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BDS2 BAMS > Sensory, Motor Systems and Senses > Flashcards

Sensory, Motor Systems and Senses Flashcards

1
Q

what is the sensory nerve involved in innervating the lower molars?

A

Mandibular branch of Trigeminal Nerve

CNV3

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2
Q

what are the 3 branches of the trigeminal nerve

A

mandibular

maxillary

opthalimic

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3
Q

12 Cranial Nerves

A 
I: Olfactory 
II: Optic
III: Oculomotor 
IV: Trochlear
V: Trigeminal 
VI: Abducens
VII: Facial
VIII: Vestibulocochlear 
IX: Glossopharyngeal 
X: Vagus
XI: Accessory 
XII: Hypoglossal
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4
Q

The sensory branch of the Inferior alveolar nerve which supplies the chin and lower lip is called?

A

MENTAL – comes from mental foramen to supply chin soft tissue

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5
Q

where does the mental nerve of the inferior alveolar nerve exit

A

exits the mandible via the mental foramen (supplying sensory branches to the chin and lower lip).

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6
Q

what nerve is effected by ID block

A

inferior alveolar dental nerve

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7
Q

where does the ID block numb to

A

the midline of mandible

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8
Q

basics of ID block (cover more later)

A
  • Target – mandibular sulcus superior to mandibular foramen
  • Greatest depression on coronoid notch determines height and angle of injection
  • Advanced from contralateral premolar region
  • Bone contact then retract slightly
  • Both patient and dentist need PPE – eye protection
  • Inferior alveolar nerve and lingual nerve are close together – withdraw slightly can anesthetize lingual nerve too
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9
Q

where does the needle hit in ID block

A

Needle is not hitting the nerve

Deposit LA next to nerve on the bone
- Feel bone before inject – if feel soft then don’t inject

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10
Q

paraesthesia

A

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

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11
Q

dysaesthesia

A

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

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12
Q

why is Paresthesia/dysesthesia a good sign

A

good sign not complete anesthesia

- Can be reversed definitely therefore Good if develop it

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13
Q

why may numbness remain?

A

due to temporary trauma/damage of the ID nerve

  • Can ulcerate lip as don’t feel it – more prone to biting it

Will eventually go away, oedema on nerve but no completely dissection on nerve so will reverse

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14
Q

What mechanisms are involved in the gag response?

A

just mechanical

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15
Q

what does the gag reflex do?

A

Acts to prevent material entering pharynx

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16
Q

what evokes the gag reflex

A

Evoked by mechanical stimulation or fauces, palate, posterior tongue, pharynx

Some patients gag when instruments and/or materials are placed in the mouth

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17
Q

what nerves are involved in gag reflex

A

Efferent (motor) response from V, IX, X, XI and XII
- Trigeminal, Glossopharyngeal, Vagus, Accessory, Hypoglossal

The motor (secretory) visceral nerves of salivary glands are also stimulated

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18
Q

afferent neurons

A

sensory

these carry a message into the CNS. They are going toward the brain or spinal cord.

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19
Q

efferent neurone

A

motor

these carry a message to a muscle, gland, or other effector. They are said to carry the message away from the CNS

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20
Q

interneuorn

A

connecting neuron

these neurons connect one neuron with another. so multiple in many reflexes, interneurons connect the sensory neurons with the motor neurons.

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21
Q

how can a RPD be made to manage gagging reflex (3)

A

The posterior part of this RPD is constructed with a retaining mesh to facilitate the attachment of acrylic extension.

  • design is indicated when the post-dam cannot be tolerated by the patient (gagging reflex), allowing it to be adjusted more easily.
  • this approach will reduce the weight of a large metal connector.

Mesh covered in acrylic – can reduce it (complete mesh cannot reduce so give availability of reduction)

Magnets
- For retention instead of maximal coverage
- Or shortened post-dam area
Compromise retention but otherwise may not be able to wear

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22
Q

examples of gagging control mechanisms for when taking impressions

A

Not too runny, not tolerated by patient (may make thicker)

Hot water faster setting

Select fast set alginate brand

Patient chin down

Come from back of patient not from front like usual lower impression – rotation movement

Breathe from the nose – distract the patient

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23
Q

Patient attends the practice, he 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 cheeks’ As you investigate further the patient tells you that he had a bad ear infection last week
what may explain this?

A

Related to motor nerve not sensory
- Related to facial nerve

Damage to facial nerve (CNVII) – bell’s palsy
- Injected facial nerve distally in parotid – inject one of the 5 branches

Ear infection – swelling pushes on facial nerve

Effects function of orbicularis oris and buccinator – food bolus no longer in centre of oral cavity

White hankie is telltale sign of facial paralysis
- Cannot control saliva as lost muscle control

Bells

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24
Q

what types of disorder is Bell’s Palsy?

