Mott Community College

Course Name:
Semester:

Pain Management
Spring 2016

Instructor Information:
Name:
Office Location:
Office Phone Number:
E-mail Address:
Fax Number:
Division Phone Number:
Instructor Office Hours:

Jennifer Walker, RDH, MA

MMB 2036E
(810) 762-0495, Cell (810) 875-1084
Jennifer.walker@mcc.edu
(810) 232-8874
(810) 762-0493
See posting and by appointment.

Clinical Faculty:
Name:
Office Location:
Office Phone Number:
E-mail Address:
Fax Number:
Division Phone Number:
Instructor Office Hours:

Jennifer Walker, RDH, MA

MMB 2036E
(810) 762-0495, Cell (810) 875-1084
Jennifer.walker@mcc.edu
(810) 232-8874
(810) 762-0493
See posting and by appointment.

Name:
Office Location:
Office Phone Number:
E-mail Address:
Fax Number:
Division Phone Number:
Instructor Office Hours:

Susan Weiss, DDS

MMB 2036B
(810) 762-0328
susan.weiss@mcc.edu
(810) 232-8874
(810) 762-0493
See posting and by appointment.

Name:
Office Location:
Office Phone Number:
E-mail Address:
Fax Number:
Division Phone Number:
Instructor Office Hours:

Rita Szukhent, RDH, MS

MMB 2036G
(810) 762-0486
rita.szukhent@mcc.edu
(810) 232-8874
(810) 762-0493
See posting and by appointment.

Prerequisites:

All participants must have successfully completed the first year of the
dental hygiene program. Pre-requisites and co-requisites must follow
established sequence. Program coordinators signature required.
Students must show evidence of current certification in
basic or advanced cardiac life support.

Days/Times/
1

Location:

Lecture, Tuesday 8:00 10:45, MMB 2024

Note: Additional lecture Wednesday, May 11, 12:30-3:15
May 4 through June 28
Lab: Tuesday 11-2:40 OR Wednesday 8-11:40
Week of May 17 through June 29

Course Prefix
And Number:

DHYG 180

Credit/Contact Hours:

3 credit/4 contact

Texts:
Title:
Author:
Publisher:
Edition:
ISBN Number:

Local Anesthesia for the Dental Hygienist

Logothetis
Elsevier
2nd
978-0323396332

Title:
Author:
Publisher:
Edition:
ISBN Number:

Handbook of Nitrous Oxide and Oxygen Sedation

Clark and Brunick
Mosby, St. Louis, Missouri
4th ed. 2015
978-1-4551-4547-0

Course Description:

This course will provide the student with basic and current concepts of
local anesthetic and pain control for the safe and effective
administration of local anesthetics and nitrous oxide/oxygen sedation.
This course will prepare candidates for the CDCA examination for local
anesthesia and nitrous oxide/oxygen sedation certification.

Course Content:

At the conclusion of this course the student will be able to administer,

under supervision, local anesthesia and nitrous oxide oxygen analgesia
and be prepared to take the licensing examination in both local
anesthesia and nitrous oxide oxygen
sedation.

Learning Experiences:

Group discussion, collaborative learning, online and independent

learning via Blackboard

Course Objective:

Local Anesthesia
Define pain
List the functions of pain
Define and explain pain perception
Define and explain pain reaction threshold
Define and explain pain threshold
List the factors that affect the pain reaction threshold
Explain the sensory pathway of pain perception and reaction
Discuss the Gate Control theory
Describe the physiological process of pain perception and nerve
conduction
Discuss methods of pain control
2

Describe the anatomy of a neuron

Describe the physiology of nerve conduction
Explain how local anesthetics work to block nerve conduction
Name and describe the major divisions of the trigeminal nerve
Given the name of each of the divisions of the trigeminal nerve,
name and describe the branch of that division and the structures
they supply
Describe the location of the anatomical landmarks and relate
their significance to major dental anesthetic injections
Name and describe the location and function of the four muscles
of mastication
Name the vessels in close proximity to the injection sites
Name and describe the properties of an ideal local anesthetic
Describe the changes in nerve conduction resulting from the
administration of local anesthetics
Discuss the effect pH has on ionization of local anesthetics
Describe the chemical classes of local anesthetics
Given the name of a local anesthetic, describe the classification,
onset of action, duration, metabolism and excretion
Calculate maximum safe doses of local anesthetics
Discuss the pharmacology of vasoconstrictors
Relate the basic chemical properties of vasoconstrictors with
clinical application of local anesthetics
List the reasons for the use of vasoconstrictors in local anesthetic
agents
List the vasoconstrictors that are available in local anesthetic
solutions
Describe the effects of vasoconstrictors on the central nervous
system and the cardiovascular system
List the normal concentration of specific local anesthetic agents
and the dilution of vasoconstrictors
List the most common local complications associated with the
administration of local anesthetics
List the systemic complications associated with local anesthesia
Classify a patient using the ASA classification system
Classify adverse drug reactions
Describe predisposing factors and causes of adverse drug
reactions
Describe drug factors and how they influence local anesthesia
Describe the manner of preventing, recognizing and managing
local and systemic complications
Discuss infection control procedures relevant to preparation,
administration and breakdown of local anesthesia and the
necessary equipment
Identify indications and contraindications for specific local
anesthetic injections
Administer local anesthesia safely and effectively
Nitrous Oxide/Oxygen Analgesia
Describe the development of analgesia/inhalation sedation
3

