DH 280 - Pain and Anxiety Control

Credit Hours: 2

Effective pain and anxiety control are essential components of the management of dental patients. This elective course will present 30 hours of didactic instruction required for a State of New York restricted certificate to administer local infiltration anesthesia and nitrous oxide/oxygen analgesia during dental hygiene treatment procedures. Topics include a review of dental neuroanatomy, respiratory anatomy and physiology, pharmacology of local anesthetic drugs used in dentistry and nitrous oxide/oxygen sedation, proper administration techniques, patient assessment, legal, risk management, and ethical issues. The clinical requirements for the infiltration anesthesia and nitrous oxide analgesia certificate can be completed in the elective Pain and Anxiety Control Clinic, DH 281. Minimum passing grade is “C-.”

Course Outcomes
Upon completion of this course, the student at the level of dental hygienist will be able to:

define and describe psychological, physiological, and anatomic aspects of pain at a level appropriate for the dental hygiene practice;
evaluate the indications, use and importance of NOO sedation and local anesthesia as methods to decrease fear and anxiety to a patient;
determine through specialized question-answer techniques the level and source of patient anxiety and fear;
communicate and evaluate the effectiveness of the determined course of action through changes in patient fear and anxiety levels;
explain the relationship of fear and anxiety to risk management in terms of potential legal issues, effectiveness and ethics;
describe, in general terms, the levels of anesthesia outlined by the American Society of Anesthesiologists (ASA);
describe the effects of neural anatomy upon pharmacological requirements of local anesthetics and vasoconstrictors;
explain the relationship of anatomy to anesthetic onset and duration especially in areas of infection;
name the local anesthetics, topical anesthetics and vasoconstrictors; explain their chemical properties; and classify each based on their type, vasoactivity, toxicity, and duration;
describe and classify the topical and local anesthetic compounds available to general dentistry as each applies to treatment length, potential for toxicity including vascular activity, and use with health or age compromise;
interpret and analyze the health history and treatment needs to potential drug complications as they are related to the systemic actions of the specific anesthetic or vasoconstrictor and then name the best drug choice for the patient;
calculate the maximum dose of a local anesthetic or vasoconstrictor based upon weight, age and ASA;
list, sequence and describe the overdose reaction signs associated with local anesthetics and vasoconstrictors;
list and discuss the management of local anesthetic and vasoconstrictor overdose;
discuss the drug to drug interactions that can occur with local anesthetics and vasoconstrictors;
describe the physical and chemical properties of nitrous oxide and oxygen;
differentiate and describe sedation, anesthesia and analgesia;
describe the actions and pharmacology of nitrous oxide/oxygen (NOO) within the body;
compare the advantages and disadvantages of NOO sedation to other delivery methods;
describe the airway and compute breathing dynamics such as tidal flow, liters/ minute;
define the terms and stages of anesthesia based upon the ASA guidelines;
distinguish between the levels of conscious and unconscious sedation and explain the difference between the sedation planes in stage one and stage two;
describe the unsuitable NOO patient based upon the health history or patient interaction;
determine the correct stage and plane of sedation/anesthesia based upon the integration of known patient symptoms and state the action that should be taken;
locate the parts of NOO armamentarium including all safety devices, controls, gauges and communicate their use and their reading;
distinguish between oxygen and nitrous oxide components and recognize the quantity of gasses left in tanks;
describe the patient indicated and not indicated for NOO sedation;
define COPD and hypoxic drive; associate the varied levels of COPD and describe those patients unsuitable for NOO sedation;
discuss the systemic effects of NOO sedation on the various organ systems;
define titration and discuss its rationale;
discuss the normal reaction variation to NOO sedation;
list the steps of NOO sedation;
compare and contrast the signs and symptoms of each level of sedation to stage one, plane four;
describe the signs and symptoms of the ideal plane of anesthesia;
define and discuss emergence and recovery; list the methods to determine if the patient has fully recovered from NOO sedation;
list and discuss the complications and management that may occur during sedation;
list all information required for complete documentation of sedation;
list the potential sources of occupational exposure to NOO during sedation within the dental office;
discuss the specific health concerns (biohazards) that “at risk” employees face with this sedation;
define and discus scavenging systems;
discuss exposure prevention measures;
explain the New York State law (NYSL) as it pertains to restricted certification of dental hygienist to deliver NOO sedation and local anesthesia;
define and describe the NYSL terms and personal supervision;
utilize the health history to detect medically compromised patients and discern those conditions that place the patient at risk for local anesthetics and vasoconstrictors;
state which drugs are relatively or absolutely contraindicated for each organ system with special attention to the vasoconstrictors;
determine the specific compromised organ system and then associate the best drug choice for the patient;
associate specific organ system conditions to the ASA risk status and design specific treatment protocol for the condition including dose reduction and treatment duration;
associate specific local anesthetics to specific hereditary conditions such as prilocaine to methemoglobinemia; describe the signs, symptoms and treatments needed for each of these conditions;
list the drug-to-drug interactions of local anesthetics to specific classes of drugs and describe the interaction effect with special attention to the effect of vasoconstrictors;
list and describe the various types of local anesthetic armamentarium;
define aspiration, articulate its principles and sequence its steps;
discuss needles and the selection of the proper needle; describe problems associated with needles and their remedies;
list the information found on an anesthetic cartridge (carpule) and describe the handling and recognition of a bad cartridge;
define and describe anesthetic complications and their probable causes based upon the solution and the technique used;
discuss the probable cause of local complications, signs and symptoms, and sequence the management steps for each complication;
list the armamentarium and the setup required for local anesthesia;
define the terminology of site of penetration, angle of injection, depth of penetration and target as it applies to delivery;
list the steps required for low anxiety and painless anesthesia;
list all information that must be included in local anesthetic documentation;
list and describe the agencies that govern infection control and occupational hazards such the OSHA, NOISH, CDC and the ADA;
define an occupational exposure;
discuss the employer’s OSHA requirements in protecting “at risk” employees;
explain methods for preventing local anesthesia-related occupational exposures;
describe criteria for safe sharps disposal containers; and
explain appropriate postexposure protocol including reporting, evaluation, counseling, treatment, and follow-up.

Prerequisites: All required fall semester, second year courses in the Dental Hygiene curriculum must be passed.
Corequisites: All required spring semester, second year courses in the Dental Hygiene curriculum.
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