Study Guide

● Permanent Molars
● Cervical Muscles
● Muscles of Facial Expression`
● Muscles of Mastication
● TMJ

Permanent Molars
● 12 permanent molars (6 maxillary and 6 mandibular)
● Have furcated roots
● Maxillary and mandibular first molar contact area

○ mesial : junction of occlusal and middle

○ distal : middle
● Dilaceration = an abnormal bend or curve at the root of a tooth
● Concrescence = union of teeth by cementum
● Root Trunk = molar roots originate as a single root base
● Enamel pearl = enamel projection; most common on maxillary molars,; distal or proxima
surfaces of multirooted teeth
● Mulberry molars = multiple cusps caused by congenital syphilis
● Height of contour on all molars
○ Buccal - cervical
○ Lingual - middle
Mandibular Molars Characteristics
● First Molar: Universal # 19 & # 30; erupts between ages 6-7, largest mandibular molar,
has 5 cusps, bifurcated roots (2=mesial and distal)
○ First molar to erupt
○ Pentagon occlusal shape ; trapezoid buccal shape; trapezoid proximal shape
○ Cusp and Grooves:
■ Buccal Cusps: Mesiobuccal (MB), Distobuccal (DB), Distal (D)
■ Buccal Grooves: Mesiobuccal grooves with a prominent buccal pit
○ Roots:
■ Two roots with two canals in the mesial root, positioned mesial and distal
● Second Molar: # 18 & 31; erupts between ages 11-13, bifurcated roots, is more
symmetrical, has 4 cusps
○ Rectangular occlusal pattern with “+” groove pattern
○ 4 lobes
 ○ Cusp and Grooves:
■ 4 equally sized cusps and a cross pattern central groove
○ Roots:
■ Spaced closer together than mandibular first molars
● Third Molar: Universal # 17 & 32; erupts between ages 17-21, varies in form, often is
impacted, and has smaller, fused roots

Maxillary Molar Characteristics

● Ridges:
○ Oblique ridge runs from distobuccal to mesiolingual cusp (think of 1 diagonal
cusp to cusp line across tooth)
● Roots:
○ Trifurcated: Three roots; therefore the strongest teeth in the mouth:
■ 2 mesiobuccal, - often has two roots
■ distobuccal,
■ and 1 palatal being the largest
● First Molar: Universal # 3 &14; erupts between ages 6-7 after mandibular, largest
maxillary molar, has an oblique ridge
○ Distal marginal ridge is shorter than mesial marginal ridge
○ and a fifth cusp = the Cusp of Carabelli, is non-functional
■ ML groove separates ML cusp from Carabelli
■ Lingual groove separates distal cusp from Carabelli
○ Wider buccolingual (width) than mesiodista (length)l
○ Rhomboidal occlusal shape ; trapezoid buccal aspect ; trapezoid mesial aspect
○ Cusp & Ridges:
■ 5 cusps: Mesiobuccal (MB), Distobuccal (DB), Mesiolingual (ML),
Distolingual (DL smallest functioning cusp), & located on the mesiolingual
is the Cusp of Carabelli - (use to help identify position in arch)
● Second Molar: Universal # 3 & 16; erupts between ages 12-13, cusp similar to first molar
except it is smaller and does not have a Cusp of Carabelli on the ML cusp
○ Heart 3 cusp occlusal shape; rhomboid 4 cusp occlusal shape
○ 2 roots
○ 4 lobes
○ 1 transverse ridge
● Third Molar: Universal # 1 & 16, erupts between ages 17-21, often impacted, varies in
shape, roots may be fused
Muscles of Mastication :
Common characteristics
● All are innervated by the Trigeminal Nerve (V Cranial Nerve), specifically the
mandibular arch ;
● All inserted to the mandible
● Blood supplied by the maxillary Artery ;
● Elevation ^ = closes / Protrusion < = forward / Lateral Mvmt = side to side / Retruding =
backward
● Mastication = rhythmic opposition and separation of the jaw with the involvement of the
teeth lips, cheeks, and tongue for chewing of food in order to prepare it for swallowing
and digestion. Its purpose is to to reduce size of food particles to a size that is
convenient for swallowing with the help of saliva (bolus formation)
These 4 main muscles attached to the mandible help move the mandible by elevating,
depressing, lateral movement, retruding
● Temporalis (Temporal): Nerve Supply: two deep temporal nerve
from anterior division of mandibular nerve
○ Action: main function is to elevate the jaw
■ Elevates the mandible
● to close the mouth completely when entire
muscle is contracted
■ retracts the protruded mandible ; protruded by the
masseter
● Mandible retrudes when posterior fibers
are contracted
■ Helps in side to side grinding movements
○ Originates:
■ Derived from the first pharyngeal arch; from the
temporal fossa on temporal bone and includes
the temporal fascia; shaped like a fan
○ Insertion:
■ (Margins and deep surface) Passes infratemporal
crest inferiorly to insert medial surface, apex , and
anterior border of the coronoid process of the
mandible
■ At the anteriomedial border of ramus of the mandible