Define and differentiate the indications and contraindications for

inhalation analgesia
Define the aspect of nitrous oxide/oxygen to respiratory
physiology
Define the gas laws related to the administration of nitrous
oxide/oxygen
Describe the utilization of the fail-safe type of machines
List the components of nitrous oxide/oxygen delivery and
scavenger systems
Describe titration of nitrous oxide/oxygen gases
Demonstrate proficiency in the use of nitrous oxide/oxygen
delivery equipment
List contraindications of the use of nitrous oxide/oxygen
analgesia
Recognize adverse reactions and implement appropriate actions
Describe prevention and management of nitrous oxide medical
emergencies
Administer nitrous oxide/oxygen to produce a relative state of
analgesia and return the patient to pre administration status
Course Requirement:

Attendance in lecture and laboratory are mandatory. Clinical

proficiency for local anesthetic injections and nitrous oxide/oxygen
administration is required for successful completion of this course. No
lecture or laboratory may be missed.

Accreditation Standard
that is addressed:
2-2 A process must be established to assure students meet the
academic, professional and/or clinical criteria as published and
distributed.
2-6 The dental hygiene program must define and list the competencies
needed for graduation. The dental hygiene program must employ
student evaluation methods that measure all defined program
competencies. These competencies and evaluation methods must be
written and communicated to the enrolled students.
2-7 Written course descriptions, content outlines, including topics to
be presented, specific instructional objectives, learning experiences,
and evaluation procedures must be provided to students at the
initiation of each dental hygiene course.
2-8c Dental sciences content must include tooth morphology, head,
neck and oral anatomy, oral embryology and histology, oral pathology,
radiography, periodontology, pain management, and dental materials.
2-17 Graduates must be competent in providing appropriate life
support measures for medical emergencies that may be encountered
in dental hygiene practice.
2-18 Where graduates of a CODA accredited dental hygiene program
are authorized to perform additional functions required for initial
dental hygiene licensure as defined by the programs state specific
4

dental board or regulatory agency, program curriculum must include

content at the level, depth, and scope required by the state. Further,
curriculum content must include didactic and
laboratory/preclinical/clinical objectives for the additional dental
hygiene skills and functions. Students must demonstrate
laboratory/preclinical/clinical competence in performing these skills.
2-23 Graduates must be competent in problem solving strategies
related to comprehensive patient care and management of patients.

Evaluation Criteria
And Procedures and
Grading policy including
grading scale:

A 2.0 (at least 80%) is required to continue in the dental hygiene

program as stated in the MCC catalog.
Chapter Review Questions (Points will vary)
Homework (40 points)
Chapter Quizzes (Points will vary)
Syllabus Scavenger Hunt (10 points)
In-Class Group Work (Points will vary)
Tests x 4 (Points will vary)
Laboratory: PASS/FAIL (80% needed to pass this Laboratory)
There are sixteen injections. Each injection must be passed at a
minimum of 80%. Administration of nitrous oxide/oxygen (using
titration technique) must be passed at a minimum of 80%.
Note: Lecture and laboratory must each be passed successfully to
complete this course. Student must earn 80% minimum to pass.
Failure to achieve 80% will result in course failure. The grade will be
reported as a 1.5. The student will not be permitted to progress in the
program. The student may be eligible to apply for re-admission the
following spring semester.
Evaluations subject to change
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.0
I
W

=
=
=
=
=
=
=
=
=
=

96-100%
92-95%
88-91%
84-87%
80-83%
75-79%
70-74%
69% and below
Incomplete
Withdraw

Late policy:
See course outline for key dates and the estimated timeline for
assessment(s)
5

Any OSHA or professional behavior incident report per semester

equals a zero percentage grade per incident report, figured into the
final grade. Severity of the offense may result in dismissal from the
program.
Students who fail to meet the minimum clinical competency
requirements will be given an incomplete and must return the
following academic year, in the spring semester, to complete
requirements. Upon successful completion of required
competencies, the student will be given the earned grade.

