DH 130 - Management of Dental Pain and Anxiety in the Dental Office

1. Demonstrate understanding of pain control.
   1. Define pain.
   2. List the functions of pain.
   3. Define and explain the following components of the pain experience:
      1. pain perception
      2. pain reaction threshold
      3. pain threshold
   4. List the factors that affect pain reaction threshold.
   5. Explain the body sensory pathway of pain perception and reaction.
   6. Discuss the Gate Control theory, including the pathway and factors that can open and close the gate for individuals.
   7. Define and list the signs and symptoms of anxiety.
   8. Assess and recognize anxiety levels of individuals for the purpose of pain management.
   9. Discuss the five pain control mechanisms for pain management by the health care provider and the patient. Give specific modalities used in dentistry that would accomplish each of the five mechanisms.
2. Administer, under the direct supervision of a delegating dentist, local anesthetics in a safe and effective manner for pain control.
   1. Explain Michigan law 2002 Public Act No. 423.
   2. Identify the steps and requirements for the dental hygiene practitioner to legally administer local anesthesia in the State of Michigan.
   3. Explain and describe neurophysiology as it relates to local anesthesia.
   4. Explain the pharmokinetics of local anesthetics (ester and amide) and vasoconstrictors, including distribution, metabolism, and excretion.
   5. Describe the effects of local anesthetics (ester and amide) and vasoconstrictors on the central nervous system and the cardiovascular system.
   6. List the normal concentration of specific local anesthetic agents and the dilution of vasoconstrictors.
   7. Explain the rationale for selecting various common local anesthetic agents.
   8. Calculate maximum safe doses of local anesthetics and vasoconstrictors.
   9. Identify the indications, relative and absolute contraindications for general use of local anesthetics.
   10. Discuss why there is need for the dental hygiene practitioner to know how to prevent medical emergencies and what to do should they arise.
   11. Describe each of the following drug factors and how they influence local anesthesia:
       1. vasoactivity
       2. concentration
       3. dose
       4. route of administration
       5. route of injection
       6. vascularity
       7. vasoconstrictors
   12. Describe the clinical manifestations, signs, symptoms, and management of patients who have low, moderate, and high serum local anesthetic overdose levels which are causing a mild to severe local anesthesia and vasoconstrictor overdose reaction.
   13. Describe indications, techniques, and demonstrate proper utilization of topical and subgingival placement of local anesthesia.
   14. Describe and identify the head and neck anatomy relevant to administration of local anesthesia.
   15. Compare and contrast the types of syringes and needles including needle gauges.
   16. Demonstrate the assembly, loading, and unloading of a cartridge type syringe.
   17. Discuss the problems that can be encountered with each item in the armamentarium.
   18. Identify the indications and contraindications for specific local anesthetic injections.
   19. Demonstrate common basic injection techniques for block and infiltration anesthesia.
   20. Perform an atraumatic, safe, and effective injection utilizing the following techniques:
       1. infiltration
       2. anterior superior alveolar
       3. middle superior alveolar
       4. posterior superior alveolar
       5. nasopalatine
       6. greater palatine
       7. buccal
       8. inferior alveolar
       9. lingual nerve
       10. mental
       11. incisive
   21. List the requirements of OSHA and MIOSHA Occupational Exposure to Bloodborne Pathogens Rule and Standard for Bloodborne Infectious Diseases relating to the administration of local anesthesia.
   22. Discuss the infection control procedures relevant to preventing occupation exposure during administration of local anesthesia.
   23. Discuss the infection control principles relevant to preparation, administration, and breakdown of local anesthesia and the needed equipment.
   24. Describe the primary cause, problem, prevention, and management of each potential local complication. List the necessary equipment and supplies needed to safely administer local anesthetic.
3. Administer, under the direct supervision of a delegating dentist, nitrous oxide/oxygen analgesia in a safe and effective manner for nitrous oxide/oxygen analgesia.
   1. Explain Michigan law 2004 Public Act no. 30
   2. Identify the steps and requirements for the dental hygiene practitioner for certification and legal administration of nitrous oxide and oxygen analgesia/sedation in the State of Michigan.
   3. Briefly state the history and evolution of nitrous oxide/oxygen analgesia.
   4. Define and explain the following physiologic components of the pain experience, including the following:
   5. pain perception
   6. pain reaction threshold
   7. pain threshold
   8. List the physical and chemical properties of nitrous oxide.
   9. Explain the pharmokinetics of nitrous oxide/oxygen including concentration effect, second gas effect, air spaces, distribution, metabolism, and excretion.
   10. Describe the effects of nitrous oxide/oxygen on the central nervous system and the other major body systems.
   11. List the advantages and disadvantages of nitrous oxide/oxygen.
   12. Calculate percentage of dose of each nitrous oxide and oxygen.
   13. Identify the indications, relative, and absolute contraindications for general use of nitrous oxide/oxygen.
   14. Discuss the side effects of nitrous oxide/oxygen use.
   15. Apply methods of patient assessment for appropriate administration of nitrous oxide/oxygen, including vital signs, histories, and ASA classification.
   16. Identify the name and function of the equipment parts. List the necessary equipment and supplies needed for safe administration of nitrous oxide/oxygen.
   17. Demonstrate the assembly and break down of the equipment.
   18. Discuss the problems that can be encountered with each item in the armamentarium.
   19. Identify the signs and symptoms of analgesia/sedation.
   20. Demonstrate the technique for safe administration with titration and recovery, including a scavenging system.
   21. Discuss proper informed consent and documentation.
   22. Discuss why there is need for the dental hygiene practitioner to know how to prevent medical emergencies and what to do should they arise.
   23. Discuss the potential health hazards to the dental professional to chronic exposure.
   24. Explain the potential for abuse and the risk to long-term exposure.
4. Demonstrate the application of desensitizing agents.
   1. State the factors that contribute to hypersensitive teeth.
   2. Explain the histological factors that contribute to hypersensitive teeth.
   3. Identify the four types of pain stimuli.
   4. Summarize the three theories of pain impulse conduction.
   5. State the ideal characteristics of a desensitizing agent.
   6. List the home desensitizing agents that have ADA approval.
   7. List the agents that are used to treat hypersensitivity in the office.
   8. Summarize what hygienists need to inform and educate patients about desensitizing agents.
   9. Define iontophoresis.
   10. Demonstrate the application of various desensitizing agents.