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BDS 2 > Anatomy Of Oral Cavity And Face > Flashcards

Anatomy Of Oral Cavity And Face Flashcards

1
Q

What does the parotid gland secrete?

A

-serous saliva, more watery

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2
Q

What do the sublingual glands secrete

A

Mucous saliva, more viscous

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3
Q

What do submandibular/maxillary glands secrete?

A

A mixture of serous and mucous saliva

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4
Q

What is the frankfort plane and when is this important for radiographs?

A

the horizontal line from the lower margin of the orbit and the upper notch of the tragus of the ear (hole). Important for lining up the horizontal line in OPTs

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5
Q

what is Kennedy class 1 tooth loss

A

Bilateral edentulous areas located posterior to natural teeth. Most common

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6
Q

what is Kennedy class II tooth loss

A

A unilateral edentulous area located posterior to natural teeth

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7
Q

what is Kennedy class III tooth loss

A

A unilateral edentulous area with natural teeth remaining both anterior and posterior to it

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8
Q

what is Kennedy class IV tooth loss

A

A single, but bilateral (crossing the midline), edentulous areas located anterior to the remaining natural teeth

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9
Q

what is a modification in the Kennedy tooth loss classification (for types 1-3)

A

an extra space of tooth loss e.g. if a patient had Kennedy class II modification II; they would have UL 3-1 and UR1-3 and UR5-7

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10
Q

why are palatine injections painful

A

mucosa is tightly bound to the bone so when the fluid is injected into the tissues there is very little space for it to move into, causing a build up of a pressure and pain to the mechanoreceptors

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11
Q

why must we be very careful aspirating when doing a maxillary regional block.

A

In the area of pterygoid plexus with high vascularity so ensure we aspirate or adrenaline enters the blood system

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12
Q

why should haemophiliacs be very careful with maxillary blocks?

A

pterygoid plexus full of blood vessels that may haemorrhage and cause excessive bleeding

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13
Q

why can we not provide mandibular infiltrations?

A

very thick cortical bone with less vasculature than maxilla

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14
Q

which nerve and artery pass through the parotid gland

A

facial nerve CNVII

external carotid branch of facial nerve

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15
Q

What are the three branches of the trigeminal nerve

A

opthalmic, maxillary and mandibular

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16
Q

What are the branches and route of the maxillary V2 and what do they innervate?

A
  • posterior superior alveolar nerve branches before entering the infraorbital canal innervates posterior superior teeth
  • (in 50% of people there is a middle superior alveolar nerve innervates the middle superior teeth - branches within the infraorbital canal)
  • The nerve exits the infra orbital canal s the anterior superior alveolar nerve to innervate the anterior superior teeth
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17
Q

What does the lesser palatine nerve inntervate and where does it exit the cranium

A

uvula, soft palate and tonsils

lesser palatine foramen

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18
Q

how is the hard palate and nasal septum innervated

A
  • V2
  • majority innervated by anterior greater palatine nerve from greater palatine foramen
  • nasopalatine nerve innervates the most anterior palate through sphenonasal foramen
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19
Q

why are palatine injections painful

A

Mucosa is bound very tightly to the underlying bone so very little tissue for anaesthetic to diffuse into, building up pressure and activating pain receptors

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20
Q

what nerve passes distal to the third mandibular molar

A

lingual nerve branch of alveolar nerve

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21
Q

what joins the lingual nerve to innervate the anterior tongue motor

A

chorda tympani of CNVII facial nerve

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22
Q

what does the lingual nerve innervate

A

Lingual gingiva of all mandibular teeth
Mucous membrane of the tongue anterior to the circumvallate papillae (anterior ⅔)
floor of mouth

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23
Q

what does the mental nerve innervate

A

buccal mucosa and gingiva anteriorly and chin

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24
Q

what branch of the CNV innervates sensory information of the anterior mandibular teeth

A

incisive branch of IAN

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25
Q

what does the inferior alveolar nerve branch into

A

mental nerve

incisive nerve

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26
Q

what artery follows the inferior alveolar nerve

A

inferior dental artery of maxillary artery

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27
Q

what makes the 2 sides of the triangle of which we aim to the centre for an IAN block