Instructors Policy
Regarding make-up:
Exams and quizzes: Weekly reading quizzes cannot be made up.
Exams must be made-up within five days and will be completed at
MCCs Testing Center.
Homework: Weekly homework is due the following week and must be
turned in within the first five minutes once class begins. Assignments
turned in beyond this point are considered late including the first day.
One full letter grade will be deducted for each day assignment is late.
Course Incompletes: A student must initiate a request for an "I"
(Incomplete Grade). The "I" will be given at the sole discretion of the
instructor.
An "I" may be given only when the student: Has completed at least
75% of the class (excluding the final exam) but is unable to complete
the class work because of extraordinary, unusual or unforeseen
circumstances or other compelling reasons. Has done passing work in
the course and can complete the required work without repeating the
course.
Complete Attendance Policy:

Absence Policy
Students are expected to attend class, since they are held responsible
for the requirements of the course. Absence from class does not excuse
the student from the course requirements (Mott College Catalog).
Mott Community College is accredited by the Commission on Dental
Accreditation; in order to be an accredited Dental Hygiene program we
must abide by the Commissions Standards which include; STANDARD
2-10: The number of hours of clinical practice scheduled must ensure
that students attain clinical competence and develop appropriate
judgement.
Important Lecture Information
Being prompt and on time to class is essential. To prevent
interruptions and disruptions to the lecture, the door will be closed at
10 minutes following the beginning of lecture. No student will be
admitted until the first scheduled break.

Clinical Attendance Policies. Students who have not attended

required lectures and laboratory sessions may be excluded from the
clinical setting when their lack of preparation may pose a safety hazard
for patients, themselves, or others. Clinical absence has an impact on
the students ability to meet the objectives of the course and to
achieve a satisfactory clinical grade.
Any student who does not attend class will be marked absent.

Attendance will be taken at the beginning of each lecture as

required.
Attendance will be taken at the beginning and end of each lab
as required.

Any student leaving lab early will be marked absent.

In the event it becomes unavoidable to miss lab, the student

must call the front desk at 762-0493 to notify Mrs. Stevens

All absences will be reported to MCC.

Withdrawals: A grade of "W" indicates official withdrawal from a

course in which a student has enrolled. A student must initiate
the process to withdraw by submitting a worksheet to the
Registration Office. Students are encouraged to discuss their
reasons for their withdrawal with their counselor/advisor prior to
withdrawing from the course.
College policy on
accommodations for persons
with disabilities:

Title IX Compliance

Mott Community College is committed to providing equal opportunity

for participation in all programs, services and activities and adheres to
Section 504 of the Rehabilitation Act (1973) and the Americans with
Disabilities Act, as amended (2008) to provide effective auxiliary aids
and services for qualified students with documented disabilities.
Requests for accommodations by students with disabilities may be
made by contacting Disability Services at 810-232-9181 or on the web
adisability.mcc.edu. Once your eligibility for an accommodation has
been determined, you will be issued an Instructor Notification Letter.
Please present Instructor Notification Letters to instructors at the start
of the semester and/or two weeks prior to the accommodation date
(test, project, etc). Requests received after this date will be honored
whenever possible.
Consistent with Title IX of the Education Amendments of 1972, Mott
Community College will provide appropriate adjustments and/or
support to pregnant and parenting students. With medical
documentation from a physician, the adjustments and
accommodations may include providing a larger classroom desk or a
designated lactation room, allowing frequent trips to the restroom,
permitting temporary access to elevators, providing opportunities for
making up missed work, allowing the student to submit work after a
missed deadline due to absences related to pregnancy or childbirth, or
providing a leave of absence for a period of time.
7

For questions about your rights pursuant to Title IX and other nondiscrimination related compliance matters, contact the Title IX
Coordinator Chris Engle, Dean of Enrollment, Retention and Registrar
/ Title IX Coordinator at (810) 762-0024 or at titleix@mcc.edu.
Instructors classroom policies:
Lecture Make Up Policy:
1. Exams and quizzes:
Weekly pre-lecture and post-lecture quizzes cannot be made up.
Exams must be made-up within five days and will be completed at
MCCs Testing Center. No make-up exams will be available beyond
five days from original testing date. A reading quiz which is
administered via Blackboard must be completed during the open
testing dates. If a failed attempt occurs, the instructor must be
notified by email immediately. If a failed attempt is confirmed, the
student will be allowed to complete the reading quiz prior to the
beginning of the lecture. If a student fails to complete a quiz on
Blackboard during open testing and no attempt is made, he or she
will receive zero credit without the possibility for make-up.
Homework:
Weekly homework is due within the first five minutes once class
begins. Assignments turned in beyond this point are considered late.
One full letter grade will be deducted for each day late including the
first day.
2. Course Incompletes:
A student must initiate a request for an "I" (Incomplete Grade). The
"I" will be given at the sole discretion of the instructor.
An "I" may be given only when the student:
Has completed at least 75% of the class (excluding the final exam)
but is unable to complete the class work because of extraordinary,
unusual or unforeseen circumstances or other compelling reasons.
Has done passing work in the course and can complete the required
work without repeating the course.
Cell phones and
electronic devices:

