THE CRANIAL

NERVES
 • The role of the nerves
• The role of local anaesthesia techniques
LESSON • Nerves supplying the mandible and maxilla
OBJECTIVES • Upper teeth and associated nerves
• Lower teeth and associated nerves
 The nervous system

The nervous system is composed of the following

parts:

➢ The brain and spinal cord, forming the

central nervous system.
➢ The peripheral nerves - connect the brain and
spinal cord to the entire body
➢ The sensory organs : eyes, ears, tongue, skin
and nose

• All the information from the body and external

environment gets to the brain, it is analysed and
interpreted and actions are generated.
 Types of peripheral nerves

▪ Sensory nerves – carry sensory information from the body to the brain (examples)

▪ Motor nerves- carry motor signals from the brain to the body to allow the body to respond to the information received
accordingly. ( somatic, autonomic and enteric) page 191

▪ Make the difference between sensations

Pain
Taste
Temperature changes
Touch
 Local anaesthesia

▪ Administration of local anaesthesia

The activity of the nerves is blocked – no

impulses/information reaches the brain
 Areas covered by the nerves

• Upper jaw – buccal/labial side + palatal side

• Lower jaw – buccal/labial side + lingual side

• Anterior = front
• Posterior = back
• Superior = upper
• Inferior = lower

123 45 678 (teeth numbers)

Tip: *For this lesson, knowledge of oral anatomy is essential*

 The cranial nerves

• TRIGEMINAL NERVE- 5th cranial nerve, supplying teeth, the surrounding soft tissues (examples), the
muscles of mastication (examples) some of the suprahyoid muscles (anterior digastric and mylohyoid)

• FACIAL NERVE – 7th cranial nerve, supplying some taste sensation, submandibular and sublingual salivary
glands and muscles of facial expression.

• GLOSSOPHARYNGEAL NERVE- 9th cranial nerve, supplying some taste sensations, parotid salivary glands
and muscles of pharynx.

• HYPOGLOSSAL NERVE- 12th cranial nerve, supplying muscles of anterior 2/3 tongue and the geniohyoid
muscle

• Muscle – movement
 The trigeminal nerve

This nerve splits into 3 divisions:

Ophthalmic division – Soft tissues around eye and upper face.

Maxillary division – upper teeth
Mandibular division – Lower teeth
 The maxillary division

• The maxillary nerve branches off in 5 divisions:

1. Anterior superior dental nerve

2. Middle superior dental nerve
3. Posterior superior dental nerve
4. Nasopalatine nerve
5. Greater palatine nerve
 Areas covered by maxillary nerves

▪ Anterior superior dental nerve – sensation from

teeth 1, 2 and 3 + labial gingiva + upper lip and around
the nostrils

▪ Middle superior dental nerve – sensation from

teeth 4,5 and anterior half of 6 + buccal gingivae.

▪ Posterior superior dental nerve- sensation from

posterior half of 6 and 7,8 + buccal gingivae
Areas covered by maxillary nerves

▪ Greater palatine nerve – palatal gingivae of the 8,7,6,5,4

▪ Nasopalatine nerve – palatal gingivae of 3, 2 and 1

 Useful information

❖Pages 502-503

❖Forextraction procedures the tooth + surrounding soft tissues must be

anaesthetised (tooth + gingiva) – at least 2 nerves

❖Forrestorative procedures most of the time only the tooth needs to be

anaesthetised (tooth)
ANTERIOR MIDDLE POSTERIOR
SUPERIOR SUPERIOR SUPERIOR

NASOPALATIN GREATER
E NERVE PALATINE NERVE
 Nerves of the mandible

1. Inferior dental nerve (mental nerve)

2. Long buccal nerve
3. Lingual nerve
 Areas covered by the mandibular nerves

Inferior dental nerve – 8,7,6 teeth only

Mental nerve - 5,4,3,2,1 teeth + buccal /labial gingiva and the lower lip and
chin.

Inferior dental nerve and mental nerve are one and the same (the name
changes as a result of the inferior dental nerve existing through the mental
foramen)
 Areas covered by the mandibular nerves

Lingual nerve - lingual gingivae for all lower teeth + floor

of the mouth and anterior two thirds of the tongue. (touch
sensation)

Long buccal nerve – buccal gingivae only of 6,7,8

MENTAL INFERIOR LONG
NERVE DENTAL BUCCAL
NERVE NERVE

LINGUAL NERVE
 Relevant disorders of the nervous system

Trigeminal neuralgia
A condition affecting the sensory nerves of maxilla or mandible (the trigeminal
nerve)
✓ No known cause
✓ Symptoms- severe pain on different facial zones and muscles spasms
✓ Treatment- surgical or chemical destruction of the sensory action of the nerve

Bell’s palsy = paralysis of the facial nerve

Stroke
• Previous stroke –may result in poor speech or
muscular control that may make communication
and oral hygiene difficult for the patient.
• Cerebral thrombosis the formation of a blood clot
within a brain artery
• Cerebral embolism the blockage of a brain artery by
a loose blood clot formed elsewhere in the body
• Cerebral haemorrhage when a cerebral blood
vessel ruptures
 Disorders of the nervous system

Epilepsy – a patient with epilepsy may have a seizure

at any time, and the dental team should be able to
manage successfully.
Epileptic patients may take medication like- Epanutin
– that will cause gingival hyperplasia.
 QUESTIONS?

MANDIBULAR BRANCHES - THE INFERIOR ALVEOLAR NERVE OR INFERIOR DENTAL NERVE - HEAD AND NECK GROSS
ANATOMY MEDICAL ANIMATION -YOUTUBE
MAXILLARY BRANCHES - MAXILLARY DIVISION OF TRIGEMINAL NERVE (V2 OR VB) / MAXILLARY NERVE - ANATOMY
MEDICAL ANIMATIONS - -YOUTUBE

LEVISON’S TEXTBOOK: CHAPTER 9 (SECOND PART)

(EXTRA INFORMATION – CHAPTER 5 (PAGES 190-199)

Q&A BOOK: CHAPTER 8A