A

anterior ramus of mandible

pterygomandibular raphe

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28
Q

how do we change the angle of injection for a child’s IAN block and why

A

aim down and more lateral as their alveolar foramen is lower and mandible’s more flared

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29
Q

how do we deal with a flared mandible during IAN block

A

swing syringe laterally to try hit get closer to bone near the mandibular foramen
use indirect IAN block

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30
Q

differentiate direct and indirect IAN block and reason for

A

direct: normal route of injection from across contralateral premolars
indirect: used for flared mandibles
- hit bone, swing syringe medially and advance further before swinging laterally and advancing further

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31
Q

if we can not achieve numbness doing an IAN blcok what do we do

A

aim much higher towards the mandibular condyle to anaesthetise higher up the nerve

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32
Q

why do we not do bilateral IAN blocks

A

complete numbness of tongue and lips is very uncomfortable for patient

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33
Q

what is anaesthetised with an infraorbital nerve block

A

teeth and buccal gingiva of upper 1-5 and mesiobuccal cusp of 6

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34
Q

what does the nasopalatine nerve innervate

A

palate from 1-3 either side and nasal septum

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35
Q

what does the greater palatine nerve innervate

A

hard palate from 4-8s

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36
Q

if a patient has a middle superior alveolar nerve, what does it supply?

A

upper 4,5 and mesiobuccally cusp of 6

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37
Q

what is the aim of a mental block

A

for anaesthetic to diffuse back along the nerve to supress action potentials in the incisve and mental nerve, anaesthetising the lower anterior 4, 3,2,1

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38
Q

what nerve provides sensory innervation of the pharynx

A

mostly glossopharyngeal nerve CNIX

anterior nasopharynx innervated by pharyngeal branch of V2

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39
Q

what provides motor innervation to the pahrynx

A

vagus nerve CNX

apart from stylopharyngeus innervated by glossopharyngeal

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40
Q

what does the infra-oribtal nerve innervate

A

lower eyelid, the side of the nose, and the upper lip (buccal mucosa of upper 1-5)

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41
Q

what is the pathway of the CNV2

A

maxillary branch of trigeminal
zygomatic branch comes off before entering canal
enters the infra-orbital canal
within canal branches superior posterior, middle superior and anterior superior alveolar nerves branch off to innervate teeth
exits infraorbital canal becoming infraorbital nerve
innervates buccal mucosa, lower eyelid and upper lip

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42
Q

how does an infraorbital nerve block work

A 
anaesthetic diffuses into the infraorbital canal
affecting anterior (and middle) superior alveolar nerve and infraorbital nerve
numbs upper 1-5 and mesiobuccally cusp of 6 and lips, lower eyelid and buccal mucosa of 1-5
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43
Q

where is there overlap between soft tissue innervation in the oral cavity

A

between 5-6 long buccal and mental nerve

across any midline tongue/gingiva/lips

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44
Q

what is the pterygomandibular space bound by and why is this important

A 
medially by medial pterygoid
anteriorly by buccinator
laterally by ramus of mandible
superiorly by lateral pterygoid
where we find mandibular foramen for IAN block
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45
Q

where does the lingual nerve run in relation to the IAN

A

anterior and medially

46
Q

what muscle does the pterygomandibular raphe come from

A

superior constrictor muscle

47
Q

why is the lingua of important and what attachments occur here

A

is just above the mandibular foramen

site of attachment for sphenomandibular ligament

48
Q

what muscle attaches to the roughened mesial angle of the mandible

A

medial pterygoid

49
Q

what muscle attachment is formed on the anterior aspect of the mandibular condyle

A

lateral pterygoid

50
Q

what is and where do we find the temporal crest

A

anterior of the ramus of the mandible

splits the external and internal oblique ridge

51
Q

roughly how far above the occlusal plane o we find the mandibular foramen

A

1cm

52
Q

what is the internal part of the angle of the mandible

A

coranoid notch

53
Q

what is the lining material of the MAS called

A

schneiderian membrane

54
Q

what is pneumatization

A

movement of air sinus epithelium into a space e.g. when a maxillary molar is removed and the MAS moves into its root space