Student Code of Conduct Section U - Technology Usage

No electronic communication device, which means a device that emits
an audible signal, vibrates, displays a message or otherwise receives or
communicates a message, may be active during class without the oral
or written consent of the instructor. Such devices may include, but are
not limited to, portable pagers, hand-held radios, cellular telephones,
PDAs and any technology developed for similar purpose. The use of
any electronic device during testing will result I the student receiving
an automatic 0.0 on the quiz or exam with no opportunity for makeup.

Plagiarism:

College Policy Regarding

Emergency Closings:

Cheating, plagiarism, or other forms of academic dishonesty, including

acquisition of tests and/or other academic materials (without
permission), are violations of college conduct per MCC Student Code
of Conduct. This includes students who aid and abet as well as those
who attempt such behavior. Discipline could include: Reduction or
suspension of grade, Written or oral reprimand, Extra assignments or
any other appropriate action. A formal process of discipline as listed
in the MCC Student Code of Conduct Guide.

MCC will be closed when adverse weather or other conditions make

closure prudent. Announcements of closure due to weather will be
made using local TV and radio, the public address system, posting the
information on the MCC website, sent via email, recorded on the
Colleges weather line (810) 232-8989, or via the Emergency
Notification System which sends messages via phone or text message.

Content Outlines, with Topics to be Presented

Date
May 4

Reading/Lecture Activity
Ch. 1 Local Anesthesia in Dental
Hygiene Practice (online lecture)
Ch. 9 Syringe Components and
Type (online lecture)

Quiz/Test
Syllabus Scavenger Hunt
Due: Mon. May 9th, 6pm
Quiz #1: LA Ch. 1 via Bb
Quiz #2: LA Ch. 9 via Bb
Due: Sun. May 8th, 6pm

Homework
Ch. 1 Chapter Review
Questions (Bb dropbox)
Ch. 9 Chapter Review
Questions (Bb dropbox)
Due: Sun. May 8th, 6pm

May 10

Ch. 7 Preanesthetic Assessment

Ch. 10 Anatomic Considerations

Quiz #3: LA Ch. 7 via Bb

Quiz #4: LA Ch. 10 via Bb
Due: Mon. May 9th, 6pm

May 11
Wed.
12:303:15

Ch. 5 Local Anesthetic Agents

Ch. 6 Topical Anesthetic Agents
Ch. 11 Basic Injection Technique

Quiz #5: LA Ch. 11 via Bb

Due: Tues. May 10th, 6pm
Quiz #6: LA Ch. 5 via Bb
Quiz #7: LA Ch. 6 via Bb

Ch. 7 Chapter Review

Questions In-Class Group
Ch. 10 Chapter Review
Questions In-Class Group
Ch. 5 Chapter Review
Questions In-Class Group
Ch. 6 Chapter Review
Questions In-Class Group
Ch. 11 Chapter Review
Questions In-Class Group

May 17

Ch. 12 Maxillary Nerve

Anesthesia (pgs. 224-249)
TEST ONE (1 hour) LA Ch. 1, 7, 9,
10
Ch. 12 Maxillary Nerve
Anesthesia (pgs. 249-270)
Ch. 2 Neurophysiology
Ch. 3 Pharmacology of LAs

Quiz #8: LA Ch. 12 part one via Bb

Due: Mon. May 16th, 6pm

Ch. 4 Pharmacology of
Vasoconstrictors (online lecture)

MIDTERM (1 hour) LA Ch. 2, 3, 5,

6, 11, 12

May 24

May 31

Quiz #9: LA Ch. 2 via Bb

Quiz #10: LA Ch. 3 via Bb
Quiz #11: LA Ch. 12 part two via
Bb
Due: Mon. May 23rd, 6pm

Ch. 2 Chapter Review

Questions In-Class Group
Ch. 3 Chapter Review
Questions In-Class Group
Ch. 12 Chapter Review
Questions In-Class Group
Ch. 4 Chapter Review
Questions In-Class Group

Ch. 13 Mandibular Nerve

Anesthesia
June 7

Nitrous Ch. 1, 2, 5, 8, 9

June
14

Nitrous Ch. 3, 6, 10, 11, 13

June
21

Ch. 8 Determining Drug Doses

Ch. 15 Local Anesthetic
Complications
Ch. 16 Legal Considerations and
Risk Management