● Palpation:
● Masseter: Strongest, shaped like rectangle; quadrilateral
muscle; covers the lateral surface of the mandible ; located
anterior to the parotid salivary gland
○ Nerve supply: masseteric nerve, branch of anterior
division of mandibular nerve
○ Action: Parallels the pterygoid muscle ; bilateral
contraction ; main function is to elevate the jaw
■ Elevates the mandible = causing it to close
■ Superficial fibers cause protrusion
○ Layers:
■ Superficial layer:
● Origin: deep from zygomatic process and
anterior ⅔ of the lower border of the zygomatic
arch
● Insertion:into lower part of lateral surface of
ramus (“angle” of mandible)
■ Deep layer:
● Origin: posterior ⅓ and medial surface of the
zygomatic arch; is concealed by superficial layer.
● Insertion: into rest of ramus middle layer into central part of ramus
(mandibular ramus)
■ (Not mentioned) Middle layer: posterior ⅓ of lower border of zygomatic
arch

○ Palpation:
■ Can be palpated both intraorally and
extraorally
■ Ask patient to clench teeth and place
fingers of each hand over the muscles
(bimanual)

○ Clinical Consideration:
■ Masseteric Hypertrophy: masseter
becomes enlarged with habitual clenching or grinding of teeth; firm when
palpated - present with attrition or abfraction
● Medial Pterygoid (Internal Pterygoid):
○ Deepest muscle of mastication.
○ Thick quadrilateral muscle that connects mandible w/ maxilla, sphenoid, and
palatine bones.
○ Two heads separated by the inferior head of lateral pterygoid muscle at their
origin
○ Nerve Supply: branch from the main trunk of mandibular nerve - nerve to medial
pterygoid
○ Blood Supply: receives blood from pterygoid and buccal branches of the
maxillary artery (facial artery)
○ Action: main function is to elevate the jaw; in synergy with masseter facilitates
chewing;Elevation of the mandible protrusion
■ Unilateral Contraction (only side to side)
● The medial pterygoid slightly rotates the mandible inward
● If the lateral pterygoid on the same side also contracts, the
mandible on that side moves forward and inward
■ Alternating Contraction:
● Alternating between the medial and lateral pterygoid muscles on
both sides causes a side-to-side, grinding motion
■ Bilateral Contractions (both
sides together):
● Both medial pterygoids
contracting together
elevate the mandible
(closing the jaw)
● When both lateral
pterygoids also
contract, the mandible
is pushed forward
(protrusion)
■ Combined Action
● The medial pterygoid typically works with other jaw muscles to
help with chewing and grinding food between the upper and lower
teeth

○ Originates: Has two heads that attach at different points but both insert on the
inner surface of the mandible; allowing for a strong pull on the jaw
■ Superficial Head (smaller part):
● Starts from the pyramidal process of the palatine bone and the
maxillas tuberosity
■ Deep Head (bulk of the muscle):
● Starts from the inside of the lateral pterygoid plate of the sphenoid
bone and the pyramidal process of the palatine bone.
 Both heads attach to the inner surface of the mandibular ramus (vertical
part of the jaw) and the angle of the mandible, near the mandibular
foramen

