Mock 2# Flashcards
periodontal abscess
localised acute exacerbation of a pre-existing pocket
Usually vital, pain on lateral movements, usually mobile, loss of alveolar crest, more likely to have generalised horizontal bone loss
periapical abscess
localised collection of pus around apex of a non-vital tooth as a result of pulp necrosis
non vital, TTP vertically, may be mobile, loss of lamina dura, radiolucency?
occlusal trauma
tooth mobility which is progressively increasing and or tooth mobility with symptoms AND radiographic evidence of increased PDL width
periapical periodontitis
periodontal disease which has reach the apex of a tooth, resorption of alveolar bone, loss of attachment - apical migration of junctional epithelium.
plaque, age, smoking, stress, diabetes
chronic gingivitis
Bleeding on Probing, inflammation of gingival tissues, false pockets due to oedema.
No bone loss.
Pregnancy related, puberty associated, leukaemia.
maxillary nerve
through
past which parasymp ganglion
foramen rotundum
pterygopalatine gangion in ptyergopalatine fossa
branches of CNV2 (maxillary)
- Nasopalatine branch, and nasal branches (sphenopalatine foramen)
- greater and lesser palatine branches,
- zygomatic branch (inferior orbital fissure)
- post sup alveolar,
Enters maxillary sinus,
- middle and ant sup alveolar nerves,
exits via infra orbital foramen where it become the infra orbital nerve ( labial, nasal, palpebral branches)
Also pharyngeal branch at beginning and pteryogopalatine ganglion parasympathetic ganglion (greater petrosal nerve – facial)
limit alcohol
14 units a week both sexes
2 alcohol free days
health promotion strategies for alcohol
- Advertising regarding safe limits, not drinking and driving etc.
- Changing Scotland’s Relationship with Alcohol: A Framework for Action.
- Licensing Scotland Act 2005;
- Alcoholb– increasing price per unit of alcohol
chairside interventions for alcohol
Ask, Assess, Advise, Assist, Arrange - 5As BEST
- AUDIT: alcohol use disorders identification test (good to determine if hazardous, harmful or dependent drinker)
- FAST: concise version of AUDIT (fast alcohol screening test)
- CAGE: 4 questions
ABIs - alcohol brief interventions - opportunitistc and effective
3 types candidosis
- pseduo membranous (thrush)
- erythomatous (denture induced stomatitis)
- hyperplastic
angular cheilitis
tx pseudo membranous candidosis
nystatin
- topical MW 4x daily (100,000 units) 3ml per rinse for 7 days
- CLX can be an effective adjunctive to this.
Candida subtyping should be considered if systemic antifungals to be prescribed as C.glabrata, C.tropicalis and C.krusei are resistant to fluconazole.
- Fluconazole 50mg daily for 7 days or itraconazole 10-20mg OD both for 14 days
erythromatous candidosis tx
Eliminate cause, through cleaning of denture- (alkaline hypochlorites – Milton 20 min soak,)
if steroid related then advise rinse mouth with mouth after inhaling and/or spacer device.
Otherwise as above - nystatin
hyperplastic candidosis tx
confirm diagnosis microbiologically and histopathologically,
systemic anti fungals
- fluconazole 50mg OD or itraconazole 10-20mg OD.
Can also be associated with iron, folate, vit b12 deficiencies and smoking so try to correct these!
angular cheilitis tx
CHX + Miconazole cream
- 50mg daily 7 days
azoles action
work by inhibiting ergosterol forming in fungi
maxillary impression features
coverage of tuberosity.
Coverage of hamular notch
extension ant to vibrating line,
functional depth and width of sulcus to create peripheral seal.
mandibular impression features
coverage of pearshaped pads and buccal shelf.
Retromolar pad and extension into the lingual pouch.
Functional width and depth of sulcus.
primary area of support mandibular denture
buccal shelf and pear shaped pad
primary area of support maxillary denture
hard palate
posterior border of upper denture
overs hamular notches and 1-2mm ant to vibrating line. 2mm ant to palatine fovea.
primary impression materials
impression compound, or alginate if undercuts are present
secondary impression materials
ZOE, silicone: PVS, alginate
4 cardinal signs of parkinson
postural instability,
muscle rigidity – cogwheel and lead pipe,
resting tremor,
bradykinesia – difficulty initiating movements
dental impact of parkinsons
mask like face
- hard to judge,
slow speech,
impaired dexterity (tooth brushing)
swallowing may become troublesome.