A

motor

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25
Q

facial nerve branches (5)

A
  • Temporal
  • Zygomatic
  • Buccal
  • Mandibular
  • Cervical
    To Zanzibar By Motor Car

Related to Bell’s Palsy symptoms

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26
Q

what key muscles are innervated by the facial nerve

A

buccinator and orbicularis oris

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27
Q

facial nerve number

A

CNVII

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28
Q

role of buccinator and orbicularis oris

A

Help control food bolus and prevent spillage

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29
Q

Bell’s Palsy definition

A

for any type of facial paralysis that does not have any other associated causes such as tumors, trauma and salivary gland inflammation

  • No other associated causes –cannot explain cause of paralysis directly
30
Q

Symptoms and signs of Bell’s Palsy (4)

A

Inability to wrinkle brow

Drooping eyelid; inability to close eye

Inability to puff cheeks; no muscle tone

Drooping mouth; food stuck in cheek

31
Q

Bell’s Palsy Causes (6)

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
- Caused by dentist

32
Q

how can a dentist cause Bell’s Palsy

A

Temporarily by infiltration of LA to the facial nerve branches during dental treatment

occurs when the LA 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.
- Parotid gland by posterior border of mandible

33
Q

what is a complication of ID block

A

Facial Nerve Paralysis (Palsy)

34
Q

how can you see a facial nerve paralysis (Palsy)

A

The effect is seen in inability to close the eye or blink, and inability to raise the corner of mouth or puff the cheeks.

  • Patients may feel that something is wrong but be unable to identify exactly what the problem is, and it is usually the operator who notices these specific changes.
  • Patient may not feel it or notice but clinical assessment can notice
35
Q

is facial nerve paralysis (palsy) reversible

A

yes

should wear off with LA

36
Q

management of facial nerve paralysis (palsy)

A

patients should be informed, reassured as to the transitory nature of the palsy, a

the eye should be protected with a loose pad such that the cornea is protected until the protective blink reflex returns.
- Need to protect eye from being dehydrated and cornea being damaged

37
Q

Your next patient for the day, a retired worker who was present to you seeking replacement of ill-fitting lower partial denture. On examination, there was only 2 remaining over erupted lower canines holding the denture in place. Although your patient was seeking extraction of these 2 teeth and receiving a new set of complete dentures
What would you offer your patient as treatment options?

A

Canines – strong last teeth to be extracted
- over-denture maintaining periodontal mechanoreceptors

Porcelain most aesthetic, economical but don’t use in upper denture with lower implant because very fragile and can fracture – low shearing force resistance

Implants not as appropriate as likely lost all arch

38
Q

what do periodontal mechanoreceptors allow

A

allow finer discrimination of food texture, tooth contacts and levels of functional loading.

39
Q

what are periodontal mechanoreceptors

A

the roots and their periodontal ligaments remain,

Decoronated the tooth (remove the crown but leave roots)

Have PDL so have proprioception – forces on areas, feel bolus

40
Q

advantages of periodontal mechanoreceptors (5)

A

A better appreciation of food and a more precise control of mandibular movements than is provided by full dentures.
- More natural feeling than full denture, more acceptable

Maintain shape

Psychological benefit by preventing the feeling of total loss of natural teeth.

Makes eventual transition to conventional complete dentures more acceptable

Can place precision attachment
- Reduce number of clasps – retention from studs and clasps

41
Q

precision attachment of RPD

A

Reduce number of clasps – retention from studs and clasps

42
Q

what are the consequences of a failed implant

A

Expensive, time consuming

No PDL nothing to tell patient about occlusal forces in mouth – no mechanoreceptors
- Eat something hard – open mouth as protective mechanism
Not available in artificial root

43
Q

the loss of periodontal mechanoreceptors influences

A
  • the control of jaw function
  • the precision of magnitude
  • direction
  • rate of occlusal load application.
44
Q

general touch sense from

A

mechanoreceptors

45
Q

mechanoreceptors are

A

sensory receptors that responds to mechanical pressure or distortion

46
Q

properties of mechanoreceptors

A
  • Low thresholds (0.5mN)
  • Adaptation to constant stimulus
  • Slowly & rapidly adapting types
47
Q

periodontal mechanoreceptors enable

A

us to assess the direction of forces applied to teeth

- very sensitive

48
Q

what 3 oral functions do periodontal mechanoreceptors contribute to

A
  • Mastication (food consistency)
  • Salivation
  • Interdental discrimination
49
Q

interdental discrimination is

A

Ability to gauge extent of mouth opening

50
Q

interdental discrimination is used for

A
  • Coordination of masticatory movements
  • Monitoring size of food particles
  • Detection of ‘high’ spots
    (Foil thresholds 8-60μm; Articulating paper is 40μm or less; Shimstock (metal foil for occlusal testing) is the thinnest at 8μm)
51
Q

