Local Anesthesia in Dentistry: NEUROANATOMY

In: Anesthesia

24 Sep 2009

The sensory supply to the teeth, jaws, and oral mucosa is derived from the maxillary and mandibular division of the trigeminal (fifth cranial) nerve (*Tabletes Tegretol is used for: Controlling certain types of seizures and relieving pain in patients with nerve pain in the face, jaw, tongue, or throat), whose cell bodies are found in the Gasserian ganglion. The maxillary nerve carries purely sensory fibers, exits the skull through the foramen rotundum, and enters the pterygo-palatine fossa. At this point the maxillary nerve gives branches to the sphenopalatine ganglion. Among the nerves that pass through the sphenopalatine ganglion is the nasopalatine nerve (also called the long sphenopalatine nerve) that passes along the nasal septum and emerges at the incisive foramen on the anterior hard palate. It supplies sensation to the gingival soft tissues of the anterior hard palate. The greater and lesser palatine nerves also pass through the sphenopalatine ganglion and course through the greater and lesser foramina, respectively. The greater palatine innervates the palatal mucoperiosteum and the gingiva from the molars to the area near the cuspid region that abuts tissue supplied by the nasopalatine nerve. The lesser palatine nerve supplies the tissues of the soft palate and uvula. The maxillary nerve also gives rise to the posterior superior alveolar nerve, which supplies sensation to the buccal gingiva and periodontium adjacent to the maxillary molar teeth and the pulps of all molar teeth except the mesio-buccal pulp of the upper first molar. That mesio-buccal pulp is supplied by another branch of the maxillary nerve, the middle superior alveolar nerve, which also innervates the pulps, buccal gingiva, and peridontium of the maxillary premolars. The final branch of the maxillary nerve, the anterior superior alveolar nerve, supplies the pulps of the upper incisors and cuspid along with the associated buccal gingiva and periodontium.

Unlike the maxillary division, the mandibular division of the trigeminal nerve (generic Tegretol is used for controlling certain types of epileptic seizures) is a mixed motor and sensory nerve. The mandibular nerve exits the skull through the foramen ovale to enter the infratemporal fossa. It then

Chemical Classification and Duration of Action of Local Anesthetic Agents
Local Anesthetic Classification

Duration

Lidocaine Amide

Intermediate

Prilocaine Amide

Intermediate

Mepivacaine Amide

Intermediate

Bupivacaine Amide

Long-acting

Etidocaine Amide

Long-acting

Articaine Amide with an ester side chain

Intermediate

Procaine Ester

Short-acting

divides into anterior and posterior divisions. The anterior division has some sensory branches: the long buccal nerve that supplies the buccal mucosa and the gingiva adjacent to the lower molar and second premolar teeth. Other fibers supply sensation to the skin of the cheek. The posterior division is primarily sensory. It branches to give the auriculotemporal, lingual, and inferior alveolar dental nerves. The lingual nerve innervates the lingual gingiva, floor of the mouth, and anterior two thirds of the tongue. The inferior alveolar nerve supplies sensation to the pulp and periodontium of all the molar and premolar teeth on 1 side of the mouth. Near the mental foramen, the inferior alveolar nerve branches into the incisive and mental nerves. The mental nerve innervates the buccal gingiva and the mucosa from the mental foramen forward to the midline, including the skin of the lower lip and chin. The incisive nerve supplies the pulps of the first premolar, canine, and incisor teeth. levitra 10 mg


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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.

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