HomeMy WebLinkAboutDHY-220
Division of Health Professions
Dental Hygiene Department
Course Syllabus
DHY 220- Local Anesthesia for the Dental Hygienist
Semester and year: Summer 2 (1st year)
Section Number: 001
Meeting Times: DHY 220-001
Location:
Instructor:
Office Location
Phone:
Departmental Secretary: Mary Geminiano
Office Hours: By appointment
Email Address:
Course Description:
This course is designed to provide the student with the necessary knowledge and skills
to properly administer local anesthesia to patients who require pain management during
dental hygiene treatment. Special emphasis will be given to the pharmacology of local
anesthetic pain control, injection fundamentals and the clinical administration of local
anesthesia and reversal agents. Local and systemic complications along with legal
considerations will also be presented.
• Credit 3 Labs; 1 Credit
• Prerequisites BIO209, CHM112, DHY201, DHY205, DHY209
• Corequisite DHY200
COURSE OBJECTIVES
Upon completion of this local anesthesia course, the student will be able to:
Student Learning Outcome: Means of Assessment:
1. Understand the theoretical, practical and
pharmacological aspects of local anesthesia.
Written examinations/quizzes
2. Evaluate a patient’s medical history, physical
status, indications and contraindications for the
use of local anesthesia.
Clinical competencies
Written examinations/quizzes
3. Identify and locate the anatomical structures
related to the administration of local anesthesia.
Clinical competencies
Written examinations/quizzes
4. Gain clinical proficiency in the administration of
the following types of injections: mandibular nerve
block, mental nerve block, long buccal nerve
block and infiltrations of the mandible and maxilla.
Clinical competencies
Written examinations/quizzes
Case Study analysis
5. Recognize and manage any adverse reactions
and medical emergencies related to the
administration of local anesthesia.
Written examinations/quizzes
Case Study analysis
6. Gain knowledge on reversal agents for local
anesthesia.
Written examinations/quizzes
Case Study analysis
7. Demonstrate proper record keeping, current
acceptable infection control protocols and quality
assurance procedures in both clinical and
laboratory settings.
Written examinations/quizzes
Teaching Methods Learning Experiences/Activities
1. Preclinical preparation of students for
local anesthesia administration
2. Kinesthetic learning through patient
experiences in clinic
3. Web based enhancement of materials
for review and preparation for test
1. Visual, auditory, and tactile
assessment of patients
2. Analysis of all patient
data/assessments to formulate a
dental hygiene diagnosis, care plan,
and determination of local anesthesia
to be administered
3. Visual, auditory, and tactile
implementation of treatment utilizing
various infiltration and block
administration techniques
4. Discussion and documentation of all
patient injections/treatment
5. Evaluation of patient’s response to
local anesthesia at time of
appointment and/or subsequent visits
Student will complete a minimum of thirty-
two injections during the semester.
a. Ten maxillary injections including
infiltrations, greater palatine blocks,
nasopalatine blocks, PSA and ASA
blocks and infraorbital blocks;
b. Ten inferior alveolar injections on at
least 3 different “patients;” (classmates)
c. Twelve mandibular infiltration-type
injections including five mental
injections and five long buccal injections
American Dental Education Association (ADEA) Entry Level Competencies for the
Allied Health Professionals (Core Competencies (CC) include:
Professional Knowledge
1. Professionalism
1.1 Apply professional values and ethics in all endeavors.
1.2 Adhere to accreditation standards and federal, state and local laws and regulations.
1.3 Promote quality assurance practices based on accepted standards of care.
1.4 Demonstrate interpersonal skills to effectively communicate and collaborate with
professionals and patients across socioeconomic and cultural backgrounds.
2. Safety
2.1 Comply with local, state and federal regulations concerning infection control
protocols for blood-borne and respiratory pathogens, other infectious diseases and
hazardous materials.
2.2 Follow manufacturers’ recommendations related to materials and equipment used
in practice.
2.3 Establish and enforce mechanisms to ensure the management of emergencies.
2.4 Use security guidelines and compliance training to create and maintain a safe, eco-
friendly and sustainable practice compatible with emerging trends.
2.5 Ensure a humanistic approach to care.
2.6 Uphold a respectful and emotionally safe environment for patients and practitioners.
3. Critical Thinking
3.1 Demonstrate critical and analytical reasoning to identify and develop
comprehensive oral health care solutions and protocols.
3.2 Apply individual and population risk factors, social determinants of health and
scientific research to promote improved health and enhanced quality of life.
4. Scientific Inquiry and Research
4.1 Support research activities and develop research skills.
4.2 Use evidence-based decision-making to evaluate and implement health care
strategies aligned with emerging trends to achieve high-quality, cost-effective and
humanistic care.
4.3 Integrate accepted scientific theories and research into educational, preventive and
therapeutic oral health services.
Health Promotion and Disease Prevention
5.Health Education and Community Connection
5.1 Endorse health literacy and disease prevention.
5.2 Communicate and provide health education and oral self-care to diverse
populations.
5.3 Facilitate learning platforms for communities of interest by providing health
education through collaboration with dental and other professionals.
5.4 Promote the values of the dental profession through service-based activities.
5.5 Evaluate outcomes for future activities supporting health and wellness of individuals
and communities.
6.Advocacy
6.1 Promote an ethical and equitable patient care and practice environment by
demonstrating inclusion of diverse beliefs and values.
6.2 Uphold civic and social engagement through active involvement in professional
affiliations to advance oral health.
Professional Development and Practice
Professional Growth
7.1 Commit to lifelong learning for professional and career opportunities in a variety of
roles and settings.
7.2 Engage in research, education, industry involvement, technological and
professional developments and/or advanced degrees.
7.3 Demonstrate self-awareness through reflective assessment for continued
improvement.
