papillary layer is the more superficial layer of the lamina propria. It consists of loose connective tissue within the connective tissue papillae, along with blood vessels and nerve tissue. The tissue has an equal amount of