Anatomy & Histology · patient case question
Pain from the exposed bone in this socket is carried by which nerve?
Patient case: Ten Days After the Extraction
Patient: 31-year-old female
Chief Complaint: “The pain started three days after the tooth came out and it has been getting worse, not better. It goes up to my ear.”
Background: Tooth #17 was extracted ten days ago. She smokes about half a pack a day and takes a combined oral contraceptive.
Medications: Ethinyl estradiol / levonorgestrel
Vital Signs: BP 118/72 mmHg · HR 78 bpm · RR 16 · T 98.6°F
Findings: The socket is empty of clot with exposed grey bone at its base. Foul odour. No swelling, no purulence, no lymphadenopathy, no trismus.
Show answer and explanation
Correct answer: D. Inferior alveolar nerve
- A. The long buccal nerve supplies the buccal soft tissue and gingiva adjacent to the mandibular molars, not the bone of the socket itself.
- B. The facial nerve (VII) is MOTOR to the muscles of facial expression. It carries no general sensation from the jaws at all.
- C. The lingual nerve supplies the lingual gingiva, the floor of the mouth and general sensation to the anterior two-thirds of the tongue — soft tissue, not the alveolus.
- D. CORRECT. The INFERIOR ALVEOLAR NERVE, a branch of V3, supplies the mandibular teeth and the bone of the body of the mandible through its dental and interdental plexus. Exposed alveolar bone and the denuded socket walls of a mandibular third molar site are innervated by its terminal branches — this is why the pain of alveolar osteitis is deep, boring and severe, and why it radiates along the nerve's distribution toward the ear and temporal region.
Note: Referred pain to the ear from a mandibular third molar site travels via the auriculotemporal nerve, which shares the V3 trunk — which is why patients so often describe earache with dry socket.
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