Innervation of Teeth and Tissues: Facial, Glosspharyngeal, Hypoglossal

Exam 2, DLA 1210

1. Innervation of Teeth and Tissues Facial Nerve, Glossopharyngeal Nerve, Hypoglossal Nerve,

2. Innervation of Maxillary Teeth and Tissues NERVE TEETH TISSUES Anterior Superior Alveolar (ASA) Centrals, Laterals, Canines Facial gingiva and PDL of anterior teeth Middle Superior Alveolar (MSA) First and Second Premolars, Mesiobuccal root of first molar Facial gingiva and PDL of premolar area Posterior Superior Alveolar (PSA) First Molars, distobuccal and lingual roots only Second and third molars (all roots) Facial gingiva and PDL of molar area Nasopalatine NONE Anterior palatal mucosa tissues Palatal mucoperiosteum from lateral incisor to lateral incisor Greater Palatine NONE Molar and Premolar palatal mucosal tissues Palatal mucoperiosteum from posterior of molars to canine teeth

3. Innervation of Mandibular Teeth and Tissues NERVE TEETH TISSUES Inferior Alveolar (the lingual nerve is usually involved, because they run parallel to each other) All mandibular posterior teeth (premolars and molars) Labial mucosa around lower lip Anterior two-thirds of the tongue (lingual nerve) Floor of the mouth (lingual) Lingual mucosa of all teeth (lingual) Incisive Anterior Teeth Chin and lower lip anterior to the mental foramen Mental NONE Chin and lower lip anterior to the mental foramen Buccal NONE Buccal mucous membrane of the cheek and gingiva of premolars and molars Lingual NONE Lingual mucosa of all teeth Anterior two-thirds surface of the tongue Floor of the mouth

4. Anterior Superior Alveolar Nerve ( ASA ) Facial tissue and pulp AKA- Infraorbital Nerve Height of muccobuccal fold at the maxillary first premolar Numbs maxillary centrals, laterals and canines Topical is placed at the apex of tooth to be numbed 6,7,8,9,10,11

5. Middle Superior Alveolar Nerve ( MSA ) Buccal tissue and pulp Height of muccobuccal fold at the maxillary 2 nd premolar Numbs mesial half of maxillary 1 st molar and both premolars Topical is placed at the apex of the root of the 2 nd premolar 5,4,3:M and 12,13,14:M

6. Posterior Superior Alveolar ( PSA ) Buccal tissue and pulp Numbs distal half of the maxillary 1 st and all of 2 nd and 3 rd molar Topical is placed at the apex of the distobuccal root of the 2 nd molar. 1,2,3:D and 16,15,14:D

7. Greater Palatine Nerve Lingual tissue Anterior to the greater palatine foramen Middle of the maxillary second molar on the palate Numbs hard palate and soft tissues covering hard palate from the distal of the canine posteriorly 6:D,5,4,3,2,1 and 11:D,12,13,14,15,16

8. Nasopalatine Lingual tissue Incisive papilla Numbs the anterior 1/3 of the hard palate from canine to canine 6-11

9. Maxillary Nerve Buccal, lingual tissue and pulp Height of muccobuccal fold above distal of maxillary 2 nd molar Numbs the buccal, palatal, and pulpal tissues in one quadrant Skin of the lower eyelid, side of nose, cheek and upper lip 1-8 and 9-16

10. Inferior Alveolar (IA) Block Injection Lingual, Buccal tissue and pulp AKA- Mandibular Block Inside of mandibular ramus, posterior to retromolar pad Numbs the whole quadrant from mandibular 3 rd to central incisor Topical is placed just posterior to the retromolar pad at the ascending ramus 25-32 and 17-24

11. Buccal Nerve Buccal tissue Numbs buccal tissue adjacent to the mandibular molars only Topical placed mucous membrane to the distal and toward the buccal of the last mandibular molar tooth in the arch 30,31,32 and 17,18,19

12. Lingual Nerve Numbs lingual tissues and side of tongue, mandibular teeth to the midline Topical placed Lingual to mandibular ramus and adjacent to maxillary tuberosity 17-24L and 25-32L

13. Mental Nerve Facial/buccal tissues Numbs mandibular premolars, canines and facial tissues adjacent to those teeth Topical placed anterior to the mental foramen, between the apices off the roots of the mandibular premolars 27,28,29 and 22,21,20

14. Incisive Nerve Facial tissue and pulp Numbs premolars, canine, lateral and central incisors Buccal mucous membrane from the mandibular second premolar, lips and chin Topical placed at the height of muccobuccal fold, anterior to mental foramen 22-27

15. I want to numb…… #20 for a crown prep Lingual foramen, Incisive Nerve Muccobuccal fold, anterior to mental foramen

16. I want to numb…… 22, 20, & 18 for large amalgam restoration Inferior Alveolar (IA) (mandibular block) Just posterior to the retromolar pad at the ascending ramus

