Dr.Jayakumar.Patil

INTRODUCTION TRIGEMINAL NERVE ORIGIN BRANCHES &COURSE

NERVE SUPPLY NERVE SUPPLY TO UPPER AND LOWER TEETH NEUROANATOMY OF PULP TISSUE CLINICAL IMPORTANCES OF NERVE SUPPLY.

CONCLUSSION

REFERENCES

The management of pain in the practice of dentistry requires that the doctor and dental hygienist posses a thorough knowledge of nerve supply of teeth and associated structure.

The right and left trigeminal nerve supply the teeth, bone and the soft tissues of oral cavity with overwhelming majority of their sensory innervations.

INTRODUCTION

TRIGEMINAL NERVE -FIFTH CRANIAL NERVE

-MIXED NERVESENSORY ROOT → SEMILUNAR GANGLIONMOTOR ROOT → UPPER PONS

-4 NUCLEUSMOTOR MESENCEPHALICSUPERIOR SENSORYSPINAL

TRIGEMINAL GANGLION

Made up of PSUEDOUNIPOLAR NERVE CELL → T –SHAPED PROCESS

CLINICAL ANATOMY•TRIGEMINAL NEURALGIA may be abolished by INJECTING ALCOHOL in to GANGLION

BRANCHES

AREA OF SUPPLY

FaceGreater part of the scalpTeeth Oral & nasal cavitiesDura mater Cerebral blood vessels

CLINICAL ANATOMYThe sensory distribution of V nerve explains why Headache is uniformly common symptom

OPHTHALMIC NERVE

Superior & SmallestBranches through --- superior orbital fissureSupplies --- Eye ball lacrimal gland Conjunctiva Nasal mucosa Skin of nose Eyelid Part of scalp

BRANCHES OF OPHTHALMIC NERVE

Before entering SOF

MAXILLARY NERVEArises --- ganglionRuns forward lateral to --- cavernous sinusLeaves --- foramen rotundum

MAXILLARY NERVE

Enters --- Pterygopaltine fossa

Continued--- Infra orbital nerve

Intimately related --- pt. ganglion

BRANCHES OF MAXILLARY NERVE

CRANIAL CAVITY --- MENINGIAL PT. FOSSA --- GANGLIONIC ZYGOMATIC POSTERIOR SUP. ALV.

INFRAORBITAL CANAL--- MIDDLE SUP. ALV. ANTERIOR SUP. ALV. ON FACE --- PALPEBRAL NASAL SUPERIOR LABIAL

BRANCHES OF MAXILLARY NERVE

Post sup alv nerve leaves----max nerve in pt. fossaEnters---- posterior surface of max bodyPierce---- infra temporal surface of maxillaSupply---- upper molars

Infra orbital nerve----continuation obital fissure orbital canal orbital faramen

Nasopalatine nervePasses across roof of nasal cavityMoves downward to reach floorEnters ----incisal foramen

Greater palatine nervePasses ---- pterygopalatine canalEnters---- greater palatine foramen

AREA OY SUPPLY

Skin of lower eyelid middle portion of face side of nose upper lip

Mucous membrane of nasopharynx maxillary sinus soft palate tonsil hard palate

Maxillary teeth & periodontal tissue

MANDIBULAR NERVE

Largest division

Motor & Sensory component

Both emerge---foramen ovale

BRANCHES OF MANDIBULAR NERVEMAIN TRUNK--- MENINGEAL NERVE TO MEDIAL PTERYGOID

ANTERIOR TRUNK---BUCCAL N. MASSETRIC N. DEEP TEMPORAL N. N. TO LATERAL PYERYGOID

POSTERIOR TRUNK---AURICULOTEMPORAL N. LINGUAL N. INFERIOR ALV. N.

BRANCHES

MANDIBULAR NERVE

BRANCHES OF MANDIBULAR NERVE

INFERIOR ALVEOLAR NERVE

Descends medial --- lateral pterygoidEnters --- mandibular canal Via --- mandibular foramen

Branches ---mylohyoid branch mental nerve incisive nerveArea supplied--- all anteriors buccal gingiva of ant region lower lip

LINGUAL NERVESensory ---- anterior 2/3 of tongue floor of the mouth mandibular lingual gingiva

Joined --- chorda tympani

AREA OY SUPPLY

Skin of temporal region auricula ext aud meatus cheek lower lip chin region

Mucous menbrane of cheek tongue mandibular teeth & periodontium bone of mandible TMJ parotid gland

Motor supply

Greater palatine N

Naso palatine N

PALATE

Mental N

Incisive Br

IA Nerve

Molar Br

Most densely innervated in the body.

Important signals for neurogenic inflammation, for stimulation of repair, and for assisting with everyday “house keeping” functions in the dentin-pulp border area.

Powerfull role for dental innervation in pulpal biology and dental injury reactions.

► TYPES OF INNERVATIONS OF PULP Sensory, Sympathetic fibers Parasympathetic fibers

► SENSORY NERVE FIBERS Myelinated and Unmyelinated fibers. A/c diameter and conduction velocity

► SYMPATHETIC AND PARASYMPATHETIC FIBERS Sympathetic – Superior cervical ganglion. Both symp and parasymp fibers thought to involved in the dentin formation.

Fiber Diameter

(μm)

Conduction velocity

(speed of impulse

m\sec)

Function

A-Alpha(α) 13 to 20 70 to 120 m/s Motor, proprioception

A-Beta(β) 6 to 13 40 to 70 m/s Pressure and touch

A-Gamma ( γ)

3 to 6 15 to 30m/s Motor to muscle spindles

A-delta(δ) 1 to 5 6 to 30 m/s Pain, temperature, touch

B-fiber < 3 3 to15m/s Preganglionic autonomic

C-fiber 0.4 to1 0.4 to 2m/s Pain

Monitor painful sensations.

Two types – mediate the pain A – fibers; Rapid and Sharp pain C – fibers ; Dull aching pain.

A – delta fibers; myelinated most numerous. periphery of the pulp.

C – fibers ; Non myelinated most numerous; found chiefly in the pulp core.

Electric pulp test -- stimulates A fibers – Unreliable in Young teeth – Unreliable in Older patients

Cold test – do not injure the pulp.

Heat test – greater potential to produce pulp injury.

INFILTRATIONS

NERVE BLOCK

FIELD BLOCK

PSA NERVE BLOCK

Greater Palatine Block

Nasopalatine Block

IA NERVE BLOCK

Area anesthetized by an IA nerve

1.GRAYS ANATOMY 38TH EDITION

2. B.D . CHAURASIA’S HUMAN ANATOMY 4TH EDITION

3. PATHWAYS OF PULP 8TH EDITION STEPHEN COHEN RICHARD C. BURNS 4. SELTZER AND BENDER’S DENTAL PULP

5.LOCAL ANEASTHESIA STANELY MALAMED

THANK YOU…………