Mental Foramina’s New Look

Amy Dukoff, D.M.D.
Mental Foramina’s New Look

Amy Dukoff

ROFOUND ANESTHESIA is imperative for endodontic treatment. In the mandibular premolar area, the nerve exiting the mental foramina is the mental nerve. The mental nerve provides the anesthesia to the chin, lower lip, and buccal gingivae of anterior teeth. By anesthezing this area, the patient feels more profound anesthesia in the mandibular area, enabling the clinician to treat the patient.
    The mental nerve is a branch of the inferior alveolar nerve, which exits the mandibular canal through the mental foramen. This nerve divides into branches in order to innervate the skin in several regions, such as the mental area, buccal mucosa, and lower lip. This nerve provides sensation to the buccal gingival of mandibular anterior and premolar teeth. The mental nerve mainly exits by the mental foramen from a classically round opening. However, the shape can change to oval. Furthermore, as one ages, the location of the mental foramina can move upward toward the alveolar ridge. Lastly, the presence of accessory foramina allow for additional branches of the mental nerve. During surgery it is important to look for their presence to avoid injury to them. Variations in their occurrence have been associated with ethnicity. For example, in the Polynesian population, the incidence of accessory canals is more frequent than in the Caucasian population. The study of anatomic variations in the accessory mental foramina has been improved by the technique of cone-beam computed tomography (limited CBCT).
    The mental foramina and accessory foramina should be identified before beginning a patient’s treatment. In endodontics, it is important to identify the mental foramina in relation to the apex of a root canal. Since instrumentation can produce inflammation of the apical tissue, the distance from the root apex to the mental foramina must be considered to reduce post-operative symptoms. Furthermore, an infection or a swelling in the area can affect the mental nerve, causing symptoms of numbness. Also, care must be taken during obturation to avoid extrusion into the surrounding periapical tissue. The proximity of the root’s apex to the mental foramina should be evaluated before patient care begins.
    The mental foramina and its exiting mental nerve are important in clinical practice. The patient must have profound numbness during all of our procedures. Variations of the mental foramina’s physical characteristics should be taken into consideration while providing patient care.

July - September 2009

The patient must have profound numbness during all of our procedures.

Remember to make sure to get a reliable, accurate, and repeatable reference point when taking your measurement control. Sometimes it may be necessary to flatten a cusp tip rather then use the cusp slope when measuring. You can use an indelible marker to make a small mark on a crown surface to give yourself further accuracy and repeatability during the visit. Also remember to re-measure as you instrument because canal straightening ultimately can shorten your measurement control by .5 mm to as much as 1 mm.

Doug Kase

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