3 receptors that contribute to interdental discrimination

A
  1. TM joint receptors
  2. Muscle receptors
  3. PDL receptors
52
Q

what is proprioception

A

‘Self’ sense

Awareness of position and orientation of body parts

53
Q

what are 3 proprioceptors

A

Joint receptors

Muscle receptors

  • muscle spindles
  • Golgi tendon organs

Periodontal receptors

54
Q

what may joint receptors of proprioception signal

A
  • joint position (mouth open, closed)

- joint movement (opening, closing)

55
Q

what is joint receptors of proprioception information used for

A

Information useful in controlling jaw movements, e.g. chewing

56
Q

consequence of loss of periodontal mechanoreceptors incomplete dentures

A

do not carry enough sensory information to restore the necessary natural feedback pathways for motor function.

  • they are inherently unstable during normal functional jaw movements.
57
Q

what 5 disorders can lead to dysphagia

A
  • stroke can be first sign
  • brain injury
  • multiple sclerosis
  • gastroesophageal reflux disorder
  • tumours

also medicine can effect salivary glands

58
Q

if patient complains fo food getting stuck in their throat what must you first do

A

most likely differential diagnosis

- exclude stroke first

59
Q

how to assess if a stroke has occurred

A

Comparing sensorial and motor responses from both sides of face and oropharynx can easily detect stroke
- Stroke is unilateral

Touch areas and compare with other side (one effected and one not)

Minor strokes proceed major stroke, diagnose early to help save

60
Q

FAST actions to assess a stroke

A

facial weakness,
arm weakness,
speech problems,
time to call 999

61
Q

nociceptors

A

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

Nociceptors in the dental pulp are the most important ones for dentists
- Pulpitis and toothache

62
Q

sensitivity of oro-facial tissue

A

very sensitive

receptors have low thresholds for activation
- but not all regions are equally sensitive

63
Q

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

A
  • Taste buds and olfaction of mint
  • Will also have the experience of tasting a polo which will facilitate correlation
  • 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
64
Q

how are smell and taste related

A

sense of smell stimulates salivary glands.

65
Q

how can smelling disorders effect taste

A

sense of small stimulated salivary glands (related)]

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

66
Q

how can a denture effect taste?

A

cover palate lose 2 point discrimination (need palatal coverage for support)
- Effects texture and therefore taste
Horseshoe or ring shaped or anterior and posterior strapped dentures better as palate exposed

67
Q

senses involved in wine tasting

A

Olfactory – sense of smell stimulates salivary glands

Sight

Texture – thickness/viscosity of liquid

Temperature and thermorecptors

68
Q

It is 9am and you first patient, who had a wisdom tooth surgically extracted under LA 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 still ulceration in the area
Can you provide an explanation as to what had happened?

A

Traumatised inferior alveolar dental nerve when delivering LA
- From trigeminal mandibular, sensory and motor

Trauma from needle hitting not chemical
- Didn’t completely dissect nerve just traumatised (dissect potential on extraction)

Reversible damage (return to normal feeling eventually)

Due to numbness patient will have lack of awareness of their bite force – causing ulceration over repeated bite
- Absence of sensation

Not hit mental branch of mandibular nerve (last branch stemming from main nerve, by mental foramen

69
Q

Plan to take an impression to prepare a new denture for your 10am. As you select a suitable tray, you recall patient is prone to gagging every time you place a tray in their mouth. What mechanisms are involved in the gag response?

A

Mechanical
- Fauces, palate, posterior tongue, pharynx

Reflex – prevent material entering pharynx
- Hit receptors that trigger CN9

nerves involved
- Efferent (motor) response from V, IX, X, XI and XII
(Trigeminal, Glossopharyngeal, Vagus, Accessory, Hypoglossal
- The motor (secretory) visceral nerves of salivary glands are also stimulated

70
Q

11am patient arrives to tell you that she has a ‘stinking cold’ and that her nose is ‘bunged up’ and complains she has lost her taste. Can you provide an explanation for her complaint?

A

Smell related to taste – because smell stimulates salivary glands
- lose sense of smell = lose sense of taste

can mix up smell and taste – subjective to patient
- taste can also be related to texture

BDS2 BAMS (54 decks)

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