DHY 240 - Pain Management I

2. Describe the level of supervision required for a dental hygienist to administer local anesthesia in Michigan.

3. Articulate the importance of adequate pain control including anxiety assessment and relief, as a prelude to providing quality dental care.

4. Describe the physiological mechanism of nerve conduction, the origin of pain, and how local anesthetic agents prevent impulse transmission.

5. Identify/describe the pharmacology of the commonly used local anesthetic agents and vasoconstrictors.

6. Describe the anatomy of the trigeminal nerve in reference to injection sites.

7. Describe the techniques for obtaining local anesthesia for all areas of the dentition.

8. Identify and describe the signs and symptoms of reactions to local anesthetic agents and describe or demonstrate emergency protocol to manage these reactions.

9. Identify common complications encountered in conjunction with local anesthesia, and be able to demonstrate protocol to treat such complications.

10. Identify the anatomical landmarks on a patient as they relate to the following injections: Supraperiosteal (infiltration), Middle Superior Alveolar Nerve Block (MSA), Posterior Superior Alveolar Nerve Block (PSA), Greater Palatine Nerve Block (GP), Nasopalatine Nerve Block(NP), Inferior Alveolar Nerve Block(IANB), Buccal Nerve Block(BNB), Mental/Incisive Nerve Block (MI), Periodontal Ligament Injection (PDL).

11. Identify which nerve, teeth, and soft tissue structures are anesthetized with each of the above injection.

12. Accurately calculate a patient’s maximum recommended dose of local anesthetic and vasoconstrictor.

13. Select the appropriate type of local anesthetic for a given patient based on the patient’s medical history and need for pain control.

14. Satisfactorily perform the following injections:  supraperiosteal infiltration, posterior superior alveolar nerve block, middle superior alveolar nerve block, greater palatine nerve block, nasopalatine nerve block,inferior alveolar nerve block, buccal nerve block, mental/incisive nerve block, periodontal ligament injection (PDL),  and document appropriately.

15. Use appropriate posture, gestures, eye contact, and vocal expressiveness to effectively communicate information. 

16. Consider the context, costs, benefits and consequences of potential solutions to problems or issues. 

17. Develop a plan to implement a solution to a problem or issue. 

18. Complete work accurately, with attention to detail. 
Course Outline:
Lecture:

I.   Theory of Pain Control (1 Hour)

A.  Benefits to the patient

B.  Benefits to the clinician

II.  Anatomy Review of the Trigeminal nerve (1 Hour)

A.  Opthalmic division

B.  Maxillary division

C.  Mandibular division

III.  Pharmacology of Local Anesthetics (4 Hours)

A.  Patient selection/ selection of agents

B.  Indications for use of vasoconstrictors

C.  Adverse reactions to local anesthetics

1. Management of medical emergencies

D.  Documentation

IV.  Origin of Pain (2 Hours)

A.  Nerve conduction

B.  Stimulation of pain receptors

C.  Prevention of nerve impulse transmission

V.  Techniques of Local Anesthesia (4 Hours)

A.  Review of Armamentarium

B.  Infection Control

C.  Identification of injection sites

1. Anatomical landmarks

D. Techniques used for local anesthesia

1. Infiltration

2. Blocks

E. Common injections used for local anesthesia

VI.  Common Complications Associated with Local Anesthesia (2 Hours)

A.  Assessment

B.  Treatment

C.  Medical Emergencies

Lab:

I.  Armamentarium and Basic Injection Techniques (Lecture 1^st Hr.) (3 Hours)

A.  Assembly

B.  Care and handling of syringe, cartridges and needles

C.  Inject inanimate objects      

   II. Maxillary Anesthesia (12 Hours)

A.  Review and demonstrate injection sites

B.  Partner practice administering the following injections:

1. Supraperiosteal/ Infiltration

2. Posterior Superior Alveolar

3. Middle Superior Alveolar

4. Greater Palatine

5. Nasopalatine 

III. Mandibular Anesthesia (12 Hours)

A.  Review and demonstrate injection sites

B.  Partner practice administering the following injections:

1. Inferior Alveolar

2. Long Buccal

3. Mental/Incisive

4. Supplemental Injection (PDL or Intraseptal)

IV.  Alternative Anesthesia Delivery Systems (1 Hour)

Discussion: 35-45%

Laboratory/Clinic     

Video/Demonstration: 10-20%

Partner Practice: 35-45%                                    

 
Mandatory Course Components:
Lecture:         Tests: 50-70%

                     Quizzes: 10-40%

Lab:              Guided Patient Experiences (9) - Credit only

                      IANB and BNB Process Evaluations - 30%

Each of the 9 Guided Patient Experiences must be completed in order to pass the class.  In addition, two Process Evaluations must be completed with a minimum score of 78% in order to pass the class.

Lecture average grade must be 78% or greater in order to pass the class.
Equivalent Courses:
None

Lecture average grade must be 78% or greater in order to pass the class.

Both lecture and lab must be completed to minimum requirements in order to pass this class.