55
Q

what is trismus and what can cause it

A

reduced mobility of the mouth
LA into muscles of mastication
haemorrhage build up against nerve after XLA
oropharyngeal cancer enters masseter

56
Q

what and where is the lingual foramen

A

small midline opening on the posterior aspect of the symphysis of the mandible, just above the mental spine below central incisors
Passage of lingual artery, nerve and vein

57
Q

how and where does the parotid duct secrete its products into the mouth

A

stensons duct

buccal mucosa of upper 7s

58
Q

what are the 2 small indentations at the margin of hard and soft palate and why are they important for prosthesis

A

fovea palatini

upper denture should extend 1-2mm in front of this

59
Q

what is the hamular notch

A

junction between most posteiro part of maxilla and the hamular process of sphenoid bone

60
Q

what is the tissue between lip and gingiva called

A

gingival frenae

61
Q

what are the incisive papillae

A

2 small mucosal prominences on the hard palate just posterior to the incisors

62
Q

what is the average distance between the distal border of the incisive papilla and the labial surface of incisors?

A

12mm

63
Q

what is the retromolar pad

A

mass of soft tissue located at the posterior end of the mandibular alveolar ridge

64
Q

what’s another name for the mylohyoid ridge

A

internal oblique ridge

65
Q

what mucosa lie in the mouth above the ramus of mandible

A

internal and external oblique ridge

66
Q

what is the lingual gingival remnant LGR

A

remnant line on newly edentulous patients where teeth used to be

67
Q

what is the lingual frenum

A

mucosa attaching tongue to floor of mouth/lower ridge

68
Q

where are the two bony projections at the lingual surface of the midline mandible and what are their attachments

A

genial tubercles that attach to geniohyoid inferiorly & genioglossus superiorly

69
Q

explain the strength of the cortical plates of the mandible

A

anteriorly the labial plate is weaker (lingual stronger)

posteriorly the buccal plate is stronger and lingual is weaker

70
Q

in a edentulous patient, how will the lower residual ridge change shape

A

will resorb over time becoming lower (sulci shallower)
anteriorly the labial cortical plate resorbs more
posteriorly the buccal cortical plate is stronger and lingually weaker
resorbs labially anteriorly and lingually posteriorly
residual ridge becomes wider at the back and shorter at front

71
Q

how does the maxillary arch resorb

A

slower than mandible
all maxilla has weaker buccal/labial plate so resorbs here
leaving a more palatal, smaller residual ridge

72
Q

what helps reduce resorption after XLA

A

implant retained tooth
retained roots
little evidence showing dentures reduce resorption

73
Q

what increases risk of bone resorption

A

lack of teeth XLA

systemic disease e.g. osteoperosis

74
Q

where is the buccal shelf located

A

the widening bone buccal to lower 7/8

75
Q

what is the interpapillary line

A

horizontal line parralell to the line made in-between the two pupils of our eyes

76
Q

what is the alatragar line

A

line between the inferior border of alar of nose and upper border tragus of ear

77
Q

what is the alar

A

side of nose

78
Q

what is the tragus

A

small point of cartilage protruding backwards covering the entrance to the ear

79
Q

what is foxes plane

A

parallel to the alatragar line

line at which the upper maxillary teeth follow posteriorly

80
Q

What are some features of the ideal occlusion

A 
ICP = RCP
Canine lateral guidence
Anterior guidence 
Forces down long axis of tooth
Mutual protection
81
Q

What is mutual protection

A

Anterior teeth protect posterior teeth whilst in eccentric positions (protrusion and lateral excursions)

Posterior teeth protect anterior teeth during mastication and intercuspation

82
Q

what muscle is the labial sulcus determined by

A

obicularis oris

83
Q

what is the buccal sulcus determined by

A

masseter posterior

buccinator anterior

84
Q

what is the average mandible angle and how do we find this

A

~30 dgerees

difference in angle between CR and protruded jaw

85
Q

what is bonwills triangle

A

equilateral triangle from tips of mandibular condyle and tips of lower incisors

86
Q

what is balanced occlusion

A

refers to posterior contact points being balanced in ICP when in CR

87
Q

what is balanced articulation

A

balanced contact points when in eccentric positions

88
Q

what is an eccentric position

A

relation of mandible to maxilla when the jaws are not in centric relation

89
Q

what is the mandibular symphysis

A

inferior point of the mandible at midline

90
Q

what is the MMPA on a ceph and how do we find it and what should it be

A

mandibular maxillary plane angle
find intersection between ANS-PNS line and lower border of mandible
27 degrees