Abnormal posture make make examination difficult
dry mouth (anticholinergic effect of drugs)
depression associated with the disease,
- depression could lead to dental neglect
Drug interactions.
how may pt with parkinsons dentally present
OH deteriorates, hard to access surgery, dry mouth, lack muscle control – hard for dentures, dyskinesia
signs of dementia pt with pain
frequent pulling at face and mouth,
refusal to eat,
previously worn dentures left out,
disturbed sleep,
increased restlessness and moaning
CHX drug group
bisbiguanides
CHX mech of action
Di cationic,
- one cation attaches to dental pellicle and the other to the bacterial membrane,
low conc: increases permeability,
high conc: precipitation of cytoplasm and cell death
substantivity
persistance of action (depends on: absorption to oral surfaces, maintenance of antimicrobial activity, slow neutralisation)
Substantivity 12hrs for CHX
- Factors that influence: Other drugs, food and drink, sodium lauryl sulphate
dose of CHX mouthwash
- 2% 10ml = 20mg twice/day
- 12% 15ml = 18mg twice/day
indications for CHX
- Short term use for specific problem (candiosis),
- post surgery,
- disabled pts,
- immunocompromised pts,
- reduced salivary flow,
- gingivitis,
- oral ulcerations,
- adjunctive to OH,
- Full Mouth Rehabilitation,
- fixed appliances,
- irrigation of sockets,
- RCT-irrigant,
- pre-surgery to maintain OH,
- mucocitis – cancer pt,
side effects of CHX (3 main)
decreased GI absorption
staining
taste disturbance
incidence
the amount of new cases in the population a specific time period
prevalance
proportion of the population affected by a disease at a single point in time.
anterior xbite
z spring
posterior bite plane
post xbite
mid palatal screw
posterior bite plane
wire gauge for active components
0.5mm HSSW
retention
resistance to displacement forces
anchorage
resistance to unwanted tooth movement
base plate functions
connector
dissipates forces
retention
aim ortho tooth movement per month
1mm per month
retention wire gauge
primary and permenent
primary - 0.6mm
permanent - 0.7mm
HSSW
ortho device for habit breaker
deterrent rake or crib design on palate.
digit sucking effect on teeth
AOB
arch narrowing.
Proclined upper teeth,
retroclined lower teeth,
post x-bite.
socket measures to stop bleeding
Direct pressure,
vasoconstriction (LA),
diathermy,
surgicel (Oxidised celluslose),
Bone Wax
ferric sulphate
haemostatic agent (15.5%)
only in primary teeth as stains
- also used in pulpotomy*
- (saline and pressure in adult)*
how to stop soft tissue bleed
suturing,
Cauterisation,
Direct Pressure,
haemostatic clips,
ligatures
nerves affected by inferior-alveolar nerve block
lingual neve, inferior alveolar nerve (Incisive and mental braches also)
how to test for IDB anaesthesia
Numbness of lip and chin on same side,
numbness of lingual gingivae,
numbness ant 2/3rds tongue,
all mandibular teeth on that side
xerostomia
dry mouth
- subjective complaint of dryness of the mouth, can be a sign and a symptom.
Half the amount of normal unstimulated flow rate
- Clinically; <0.3 ml/min unstimulated salivary flow,
medications which can cause dry mouth
- Tricyclics antidepressants,
- antihistamines,
- anticholinergics,
- diuretics,
- antipsychotics,
- benzodiazepines,
- B blockers
(polypharmacy)
other than meds what can cause dry mouth
- Sjogrens syndrome,
- radiotherapy to head and neck,
- anxiety,
- dehydration,
- surgery (removal of gland),
- Stress,
- Diabetes,
- rheumatoid arthritis,
- parkinsons,
- alzheimers,
- Stroke,
- Nerve damage (Chorda Tympani)
tx ED#
- radiographs to ensure no root displacement etc.
- glass ionomer cement can be used in an emergency,
- restore with composite or if fractured piece retained cement it back on.
- Review clinically and radiographically at 6-8 weeks and 1 year
tx EDP#
<24hours
- direct pulp cap of setting CaOH and hermetic seal with GI
Radiographic and clinical review at 6-8 weeks and 1 year.
>24 hours
- partial pulpotomy
pulpotomy
LA,
- isolate if possible,
- cleaned, dry,
- perform pulpotomy to 2mm with round diamond bur.
