The Mylohyoid Nerve -MHN: clinical significance and implications for analgesia of mandibular teeth in restorative and surgical dentistry

Inferior alveolar nerve block (IANB) is widely used in dental clinical practice for permanent mandibular teeth analgesia and impacted wisdom teeth surgery. Causes of dental analgesic failure should always be identified in order to ensure successful painfree dental treatment. Factors implicated in mandibular teeth analgesia failure include bifid inferior alveolar nerve, double/accessory mental foramen, exaggerated bone density, cross innervation of incisors, tissue inflammation, inactive anesthetic solution, and mylohyoid nerve accessory innervation. Mylohyoid Nerve-MHN-,a motor nerve to mylohyoid and digastric anterior belly muscles , is often implicated as a secondary( = additional) sensitive innervation of mandibular permanent teeth. It may escape analgesia in IANBs, and alternative local analgesia (MHN block) should be implemented to ensure total pain control of mandibular teeth.