91
Q

what should the angle between maxillary plane and upper incisors be (on a ceph)

A

109 degrees +/- 2 degrees

92
Q

what should the mandibular plane form with the lower incisors

A

92 degrees +/- 2

93
Q

what 3 types of mucosa are found in the mouth and where

A

masticatory mucosa covers the gingiva and hard palate - keratinized stratified squamous epithelium tightly bound to underlying bone
lining mucosa covers lips, sucli, cheeks - non-keratinized stratified sqaumous pithelium with high adiose tissue loosely bound to underlying bone
special mucosa covers upper surfae of tongue with squamous tratified non-keratinized with papillae

94
Q

what type of epithelium lines the nose

A

ciliated pseudostratified columnar cells

95
Q

what is the name for the phenomenon that occurs posteriorly in protrusion

A

Christensen’s phenomenon.

disocclusion of posterior teeth

96
Q

give 4 reasons why the canines are ideal for lateral excursion guidance

A

Morphology – very strong tooth with long roots
Favourable crown:root ratio
Distant from the hinge of the mandible
Distant from the powerful muscles of mastication

97
Q

why are anterior teeth ideal for protrusive excursion

A

furthest away from masseter so less force

furthest away from hinge so less force due to moments

98
Q

why is it ideal to have RCP = ICP

A

condyles and muscles are working in their most physiologically stable position whilst the teeth are occluding which spreads load across most teeth rather than single or small groups of teeth

99
Q

why is a cusp-fossa relationship important

A

increase longevity and long term stability as it

prevents horizontal forces on the tooth and its root

100
Q

what checks must we make when placing a restoraiton

A

BEFORE AND AFTER
restoration not too high
Contact in ICP
Maintaining contacts on all other teeth - we are not changing the occlusal schemes.
Fitting our restoration with the existing scheme.
Contact in protrusion or laterotrusion? In most cases no, unless the tooth we are restoring previously had these contacts
Skeletal/Incisor/Angle classifications
Signs of occlusion issues? Wear facets, craze or fracture lines, fremitus.
Occlusal vertical dimension – can often be decreased due to tooth wear

101
Q

what is prognathsim

A

positional relationship of the mandible or maxilla to the skeletal base where either of the jaws protrudes beyond a predetermined imaginary line in the coronal plane of the skull

102
Q

what innervates trapezius and sternocleidomastoid

A

accessory nerve XI

103
Q

what does the facial nerve supply

A

motor innervation to facial msucle expressions

sensory taste receptors of anteiror 2/3 via chorda tympani

104
Q

what involvement does the vagus nerve have with the oral cavity

A

motor to pharynx and larynx

sensory to larynx

105
Q

which muscles innervates muscles of the tongue

A

hyoglossus XII

106
Q

what are the functions of glossopharyngeal nerve

A

sensory to pharynx
gag reflex
taste posterior 1/3 tongue
swallowing

107
Q

what are the functions of CNV

A

trigeminal
sensory to facial tissue
motor to muscles of mastication - lead to trismus

108
Q

how is the tongue innervated

A

glossopharyngeal IX - posterior 1/3 taste of tongue
hypoglossus XII - motor control of muscles of tongue
facial nerve VII- anterior 2/3 taste of tongue
trigeminal nerve V- senosry to tongue

109
Q

what forms the TMJ

A

mandibular condylar head
fitting into the glenoid fossa of the sphenoid bone
with anterior articular eminence of the sphenoid bone

110
Q

explain the drainage of the lymphatics of the teeth

A

maxillary and posterior mandibular teeth drain to submandibular
lower incisors drain to submental

111
Q

where does the ear’s lymphatics drain to

A

mastoid lymph node

112
Q

what anatomy is important for ID blocks

A

pterygomandibular raphe of superior constrictor muscle
Coronoid notch deepest concavity of the mandible
occlusal plane 1cm above

BDS 2 (13 decks)

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