- Saline cotton wool pellet to achieve heamostasis (ferric sulphate option)
- CaOH or white MTA onto exposed pulp
- GIC covering
- restore with composite
radiograph and clincal review at 6-8 weeks adn 1 year
what trauma is rubber dam contraindicated with
luxation injuries
clincal syptoms of trauma
Pain, oedema, bruising, change of bite, missing part of tooth, inability to close mouth, tooth discolouration,
radiographic signs trauma
External/Internal inflammatory root resorption,
periapical radiolucency??
(external surface resorption or ankylosis?)
waste disposal legislation
Health and safety at work act(1974),
COSHH(2002),
environmental protection act (1990)
black waste line
domestic -> landfill
yellow waste line
clincal -> disnifected and landfill
orange waste line
special clincal waste (sharps) -> incineration
red waste line
amalgam waste -> centrifuged to remove mercury, which is recycled
amalgam waste containers
white containers with red lids
rigid, leak/spill proof, mecury vapour suppressant
picked up regularly
consignment/transfer note
description of waste, origin-source, quantity, transport and destination
Kept for 3 years
basic difference between
alzeheimers
vascular dementia
lewy bodie dementia
Alzheimer’s diease- brain chemistry and function
Vascular dementia- oxygen supply related due to stroke or small vessel disease
Lewy bodies – spherical protein deposits in the neurons, stops normal propagation.
early stage dementia symptoms
difficulty concentrating,
decreased memory of recent events,
socializing becomes difficult,
confusion,
poor judgement,
anxiety
middle stage dementia symptoms
major memory deficiencies and may need help with every day activities e.g bathing and preparing meals.
Might not know where they are or what time/day it is.
Incontinence.
Forget names of friends and family,
personality changes,
risk of wandering
late stage dementia sympotms
essentially no ability to communicate,
assistance required for most activities, eating, toilet,
lose physical/motor skills; walking,
- may be bed bound,
difficulty swallowing
MCC
separation interproximally taper
5-6 degree
MCC
aesthetic area reduction
1.3-1.5mm
shoulder margin
2 plane reduction buccal to avoid buccal pulp horn
MCC
palatal reduction
0.5mm
chamger
1 plane reduction
MCC
occlusal reduction
- 6-2.0mm
- 8mm functional cusp bevel
reduce marginal ridges and cusp to try and retain occulsal morphology
properties of IM for off site lab
decontaminable
dimensionally stable for adequate time (no distortion)
compatible with lab facilities
non toxic
non irritant
child abuse index of suspicion
delayed presentation of injury
suspicious injuries e.g. hand prints, bites, burns, multiple injuries, facial bruising or in safe zone
strange or aggressive behaviour
on edge
sensitive to movement and noise
what to do if suspect child abuse
Speak to parent and kid,
ask how they got injuries,
does this match up with presentation?
Ask reason for delayed presentation.
If still concerned, contact child protection for advice, follow up in writing,
speak with health visitor, school nurse/head teacher, GP to investigate history of concern, social services
managing neglect
Not role of dentist to manage neglect,
- within scope of dentist to give evidence surrounding injuries and therefore importance of impeccable record keeping.
Single unit:
- Raise concerns with parents, explain change required, offer support, keep accurate records, liaise with parents/carers, monitor progress,
Multiagency approach:
- if still worried liaise with child protection/ other agencies - Social services
4 examples of inherited bleeding disorder
haemophilia A
haemophilia B
haemophilia C
von williebrands disease
haemophilia A
factor 8 deficiency
DDAVP, recombinant factor 8
haemophilia b
factor 9 deficiency - christmas factor
replace factor 9
haemophilia c
factor 11 deficiency
von williebrands disease
von williebrands factor def
DDAVP
thrombocytopenia
what
tx
low circulating platelet
platelet transfusion
blood tests to confim thrombocytopenia
prothrombin time
bleeding time
platelet count
INR for XLA
under 4 (3.5 in GDH)
safely 1.5-2.5
action of warfarin
acts on vit k dependent clotting factors 2, 7, 9, 10
oral cancer risk factors
alcohol
smoking (synergistic)
male
HPV
UV chewing tobacco (pan)
age
candidosis and alchohol
mucosal abnormalities (leukoplakia)
biofilm
definition
Matrix (polymers) enclosed microbial populations adherent to each other and/or to surfaces or interfaces. Create an environment favourable for growth.
niche
definition
describes each species individuality in terms of how they behave, the environment the live in and what they survive on.
stages of colonisation
reversible attachment
- Pioneer species,
- microcolonisation
irreversible attachment
- Extra cellular products,
biofilm maturation
- biofilm development,
- mature plaque
dispersal
3 things involved in adhesion
fimbria
water insoluble glucans
adhesins
successful colonisation needs (3)
adherence
substrate (energy)
liveable environment (pH etc)
suturing aims
approximate tissues and compress blood vessels
reposition tissues and cover bone,
prevent wound breakdown,
achieve haemostasis a
nd achieve healing by primary intention.