○ Insertion: Opposite the insertion of masseter - descend posterolaterally

(vertically) - have triangular appearance
■ Roughened area of medial surface of the angle and ramus of mandible on
interior side
■ Connects to mylohyoid

● Lateral Pterygoid:
○ Originates:Two Heads (or bellies)
■ Superior Head:
● Origin: smaller, originates from the
infratemporal crest of the sphenoid
bone
● Insertion: Anteriomedial portion of the
TMJ capsule and articular disc
■ Inferior Head:
● Origin: Larger; starts on the lateral
surface of the lateral pterygoid plate of
the sphenoid bone
● Insertion: Pterygoid fovea on the neck
of the mandible (condyloid process)
○ Action:
■ Bilateral Contraction (both sides together):
● Protrudes and slightly depresses the
mandible
■ Unilateral Contraction (one side only)
 ● Rotates the mandible toward the opposite side, allowing for side to
side jaw movement
○ Function:
■ Chewing and grinding
■ Jaw opening and stabiliziation
■ Side to side movement

Hyoid Muscles:
● Group of muscles located around the hyoid bone
● Important for swallowing, speaking, and jaw movement
● Supra- elevates and infra- depresses the mandible
● Divided into inra- and supra- muscles

Suprahyoid Muscles: located above the hyoid bone / Digging Some of My Goodies / Primarily
innervated by mandibular nerve (V3) and facial nerve (VIII)
● Digastric Muscle
○ Origin:
■ Anterior belly from the digastric fossa of the mandible,
■ posterior belly from the mastoid notch of the temporal bone
○ Insertion: Intermediate tendon to the body of the hyoid
 ○ Action: lower the mandible, raises the hyoid bone
○ Innervation:
■ Anterior belly: Trigeminal nerve 5 - mandibular nerve
■ Posterior belly: Facial nerve (VIII)
● Stylohyoid Muscle:
○ Origin: Styloid process of the temporal bone
○ Inserton: body of the hyoid bone
○ Action: Elevates and retracts the hyoid
○ Innervation: Facial nerve (VIII)
● Mylohyoid Muscle:
○ Origin: Mylohyoid line of the mandible
○ Insertion: Body of the hyoid and midline raphe
○ Action: Elevates the hyoid and floor of the mouth, helps with swallowing
○ Innervation: Mandibular nerve (V3)
● Geniohyoid Muscle:
○ Origin: Mental spine of the mandible
○ Insertion: Body of the hyoid
○ Action: Pulls the hyoid forward and upward, aids in swallowing
○ Innervation: C1 via the hypoglossal nerve (XII)

Infrahyoid Muscles: Mostly depress the hyoid bone down / Some Only Sing Together / Primarily
innervated by ansa cervicalis, except for thryrohyoid, which is innervated by C1 via the
hypoglossal nerve (XII)
● Sternohyoid Muscle:
○ Origin: Manubrium of the sternum and clavicle
○ Insertion: Body of the hyoid
○ Action: Depresses the hyoid after swallowing
○ Innervation: Ansa Cercicalis (C1-C3)
● Omohyoid Muscle:
○ Origin: Scapula
○ Insertion: Body of the hyoid
○ Action: Depresses the hyoid, stabilizes the hyoid
○ Innercation: Ansa cervicalis (C1-C3)
● Sternothyroid Muscle:
○ Origin: Manubrium of the sternum
○ Insertion: Thyroid cartilage
○ Action: Depresses the larynx and hyoid
○ Innervation: Ansa cervicalis (C1-C3)
● Thyrohyoid Muscle:
○ Origin: Thyroid cartilage
○ Insertion: body of the hyoid
○ Action: Raises the larynx, depresses the hyoid
○ Innervation: C1 via hypoglossal nerve (XII)