June
28

Quiz #12: LA Ch. 4 via Bb

Quiz #13: LA Ch. 13 via Bb
Due: Mon. May 30th, 6pm
Quiz #14: Nitrous Ch. 1, 2, 5, 8, 9
via Bb
Due: Mon. June 6th, 6pm
Quiz #15: Nitrous Ch. 3, 6, 10, 11,
13 via Bb
Due: Mon. June 13th, 6pm
Quiz #16: LA Ch. 8 via Bb
Quiz #17: LA Ch. 15 via Bb
Quiz #18: LA Ch. 16 via Bb
Due: Mon. June 20th, 6pm

Ch. 13 Chapter Review

Questions In-Class Group
Questions In-Class Group

Questions In-Class Group

TEST THREE Nitrous
(Blackboard) Due: June 19 at
9 pm
Ch. 8 Chapter Review
Questions In-Class Group
Ch. 15 Chapter Review
Questions In-Class Group
Ch. 16 Chapter Review
Questions In-Class Group

FINAL EXAM Local Anesthesia

Comprehensive

LAB SCHEDULE
Date
May 10, 11

May 17, 18
May 24, 26
May 31, June 1
June 7, 8
June 14, 15
June 21, 22
June 28, 29

Activity
Medical Emergency Review
Syringe Components and Type
Assemble/Disassemble Armamentarium
Competency: Assemble/Disassemble Armamentarium
Injection Technique: ASA-R, MSA-R, PSA-R
Injection Technique: GP-R, NP-R
Injection Technique: IAN-R, Mental-L, LB-L
Injection Technique: ASA-L, MSA-L, PSA-L
Injection Technique: GP-L, NP-L
Nitrous Administration
Injection Technique: IAN-L, Mental-R, LB-R
Nitrous Administration
Complete remaining LA and Nitrous Administration

Specific Instructional Objectives:

Complete the following objectives as you read through the course material. They will help prepare you for
course discussion and testing.
Local Anesthesia for the Dental Hygienist
Chapter 1: Local Anesthesia in Dental Hygiene Practice
Method of Instruction and Time Allocated: 30 minute video
Specific learning objectives:
1. Describe the history of pain control in health care and specifically to the practice of dental hygiene.
2. Describe how local anesthesia is practiced by dental hygienists.
3. List state requirements for local anesthesia provided by dental hygienists.
4. Describe patients perception of anesthesia and pain control.
10

5. Describe the human needs paradigm as it relates to pain control.

6. Describe patient perception of pain control.
Chapter 2: Neurophysiology
Method of Instruction and Time Allocated: 60 minute lecture; group activity
Specific learning objectives:
1. Discuss the organization of the nervous system.
2. Describe the functional unit of a nerve system and explain its main function.
3. Discuss the structure and classification of neurons and differentiate between afferent and efferent
nerves.
4. Differentiate the role of the cell body in sensory and motor impulse transmission.
5. Describe the basic structures and functions of a sensory neuron:
Dendritic (input) zone
Cell body (soma)
Axon hillock (summation zone)
Axon
Output zone (synaptic knobs)
6. Discuss peripheral nerve anatomy and discuss the speed of impulse propagation with myelinated
versus non-myelinated nerves.
7. Differentiate between type A, B, and C fibers in terms of their function, size, and relative speed of
impulse transmission.
8. Discuss neurophysiology and action potential.
9. Compare the ions in nerve transmission in regard to their functional element relative
concentrations and location during the resting stage, depolarization, and repolarization.
10. Discuss the mode of action of local anesthetic agents on nerves.
Chapter 3: Pharmacology of Local Anesthetic Agents
Method of Instruction and Time Allocated: 60 minute lecture; group activity
Specific learning objectives:
1. Define local anesthetics.
2. Discuss the mechanism of actions of local anesthetics.
3. Describe the structure of local anesthetics.
4. Discuss the difference between esters and amides.
5. Discuss the properties and ionization factors of local anesthetics.
6. Discuss the two major routes of delivery of local anesthetics.
7. Describe pH and the dissociation constant (pKa), as well as their effects on the onset of action of
local anesthetics.
8. Discuss how infection in the area of local anesthetic administration decreases its efficiency.
9. Discuss the buffering process of local anesthetics.
Chapter 4: Pharmacology of Vasoconstrictors
Method of Instruction and Time Allocated: 60 minute lecture; group activity
Specific learning objectives:
1. Discuss the problems associated with the vasodilatory properties of local anesthetics.
2. Discuss the benefits of adding vasoconstrictors to local anesthetic solutions.
3. Name the two vasoconstrictors that are added to local anesthetics available in the United States.
4. Discuss the use of vasoconstrictors in dentistry.
5. Discuss epinephrine, including:
Its mechanism of action
Epinephrine dilutions
Sodium bisulfate preservative
The actions of epinephrine on specific systems and tissues
Termination of action
11