(Prevent foreign bodies also).
types of flap
1 sided (envelope)
2 sided
3 sided
categories of suture material
resorbable or non-resorbable
monofilament or polyfilament
resorbable monofilament
monocryle
non resobable monofilament
prolene
nonresorbable polyfilament
mersilk
resorbable polyfilament
vicyrl (raptide)
handpiece used to cut bone
straight electrical handpeice with saline cooled and tungsten carbide burs
air causes surgical ambolism
key things of flap design and suture placement
- Do not cut through neurovascular structures (mental foramen),
- wide based incision,
- no sharp access,
- maximal access,
- flap margins and sutures lie on sound bone,
- no crushing,
- minimise trauma to dental papillae,
- consider post op aesthetics,
- 1 continuous stroke of scalpel,
- flap reflection down to bone,
- keep moist,
- Suture in the papillae areas and either side of relieving incision if present.
possible long term effects on permanent tooth of trauma (7)
- No damage at all,
- areas of hypoplasia and hypomineralisation
- dilacerations,
- eruption delayed,
- partial or complete arrest of tooth formation
- odontome formation,
- ectopic tooth position.
nursing/bottle caries pattern
all upper teeth included. (smooth surface)
Inappropriate use of feeding bottles and cups.
- Cups should be used from 6months,
- no sugars in bottles,
- not given to child in bed,
- soy milk cariogenic.
Frequency of consumption is major factor!
normal pattern of caries in permanent dentition
6s pits and fissures first
interproximal areas
pits and fissures
not smooth surface
types of post
4 categories to class
- preformed /custom
- tapered/ parallel
- threaded/ serrated/ smooth
- metal/fibre
parallel v tapered
Parallel has greater retention when compared to tapered, also less likely to cause root fracture as load not dispersed horizontally (transfers down long axis).
Taper useful where large natural taper already present or been created with shaping.
length of post
Length should be at least equal to crown height, (more than 1/2 root length)
leaving 4-5 mm of GP apically.
Not extending past a bend in the root.
Should reach alveolar crest height.
width of post
Width should not exceed 1/3rd of total root width, fit the coronal preparation, anti-rotational design.
baseplate function (3)
anchorage
connector/retention of components
stability
displacement forces on URA
active compenents
function - eating
gravity
speaking - vibration on palate
tongue
fiting ortho
a. Ensure name matches appliance
b. Ensure that appliance matches prescription
c. Check for sharp or protruding areas on the fitting surface
d. Check for areas of work hardening or damage to wire work (integrity of wire work)
e. Fit in the patient’s mouth immediately looking for areas of blanching or trauma.
f. Check posterior retention initially the flyovers then the arrow heads
g. Check the anterior retention.
h. Activate any active components (approx 1mm tooth movement per month)
i. Demonstrate to the patient the correct technique for insertion and removal of the appliance and ensure that the patient demonstrates this.
j. Book and new appointment for 4 – 6 weeks.
pt instructions and warnings for URA
a. Mild discomfort initially (Normal)
b. May feel big and bulky (Will get used to it)
c. May cause excess salivation (Will pass usually within 24 hours)
d. May impinge on speech (Practise reading aloud)
e. Wear 24hrs a day (including eating)
f. Non compliance significantly lengths treatment
g. Remove for contact sports (Store in a protective container)
h. Remove and clean after every meal
i. Avoid hard and sticky foods and be careful with hot foods or drink.
j. Supply a contact number in case of emergency or appliance fractures
how to monitor progess at subsequent ortho app and what would you do those app
check wear of appliance
reactivate appliance
monitor
- OJ measurement - space between 3 and 5 decreased (extraction site) and OJ not changed
- check OB reduction
if pt compliance excellent
av length URA tx
6-9 months
ghost image
image is projected on the opposite side of the xray.
- Usually higher and more anterior than original structure, usually wider horizontally.
