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BDS2 BAMS - Oral biology > Oral functions - senses > Flashcards

Oral functions - senses Flashcards

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1
Q

What are the 3 main branches of the trigeminal nerve

A
  • opthalmic branch
  • maxillary branch
  • mandibular branch
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2
Q

What are the 12 cranial nerves

A 
1 - olfactory
2 - optic
3 - oculomotor
4 - trochlear
5 - trigeminal
6 - abducens
7 - facial
8 - vestibulocochlear
9 - glossopharyngeal
10 - vagus
11 - accessory
12 - hypoglossal
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3
Q

Where does the inferior alveolar nerve stem from

A

mandibular division of the trigeminal nerve

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4
Q

What nerve stems off from the inferior alveolar nerve anteriorly

A

mental nerve

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5
Q

where does the mental nerve exit the mandible

A

mental foramen

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6
Q

what does the mental nerve supply

A

sensory branches to the chin and lower lip

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7
Q

what can you do to stop sensation to the inferior alveolar nerve

A

ID block

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8
Q

What are the boundaries of sensation blocking of ID block when given on e.g. left side of mandible

A

the whole to the left side of the mandible up to the left central incisor and left side of lower lip

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9
Q

What should be avoided when giving ID block

A

hitting ID nerve

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10
Q

what happens if you hit the ID nerve when giving ID block

A

Numbness may have remained due to temporary damage of the ID nerve

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11
Q

What does paraesthesia mean

A

an abnormal sensation, typically tingling or pricking (pins and needles)

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12
Q

What does dysaesthesia mean

A

an abnormal unpleasant sensation felt when touched, caused by damage to peripheral nerves.

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13
Q

You plan to take an impression to prepare a new denture for you patient . As you select the tray, you recall this patient is very prone to gagging. What mechanisms are involved in the gag response?

A

Afferent (sensorial) response from IX

Efferent (motor) response from V, IX, X, XI, XII

The motor (secretory) visceral nerves of salivary glands

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14
Q

What do afferent neurons do

A

Sensory neurons

- these carry a message into the CNS
i. e. going toward the brain/spinal cord

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15
Q

What do efferent neurons do

A

Motor neurons

- these carry a message to a muscle gland, or other effector.
i. e. carry the message away from the CNS

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16
Q

What do interneurons do

A

Connecting neuron

- these neurons connect one neuron with another
i. e. connect the sensory neurons with the motor neurons

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17
Q

What cranial nerves are involved in the gagging reflex

A 
Trigeminal (V)
Glossopharyngeal (IX)
Vagus (X)
Accessory (XI)
Hypoglossal (XII)
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18
Q

How can you design an RPD to accomodate a strong gag reflex

A
  • construct the posterior part of the RPD with a retaining mesh to facilitate the attachment of acrylic extension - means it can be adjusted more easily + reduces weight of a large metal connector
  • use magnets to minimise need for large connector (however may compromise a component of RPD)
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19
Q

What is bell’s palsy

A

a motor disorder
a type of facial paralysis for any type of facial paralysis that doesn’t have any other associated causes e.g. tumours, trauma and salivary gland inflammation

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20
Q

How do you recognise bell’s palsy

A
  • inability to wrinkle brow
  • drooping eyelie; inability to close eye
  • inability to puff cheeks; no muscle tone
  • drooping mouth; food stuck in cheek
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21
Q

What are the 5 branches of the facial nerve

A 
temporal
zygomatic
buccal
mandibular
cervical
22
Q

what facial muscles help to control bolus and prevent spillage

A

orbicularis oris

buccinator

23
Q

What can cause bell’s palsy

A
  • infections (HSV/cold sores)
  • otitis media (inflammation of the middle ear)
  • diabetes
  • trauma
  • toxins
  • temporarily by infiltration of LA to the facial nerve branches during dental treatment
24
Q

How can you cause bell’s palsy via LA

A

occurs when the injection is given too far distally and the parotid gland is penetrated, allowing the diffusion of the LA through loose glandular tissue, which then affects all five terminal branches of the facial nerve.

25
Q

What are the effects that are seen in a patient who has got facial nerve paralysis (palsy) from ID block

A
  • inability to close eye/blink

- inability to raise corner of mouth or puff cheeks

26
Q

How do you manage facial nerve paralysis from ID block

A

patients should be informed, reassured as to the transitory nature of the palsy, and the eye should be protected with a loose pad such that the cornea is protected until the protective blink reflex returns.

Recovery often occurs in a relatively short time (within an hour).

27
Q

Your next patient for the day, a retired worker who was presented to you seeking
replacement of his ill fitting lower partial denture. On examination, there were
only two remaining over-erupted lower canines holding his denture in place
(photo a). Although your patient was seeking the extraction of these two teeth
and receiving a new set of complete dentures, you offered him an alternative
treatment option which includes decoronation of the abutments and keeping the
roots to cover them with what’s known as overdentures (photos b,c). What are
the physiological and psychological advantages of this treatment option?

A

While the roots and their periodontal ligaments remain, periodontal mechanoceptors allow finer discrimination of food texture, tooth contacts and levels of functional loading.

A better a appreciation of food and a more precise control of mandibular movements than is
provided by full dentures.

Psychological benefit by preventing the feeling of total loss of natural teeth..
Makes eventual transition to conventional complete dentures more acceptable..