Maximum recommended dose

6. Discuss levonordefrin, including:
Actions of specific systems and tissue
Levonordefrin dilution
Sodium bisulfate preservative
Termination of action
Maximum recommended dose
7. Discuss the effects, mechanisms of action, and uses of norepinephrine, phenylephrine, and
felypressin.
8. Discuss the side effects and overdose of vasoconstrictors.
Chapter 5: Local Anesthetic Agents
Method of Instruction and Time Allocated: 60 minute lecture; group activity
Specific learning objectives:
1. List and describe the composition of local anesthetic solutions.
2. Define ester and amide local anesthetics.
3. List and discuss amide local anesthetics using their generic and proprietary names.
4. Discuss the selection considerations when choosing a local anesthetic.
5. Describe the factors that determine the duration of a local anesthetic.
6. Discuss posttreatment pain control in relation to local anesthetics.
7. Differentiate between a relative and an absolute contraindication.
8. Summarize allergies that affect local anesthetic selection.
9. Stress why the need for hemostasis control is needed.
10. Discuss the properties, helpful tips, precautions, and maximum recommended dose for the
following amide local anesthetics:
Lidocaine
Mepivacaine
Prilocaine
Articaine
Bupivacaine
11. Discuss procaine and other ester local anesthetics.
Chapter 6: Topical Anesthetic Agents
Method of Instruction and Time Allocated: 60 minute lecture; group activity
Specific learning objectives:
1. Discuss the purpose of topical anesthetics.
2. Identify ideal properties of topical anesthetics and discuss their mechanism of action.
3. List common forms of topical anesthetics and describe the methods for delivery of topical
anesthetic drugs.
4. Identify and describe the common topical anesthetic agents used in dentistry, including
classification, available concentrations, onsets of action, duration, considerations, and maximum
recommended dosages.
5. Identify and describe the common topical anesthetic agents used in dentistry.
6. Discuss special considerations when dealing with topical anesthetics in dentistry, including
recognizing signs and symptoms of adverse reactions to topical anesthetics.
Chapter 7: Patient Information and Risks
Method of Instruction and Time Allocated: 30 minute lecture; group activity
Specific learning objectives:
1. Discuss the importance of obtaining a patients medical history, dental history, and dialogue
history.
2. Discuss the role emotional status, blood pressure, pulse, respiration, and weight have on
selection/utilization of local anesthetics.
12

3. Describe dental fear and how dental professionals deal with patient fears through psychological,
physical, and chemical parameters.
4. Determine the relative risk presented by a patient prior to administering local anesthesia by
interpretation of the health history.
5. Differentiate between relative and absolute contraindications.
Chapter 8: Determining Drug Doses
Method of Instruction and Time Allocated: 45 minute lecture; group activity
Specific learning objectives:
1. Define maximum recommended doses (MRDs) for local anesthetic and discuss factors involved.
2. Name the steps to calculate MRDs for local anesthetics and perform calculations as needed.
3. Calculate the following:
Maximum number of cartridges based on MRD
Milligrams of anesthetic administered
Additional dosages of the same drug
Additional dosages of different drugs
4. Discuss the factors involved in calculating MRDs for medically compromised and elderly patients
and perform calculations as needed.
5. Name the two potentially limiting drugs in the local anesthetic solution when administering local
anesthetics with vasoconstrictors.
6. Discuss vasoconstrictor dilutions and the MRD for vasoconstrictor drugs.
7. Name the steps to calculate vasoconstrictor drug doses and perform calculations as needed.
8. Calculate milligrams of vasoconstrictor administered and additional doses of the same
vasoconstrictor.
9. Determine the limiting drug when a local anesthetic agent and a vasoconstrictor are combined in
an anesthetic cartridge.
Chapter 9: Syringe Components and Type
Method of Instruction and Time Allocated: 30 minute video
Specific learning objectives:
1. Name and discuss the three main components to the armamentarium of anesthetic equipment and
supplies.
2. Discuss the criteria for acceptance of local anesthetic syringes.
3. Name and discuss the components of the anesthetic syringe.
4. List and describe the seven types of syringes used in anesthetic procedures and the advantages and
disadvantages of each.
5. Discuss routine maintenance of reusable syringes.
Chapter 10: Anatomic Considerations for the Administration of Local Anesthesia
Method of Instruction and Time Allocated: 60 minute lecture; hands-on group activity
Specific learning objectives:
1. Locate and identify the skull bones of the head that are relevant to the administration of local
anesthesia.
2. Indicate and describe in detail the various landmarks of the maxillae, palatine bones, and mandible
that are relevant to the administration of local anesthesia on a diagram, skull, peer, and patient.
3. Discuss the importance of the trigeminal nerve in relation to administration of local anesthesia and
name the three divisions of the sensory root.
4. Identify and trace the branches of the trigeminal nerve that are relevant to the administration of
local anesthesia on a diagram, skull, peer, or patient.
5. Discuss the importance of the facial nerve and the surrounding parotid salivary gland when
administering local anesthetics
6. Identify and trace the routes of the blood vessels of the head and neck that are relevant to the
administration of local anesthesia on a diagram, skull, peer, and patient.
13