Commonly earrings, metal restorations, anatomical feature (angle of mandible) soft tissue calcifications soft palate, can interfere with diagnosis. hyoid bone, dentures, fixed appliances.
possible indications for OPT
- Evaluation of trauma,
- Third molars and their relationship to IA canal,
- Large lesions,
- Generalized disease (Periodontal bone loss),
- Inability to tolerate intraoral films,
- Assessment for surgical procedures
stroke definition
Acute focal neurological deficit resulting from cerebrovascular disease and lasting more than 24hrs (less than is transient ischaemic attack)
Can be caused by hypoxia of the brain leading to infarction or a haemorrhage into brain tissue. (Vascular/Atheroclerosis/embolism, etc)
risk factors stroke
- hypertension,
- smoking,
- alcohol,
- ischaemic heart disease,
- AF,
- diabetes mellitus,
- age,
- DVT,
prevention stroke
- reduce risk factors,
- antiplatelets (aspirin),
- anticoagulants if embolic risk.
tx stroke
rehabilitation and damage limitation,
300mg aspirin daily to reduce future risk,
reduce risk factors.
dental aspects stroke
- impaired mobility and dexterity,
- communication difficulties,
- risk of cardiac emergencies,
- loss of protective reflexes,
- loss of sensory information,
- cognitive impairment?
- Bleeding risk,
- xerostomia - polypharmacy
- facial nerve issues,
- facial paralysis.
how to give IDB porpley so not anaesthetise facial nerve
Assemble long gauge needle after checking date - record along with batch number
Apply topical LA to dried injection site.
- Approach from opposite premolar region,
- 5mm above molars on side of injection, (pterygomandibular space) lateral to pterygomandibular raphe, medial to coronoid notch and buccal pad of fat.
- Advance needle until hit bone,
- retract slightly, aspirate.
- If no blood on aspiration, administer slowly into site. (2/3)
- Deposit LA on removal to anaesthetise lingual nerve (1/3)
- Sheath needle, dispose of into sharps bin.
stroke vs bells
stroke-opposite side,
upper motor neurone disease – affects whole body including CN - except the eyes, forehead, cognitive is fine
bells - affects forhead due to IDB into nerve (lower motor neuron lesion)
psychiatric disorder examples
Anxiety neurosis, OCD, bipolar, schizophrenia, dementia, eating disorders (bulimia, anorexia)
difficulties in tx pt with psychiatric disorder
depend on type and severity of mood disorder,
- lack of personal perception of oral problems,
- lack of access,
- unable to provide adequate care,
- irregular attenders,
- ability to accept care eg anxiety needed sedation facilities.
- Obtaining capacity and consent,
- poor time keepers,
- short attention spans,
- lack understanding,
- reduced saliva - denture retention,
- maybe unable to upkeep complex tx - 1 tx RCT only
possible medications for psychiatric disorder
Tricyclic antidepressants, Benzodiazepines, Anti-psychotics-phenothiazine, MAOI, SSRI
mental health act 2003
purely regarding management and treatment of psychiatric disorders.
No provision for treatment of physical problems, can have detained pts in the community on leave of absence,
application of mental health act 2003
person has mental disorder,
- treatment is available to help treat symptoms or condition worsening,
if no treatment then significant harm to the person or others,
because of the mental disorder, ability to make decision is significantly impaired,
- use of compulsory power is necessary!
mental capacity act 2005
England only!
The Act aims to empower and protect people who may not be able to make some decisions for themselves.
It also enables people to plan ahead in case they are unable to make important decisions for themselves in the future.
>16s have capacity
scotland act for adults unable to make decisions
Adults with Incapacity Act 2000
capacity 5 principles
understand what the treatment is, purpose, nature, why being done,
Understand main benefits and risks
- and benefits and risk of alternatives and be able to make a decision,
Understand consequence of not having the treatment,
Retain the information,
Ability to communicate the decision (facilitated if necessary)
5 AWI principles
benefit,
minimal intervention,
present and past wishes,
consultation with relevant others,
encourage residual capacity.
who can consent for AWI
Welfare power of attorney or guardianship only can consent.
Not continuing power of attorney.
general authority to tx under AWI
section 47 of AWIA
If Tx needed, certificate presented then dentist can perform Tx - outlined in certificate only
Dentist can give certificate but only for dental Tx. If carried out further training
randomised control trial
used for clinical trials gold standard of study design. Strongest level of evidence of effectiveness of treatment.
Specification of participants (representative sample), randomisation by computer, control used (placebo or standard treatment) double blinding!
cohort study
prospective study, establish a group and measure exposures, follow group over time, identify those that develop disease.
Used for estimating incidence and causes of disease.
case control study
retrospective study, looks back to exposure of particular risk factor,
looks at potential cause of disease.