17. I want to numb…… The lingual tissue of #7 for a excisional biopsy Nasopalatine Nerve, Incisive Foramen Incisive papilla

18. I want to numb…… #7 for a MIDF composite, the restoration needs to extend below tissue on facial. ASA- infraorbital nerve Placed at apex of tooth needing to be numbed

19. I want to numb…… #4 for a MOB composite restoration, will need to pack cord at buccal margin MSA At the apex of the root of the 2 nd premolar What teeth are numbed? 3:M, 4 and 5

20. I want to numb…… #2 for an excisional biopsy on lingual Greater palatine Nerve What is numbed? Hard palate and soft tissues on lingual distal to canine posteriorly (i.e. 1,2,3,4,5,6:D)

21. I want to numb…… #2 for MOB amalgam restoration, decay subgingival on buccal PSA Topical placed at apex of distobuccal root of 2 nd molar. What teeth/tissues are numbed? 1,2,3:D

22. I want to numb…… Abscess on buccal tissues of 18 Buccal Nerve Topical is placed mucous membrane to the distal and toward the buccal of the last mandibular molar tooth in arch 17,18,19 buccal tissues only

23. Facial Nerve (VII)

24. Facial Nerve (VII) Both afferent and efferent Provides innervation to: A ll muscles of facial expression P osterior belly of digastric muscle Stylohyoid S tapedius muscle of middle ear Provides taste sensation to anterior two-thirds of tongue and innervation to nose and salivary glands

25. Facial Nerve (VII ) Enters the infernal acoustic meatus and travels through the temporal bone. It encounters its sensory ganglion, the geniculate ganglion, in the temporal bone. While traveling through the temporal bone, the following branches are found: Greater petrosal nerve supplies the glands of nose and mouth and lacrimal gland Nerve to the stapedius muscle supplies the inner ear Chorda tympani nerve joins together with the lingual nerve and carries taste fibers to anterior two-thirds of the tongue

26. Facial Nerve (VII) The facial nerve then exits the skull through the stylomastoid foramen and gives off the following branches : Posterior auricular nerve that supplies the posterior auricular and occipital muscles Digastric nerve provides innervation to the posterior belly of the digastric muscle Stylohyoid nerve that innervates the stylohyoid muscle

27. Facial Nerve (VII )

28. Facial Nerve (VII) (cont’d.) The facial nerve then enters the parotid gland and bifurcates into two divisions Superior temporofacial Temporal, zygomatic and buccal branches Inferior cervicofacial Mandibular and cervical branches

29. Facial Nerve (VII) The temporal division gives rise to the following: Temporal branches that supply the anterior and superior auricular muscles, frontal muscle, corrugator muscle of the eyebrow, and the orbicularis oculi Zygomatic branches that also provide innervation to the orbicularis oculi Buccal branches that supply the Procerus, zygomatic, quadratis labii superioris, nasalis, buccinator, orbicularis oris, and Risorius muscles

30. Facial Nerve (VII) The cervicofacial trunk gives rise to the following: Mandibular branch that provides innervation to the muscles of the lower lip and chin Cervical branch that supplies the platysma muscle

31. Facial Nerve (VII)

32. Glossopharyngeal Nerve (IX) Both efferent and afferent Exits skull through jugular foramen and branches to tongue and pharynx The glossopharyngeal nerve branches include: Tympanic nerve provides parasympathetic to parotid gland and sensory to middle ear Carotid sinus nerve supplies carotid sinus for its blood pressure regulators Stylopharyngeal nerve supplies the stylopharyngeal muscle

33. Glossopharyngeal Nerve (IX) The pharyngeal branches join with the spinal accessory (XI) and vagus (X) nerves to create the pharyngeal plexus. The plexus supplies the muscle of the soft palate and pharynx, except for the Stylopharyngeal supplied by the IX, and the tensor veli palatini supplies by V. It also innervates the mucosa of the soft palate, pharynx, and tonsils. The glossopharyngeal nerve also supplies the posterior one-third of the tongue with taste sensation.

34. Hypoglossal Nerve (XII) Motor supply of the tongue and e xits skull through hypoglossal canal Entirely efferent Supply geniohyoid muscle and intrinsic and extrinsic muscles of tongue, with the exception of the palatoglossal muscle, which is innervated by the pharyngeal plexus. Damage to this nerve causes paralysis of the tongue and deviation toward affected side when protruded

35. Summary Peripheral nervous system comprised of nerves traveling away from the central nervous system 12 pairs of cranial nerves providing innervation to the right and left side of the body Designated by roman numerals 31 pairs of spinal nerves

36. Additional Resources https://slideplayer.com/slide/1701488 / Complete pages 265-266 in your text book Complete Chapter 7 in your Dental Assisting Workbook You should be able to answer all questions from this chapter This would be a good idea for your final exam as well…..