28
Q

why might an implanted bridge fail

A

loss of periodontal mechanoreception influences:

  • the control of jaw function
  • the precision of magnitude
  • direction
  • rate of occlusal load application
29
Q

What are the benefits of mechanoreceptors

A
  • low thresholds (0.5mN) to senses of touch, pressure
  • adaptation to constant stimulus
  • slowly and rapidly adapting types
30
Q

What is a mechanoreceptor

A

a sensory receptor that responds to mechanical pressure or distortion

31
Q

How sensitive are periodontal mechanoreceptors and what to they enable us to assess

A

very sensitive

the direction of forces applied to teeth

32
Q

What oral functions do periodontal mechanoreceptors contribute towards

A
  • mastication (food consistency)
  • salivation
  • interdental discrimination
33
Q

What is interdental discrimination

A
  • ability to gauge extent of mouth opening
  • coordination of masticatory movements
  • monitoring size of food particles
  • detection of ‘high’ spots
  • foil thresholds 8-60µm
34
Q

What receptors contribute to interdental size discrimination

A
  1. TMJ receptors
  2. muscle receptors
  3. PDL receptors
35
Q

how thick is shimstock

A

8microns

36
Q

What is proprioception

A

awareness of position and orientation of body parts

37
Q

What proprioceptors achieve proprioception

A
  • joint receptors
  • muscle receptors (muscle spindles and golgi tendon organs)
  • periodontal receptors
38
Q

What do joint receptors signal

A

Proprioception:

  • joint position (mouth open, closed)
  • joint movement (opening/closing)
  • info usful in controlling jaw movements e.g. chewing
39
Q

how does having complete dentures impact oral function

A
  • not carry enough sensory information to restore the necessary natural feedback pathways for motor function
  • they are inherently unstable during normal functional jaw movements
40
Q

What is dysphagia

A

swallowing difficulties

41
Q

what can cause dysphagia

A

Many disorders can cause or lead to food getting stuck in your esophagus, such as:

 stroke 
 brain injury
 multiple sclerosis 
 gastroesophageal reflux disorder
 tumours
42
Q

Your following patient Mr White, a retired school teacher, arrives also
complaining (I said it was a typical day…) that “things get stuck in my throat”
when he eats. What could that be? And what should you do?

A

There could be a simple explanation for this case such as infection of the oropharynx,
especially hypopharynx.

However it could provide an early diagnostic of stroke which affects the swallowing reflex and this should be thoroughly investigated.

Some simple procedure such as comparing sensorial and motor responses from both sides of face and oropharynx (effect of stroke is unilateral)

refer to GP if unsure (could be stroke, brain injury, MS, gastroesophageal reflux disorder, tumour)

43
Q

What are nociceptors

A

Respond to intense (noxious) stimuli, that are usually associated with pain

44
Q

What nociceptors are particularly important for dentists

A

nociceptors in the dental pulp

also, muscles, joints, mucosa and PDL

45
Q

How sensitive are oro-facial tissues

A

very sensitive, receptors have low thresholds for activation

46
Q

How can you tell that the sweet in your mouth is a mint with a hole in it without looking at it?

A

You will have the taste buds and olfaction of mint.

You will also have the experience of tasting polo which will facilitate the correlation

However you acquire the format of the mint by compressing it against the hard palate with the
tongue. Mechanoreceptors will be able to identify the format since the 2 point discrimination of both tissues allows that identification.

Comment that if the mint is left at the surface of the tongue
only, there will be no perception of shape.

47
Q

Why do smelling disorders often affect the sense of taste?

” Your 11.0am patient arrives to tell you that she has a “stinking cold” and that
her nose is “bunged up”. She complains that “she lost her taste”. Can you
provide an explanation for her complaint?”

A

the sense of smell stimulates the salivary glands

In cases of infection of nasopharynx, a loss of olfactory sense (Anosmia) might be associated

Patients have difficulty to discern between taste and olfaction, thus interchanging the terms.

48
Q

The 2:00pm patient is
clearly upset and you notice he is holding a wet white hankie to his face with his
right hand. He states that “food keeps getting stuck in my cheek”. As you
investigate further the patient tells you that he has had a bad ear infection last
week. Can you describe what could have happened to explain his condition?

A

The key here is the wet hankie, which indicates paralysis of the facial

Students should mention Bell’s palsy since there is a sudden onset

Food gets stuck due to limited action of orbicularis oris and buccinators which are important for
proper mastication

Otitis media may affect the facial nerve but other causal factors could also be involved

49
Q

What senses are involved in

wine tasting?

A
  • Smell of the wine
  • Taste
  • Sight as it would not pass unnoticed the colour of the wine
  • Touch such as thickness of the liquid, presence of bubbles (it could be a sparkling wine!) and the
    texture of the wine. Regarding texture, there is a complex movement attain that information as you
    will move the liquid around.
  • Temperature of the wine
50
Q

Your first patient, who had a wisdom tooth surgically extracted
under local anaesthetic a week ago, attends complaining that his lower lip is still
numb. You examine the area and notice that the patient has been biting his lip
and there is ulceration in the area. Can you provide an explanation for what
had happened?

A
  • Lip paresthesia
  • Numbness may have remained due to damage (pressure to nerve) of the mandibular division of the V CN during anesthesia or the procedure
  • Patient should be reminded to avoid biting lip and follow-up scheduled to evaluate paresthesia
  • Prognosis is favourable as long as there is no complete section of the nerve

BDS2 BAMS - Oral biology (9 decks)

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