Confidence interval
shows how confident/precision you can be with your estimate.
Narrow CI is better,
- larger the sample the narrower the C.I is.
- (contains 1 = not statistically valid)
p value
probability of attaining a test statistic at least as extreme as the one actually observed,
<0.05 data is significant
null hypothesis
no relationship between two measured phenomena, drug not effective treatment
F tablet dosage
6mths- 3 years: 0.25mg/d
3years-6years: 0.5 mg/d
6years+: 1 mg/d if high risk
f toothpaste conc for ages
1000ppm up to 6years.
1350-1500ppm 6years+
high risk
- 10+ 2800ppm
- 16+ 5000ppm
duraphat varnish (sodium fluoride) conc
22600ppm
F mouthrinse
conc
age
225ppm
6+
toxic f dose
1mg/kg body weight
potentially lethal F dose
5mg/kg body weight
certainly lethal F dose
32-64mg/kg body weight
f toxicity symtoms (4)
- nausea
- abdominal pain
- diarrhoea
- vomitting
5mg/kg F tx
give them calcium orally (milk)
observe
5-15mg/kg F tx
give than calcium orally (milk)
get to hospital
15+mg/kg F tx
get themt A&E
need IV calcium gluconate and cardiac monitoring
tx fluorosis
acid micro abrasion
veneers
accept
natural sources of F
fish, tea
salt (if fluoridated)
milk (if fluoridated)
types of disability 5
- physical
- mental (leanring and/or social)
- congenital
- acquired through illness/trauma
- sensory
social concept disabilty
response to medical, society is an issue, needs to adapt.
medical concept disability
People with disability are issue, need Tx/care, should adapt to environment and society.
disability discrimination act 2005
GDP should not refuse to register/continue to treat because of disability, pt has right to info in a format accessible to them if reasonable, Access to facilities- adaption of surgery where reasonable
impairment
loss or abnormality of physical bodily structure or function of logic-psychic origin, or physiological or anatomical origin (loss or abnormality of physical bodily function)
disability
limitation or function loss deriving from impairment that prevents the performance of an activity in the time lapse considered normal for a human being.( limitation or function loss deriving from impairment)
handicap
disadvantaged condition deriving from impairment or disability limiting a person performing a role considered normal in respect of age, sex, social and cultural factors. (limiting factors of disability)
examples of how to adapt surgery for DDA
reasonable adjustments
Ramp, hand rail, wide doors, low desk at reception, consider turning of wheel chair, wide clutter free corridors, hoists, toilets, visible signs for visually impaired, hearing loop.
physical appearance of CF
Barrel chested,
malnourished,
failure to thrive,
smaller than average,
finger clubbing
symptoms CF
Coughing,
SOB, r
ecurring chest infections: staph aureus and p.aeruginosa,
wheeze
possible medications for CF
- oral pancreatic enzymes
- supplements
- Antibiotics for infections
- Possible tetracycline-intrinsic staining,
- beta2 agonists(salbutamol)
- Anticholinergics.
dental impact of CA
- Delayed dental development,
- enamel opacities,
- increased calculus,
- NO GA!! (pulmonary involvement),
- increased bleeding (liver impairment),
- tetracycline staining.
masseter
superficial and deep heads
zygomatic arch to ramus and angle of mandible
elevates mandible
masseteric branch CNV3
temporalis
temporal fossa on side of skull to coronoid process
elevates mandible and retracts it
deep temporal nerve branches of CNV3
lateral pterygoid
superior head - base of skull (greater wing of sphenoid bone) to anterior side of condyle
inferior head - lateral ptergoid plate to pterygoid fovea
nerve to lateral pterygoid branch CNV3
depresses mandible, protrusion and lateral movements
medial pterygoid
origin
- superficial part: medial side of lateral pterygoid plate
- deep part: maxillary tuberosity
insertion both - to medial side of ramus and angle of mandible
nerve to medial pterygoid CNV3
elevates mandible
mandibular nerve CNV3
Passes through the foramen ovale - nerve to medial pterygoid,
then splits.
ANT division:
- masseteric nerve (motor)
- deep temporal nerves, anterior and posterior (motor)
- buccal nerve (a sensory nerve)
- lateral pterygoid nerve (motor)
Post division:
- auriculo-temporal nerve(sensory)
- lingual nerve (sensory)
- inferior alveolar nerve (sensory)
- nerve to Mylohyoid (motor)
- mental nerve (sensory)