Chapter 11: Basic Injection Techniques

Method of Instruction and Time Allocated: 60 minute lecture; group activity
Specific learning objectives:
1. Describe the four anesthetic administration techniques.
2. List the steps to providing a successful injection, describe the importance of each, and discuss
various rapport strategies to reduce stress in the patient.
3. Describe basic injection techniques for computer controlled local anesthetic delivery.
Chapter 12: Maxillary Nerve Anesthesia
Method of Instruction and Time Allocated: 60 minute lecture; group activity
Specific learning objectives:
1. Discuss the importance of understanding the anatomy of the maxillary nerve and its branches
when it comes to the utilization of local anesthesia within the maxillary arch.
2. Discuss the clinical effectiveness of maxillary nerve blocks in relationship to anatomy and compare
them to similar mandibular nerve blocks.
3. Concerning the three supplementals that can be administered within the maxillary arch as well as
the mandibular arch, including the supraperiosteal, intraseptal, and periodontal ligament
injections:
List and describe the supplemental injections.
Identify the target location of each.
Demonstrate the correct placement of the local anesthetic for each injection within the maxillary
arch on a skull, peer, and a patient.
4. Concerning the four maxillary facial nerve blocks, including the posterior superior alveolar, middle
superior alveolar, anterior superior alveolar, and infraorbital blocks:
List and describe the various types of maxillary facial nerve blocks.
Identify the correct tissue inserted into by the local anesthetic needle for each maxillary facial
injection.
Identify the target location for the maxillary facial nerve blocks and demonstrate correct
administration of local anesthesia during dental hygiene clinical practice.
Discuss the indications of clinically effective injections as well as possible complications.
Chapter 13: Mandibular Nerve Anesthesia
Method of Instruction and Time Allocated: 60 minute lecture; group activity
Specific learning objectives:
1. Discuss the importance of understanding the anatomy of the mandibular nerve and its branches
when it comes to the utilization of local anesthesia within the mandibular arch.
2. Discuss the overall clinical effectiveness of mandibular nerve blocks in relationship to anatomy and
compare them to similar maxillary nerve blocks.
3. Describe the various types of mandibular nerve blocks.
4. Concerning the inferior alveolar block:
Discuss its coverage and common uses.
Describe what can occur when bilateral blocks are implemented.
Identify the correct tissue inserted by the local anesthetic needle.
Demonstrate the correct placement of the needle at the injection site and target area.
Demonstrate correct administration of local anesthesia during dental hygiene clinical practice.
Discuss the associated troubleshooting paradigm and its implications.
Discuss the indications of a clinically effective block as well as possible complications.
5. Concerning the buccal block:
Discuss its coverage and common uses.
Demonstrate the correct placement of the needle at the injection site and target area.
Demonstrate correct administration of local anesthesia during dental hygiene clinical practice.
Discuss the indications of a clinically effective block as well as possible complications.
14

Chapter 15: Local Anesthetic Complications

Method of Instruction and Time Allocated: 30 minute lecture; group activity
Specific learning objectives:
1. Define local and systemic anesthetic complications and describe the three primary categories for
local anesthetic complications.
2. Discuss the possible complications (as well as management and prevention) of local anesthetic
administration, such as needle breakage, pain during injection, burning during injection, hematoma,
facial nerve paralysis, paresthesia, trismus, infection, edema, soft tissue trauma, and sloughing of
tissue.
3. Discuss the possible systemic complications (as well as management and prevention) of local
anesthetic administration, such as local anesthetic and epinephrine overdose.
4. Discuss the possible systemic complications (as well as management and prevention) of local
anesthetic administration, such as local anesthetic and epinephrine overdose.
5. Discuss the possible systemic complications (as well as management and prevention) of local
anesthetic administration, such as local anesthetic and epinephrine overdose.
6. Discuss the possible systemic complications (as well as management and prevention) of local
anesthetic administration, such as local anesthetic and epinephrine overdose.
Syncope
Hyperventilation
Bronchial asthma
Angina pectoris
Myocardial infarction
Cardiovascular accident
Seizures
Hypoglycemia
Hyperglycemia
Mild allergic reaction
Anaphylaxis
Mild local anesthetic overdose
Severe anesthetic overdose
Vasoconstrictor overdose
Chapter 16: Legal Considerations and Risk Management
Method of Instruction and Time Allocated: 30 minute lecture; group activity
Specific learning objectives:
1. Discuss the importance of effective dental hygienistto-patient communication before treatment.
2. Discuss the importance of effective dental hygienistto-employer communication.
3. Discuss the legal issues related to dental hygiene treatment and prevention strategies to reduce
the risk of litigation.
4. Define indirect and general supervision.
5. Describe the type of information that should be documented in a patient's chart for the
administration of local anesthetics.
6. Describe the procedures to reduce the risk of accidental needle exposure.
7. Describe post-exposure protocol.
8. Successfully complete review questions and activities for this chapter.
Handbook of Nitrous Oxide and Oxygen Sedation
Chapter 1: Discovery, History and Evolution of N2O/O2 Sedation
Method of Instruction and Time Allocated: 30 minute lecture; group activity
Specific learning objectives:
1. Understand the significance of the discovery of nitrous oxide and oxygen.
15

2. Recognize the paucity of pain control in the early nineteenth century.

3. Appreciate the foresight and ingenuity of Horace Wells as the individual responsible for recognizing
the anesthetic value of nitrous oxide.
4. Appreciate the evolutionary path of nitrous oxide to its current place in the spectrum of analgesia and
sedation options.
Chapter 2: Guidelines for Best Practice
Method of Instruction and Time Allocated: 30 minute lecture; group activity
Specific learning objectives:
1. Recognize the historical safety record of N2O/O2 sedation.
2. Recognize current practice guidelines established for non-anesthesiologists working in an ambulatory
setting.
3. Formulate an initial understanding of the virtuous characteristics of N2O/O2 sedation.
Chapter 3: Pain and Anxiety Management
Method of Instruction and Time Allocated: 30 minute lecture; group activity
Specific learning objectives:
1. Identify the physiologic mechanism of pain.
2. Appreciate the many variations of pain reactions among individuals.
3. Recognize methods for assessing and measuring pain.
4. Appreciate the relationship between pain and anxiety.
5. Recognize methods for assessing and measuring fear and anxiety.
6. Define the American Society of Anesthesiologists (ASA) levels of minimal, moderate, deep, and
general analgesia-sedation.
7. Recognize the spectrum of pain and anxiety management options.
Chapter 5: Physical Properties and Pharmacokinetics/Pharmacodynamics of N2O
Method of Instruction and Time Allocated: 30 minute lecture; group activity
Specific learning objectives:
1. Recognize physical and chemical properties of nitrous oxide.
2. Recognize physical and chemical properties of oxygen.
3. Discuss the pharmacokinetic properties of nitrous oxide.
4. Discuss the pharmacodynamic properties of nitrous oxide.
Chapter 6: Manufacturing and Distribution of N2O and O2 Gases
Method of Instruction and Time Allocated: 30 minute lecture; group activity
Specific learning objectives:
1. Understand the simplicity of the nitrous oxide manufacturing process.
2. Recognize the primary users of nitrous oxide.
3. Recognize the regulatory agencies responsible for the oversight of nitrous oxide.
4. Identify how nitrous oxide is stored.
5. Identify properties of nitrous oxide and oxygen cylinders.
Chapter 8: Anatomy and Physiology of Respiration and Airway Management
Method of Instruction and Time Allocated: 30 minute lecture; group activity
Specific learning objectives:
1. Review the anatomy of the upper and lower airways.
2. Recognize the potential for airway obstruction.
3. Review acceptable airway management techniques.
4. Review the physiology of respiration.
5. Appreciate the critical gas exchange across pressure gradients with nitrous oxide.
6. Identify the role of pulse oximetry in N2O/O2 sedation.
7. Recognize the clinical significance of diffusion hypoxia in N2O/O2 sedation.
8. Describe how to manage patients in the category of moderate sedation (> 50% N2O).
Chapter 10: Patient Assessment
16

Method of Instruction and Time Allocated: 30 minute lecture; group activity

Specific learning objectives:
1. Appreciate the value of patient health history information.
2. Understand the necessity of assessing patient risk before N2O/O2 sedation.
3. Recognize the ASA Physical Status Classification System as a method of categorizing patient health.
4. Identify the components included in a preprocedural patient evaluation for N2O/O2 sedation.
5. Recognize measures for patient preparation before N2O/O2 sedation.
6. Understand the necessity for patient monitoring during N2O/O2 sedation.
7. Recognize the monitoring procedures associated with N2O/O2 sedation.
8. Recognize the importance of emergency preparedness in terms of personnel preparation and
necessary equipment.
Chapter 11: Titration of N2O and O2 Gases
Method of Instruction and Time Allocated: 30 minute lecture; group activity
Specific learning objectives:
1. Define titration as a method of drug administration.
2. Understand the significance of titration.
3. Understand the concept of individual biovariability.
4. Recognize the advantages of the ability to adjust sedation levels using N2O/O2 sedation.
Syllabus subject to change at the discretion of the instructor.
5-7-16 JW

17