Business Practices
8.1 Facilitate referrals to and consultations with relevant health care providers and
other professionals to promote equitable and optimal patient care.
8.2 Promote economic growth and sustainability by meeting practice goals.
8.3 Create and maintain comprehensive, timely and accurate records.
8.4 Protect privacy, confidentiality and security of the patients and the practice by
complying with legislation, practice standards, ethics and organizational policies.
Leadership
9.1 Develop and use effective strategies to facilitate change.
9.2 Inspire and network with others to nurture collegial affiliations.
9.3 Solicit and provide constructive feedback to promote professional growth of self.
Discipline-specific (Dental Hygiene) competencies:
DH. 1 Essential Knowledge
DH. 1.1 Apply the knowledge of the following sciences during the dental hygiene
process of care: Microbiology, Human anatomy and physiology, Human cellular biology,
Chemistry, Biochemistry, Immunology and pathology, Nutrition, Pharmacokinetics
DH. 1.2 Apply the knowledge of the following behavioral sciences during the dental
hygiene process of care: Sociology, Psychology, Interpersonal communication
DH. 2 Person-centered Care
2.1 Assessment
DH.2.1.1 Accurately collect and document a comprehensive medical, dental, social
health history and diagnostic data.
DH.2.1.2 Critically analyze all collected data.
DH.2.1.3 Identify predisposing, etiologic, environmental and social risk factors for
person- centered care.
2.2 Dental Hygiene Diagnosis
DH.2.2.1 Analyze comprehensive medical, dental and social health history.
DH.2.2.2 Integrate observational and diagnostic data as part of the dental hygiene
diagnosis.
DH.2.2.3 Use predisposing, etiologic, environmental and social risk factors for person-
centered care.
2.3 Planning
DH.2.3.1 Use the patient’s assessment to establish an optimal and realistic, person-
centered dental hygiene care plan through mutual communication.
DH.2.3.2 Use all aspects of the dental hygiene diagnosis in combination with the
person’s values, beliefs and preferences to develop a dental hygiene care plan through
shared decision- making.
2.4 Implementation
DH.2.4.1 Obtain informed consent based on the agreed-upon treatment plan.
DH.2.4.2 Execute individualized treatment based on the patient’s dental hygiene
diagnosis.
DH.2.4.3 Integrate educational, preventive and the therapeutic services to provide
comprehensive person-centered care.
DH.2.4.4 Use specialized skills and evidenced-based technology to promote dental and
periodontal health.
DH.2.4.5 Continuously re-evaluate for modifications to achieve desired outcomes.
2.5 Evaluation and Documentation
DH.2.5.3 Modify dental hygiene care plans as necessary to meet goals of patient and
clinician.
DH.2.5.4 Identify necessary referrals for success of the treatment outcomes, including
intraprofessional and interprofessional health care providers, supporting professions
and patient advocates.
DH.2.5.5 Accurately document assessment findings and data, dental hygiene diagnosis
and care plan, implementation, outcome evaluation and any communication between
professionals and patient and anyone else in the circle of care.
Course Texts and/or Other Study Materials:
Logothetis, Demetra Daskalos, Local Anesthesia for the Dental Hygienist, 3rd edition,
Mosby, Elsevier, 2022
Boyd, Wilkins Clinical Practice of the Dental Hygienist 14th edition, Jones & Bartlett
Learning. 2023 (abbreviated as W in the course readings) ISBN:9781284255997
American Heart Association. BLS for Healthcare Providers. American Heart Association,
Dallas. 2025.
Grading Policy
Clinical Grade (32 competencies) 65%
Exams (2 Quizzes and 1 Final) 20%
Professionalism and Journals 15%
Total Grade 100%
Grading Scale
92-100 A
89-91 B+
83-88 B
80-82 C+
75-79 C
Below 75 R
Incomplete (Not all requirements fulfilled) N
A cumulative average of 75 must be achieved in each of the didactical and clinical
portions of the course. When a student has not been able to earn a “C” grade or
better, in either category, the student will be required to repeat the course. Some
clinical items will carry a higher weight based on semester. (Clinical
Competencies). *Time frame provided to complete requirements to achieve Pass
Grade
MEDICAL CLEARANCE
All medical records must be complete and up-to-date. If notification is received from
the medical office that a student record is not complete, the student will not be permitted
to attend clinical sessions.
POLICY ON COURSE PREPARATION
A current CPR card in basic life support for health care providers is a prerequisite
before enrolling is this course.
All students are expected to attend all class sessions for the entire session. Class will
begin promptly at the assigned times. Clinic will begin promptly at 8:00am. Students
must arrive on time to all sessions.
During the clinical sessions, all students will work first on local anesthesia models,
progress to a student partner and then to actual clinical patients. The student will:
1. Review the patient medical history
2. Prepare the clinical treatment area
3. Select appropriate armamentarium
4. Utilize proper chairside administration techniques as discussed in class
and seen in the demonstration videos
The clinical session will demonstrate anesthesia techniques including:
▪ Maxillary and mandibular infiltrations
▪ Anterior, Middle and Posterior Superior Alveolar Nerve Blocks
▪ Palatal injections
▪ Inferior Alveolar Nerve Block
▪ Long Buccal Block
▪ Mental Nerve Block
A small amount of local anesthetic will be deposited at each site to
demonstrate proper target achieved for each injection
1. Post-operative instructions will be given and the patient will be monitored during and
after the session.
2. Student should complete all learning modules according to the assigned schedule
o Student must achieve 75% or better in order to pass the course.
SESSION TOPIC READING
ASSIGMENT
SESSION
I
Course introduction, patient evaluation and medical
risk assessment
Chapter 1
Chapter 7
SESSION
II
Neurophysiology, Pharmacology of local anesthesia
Chapter 2, 3,
SESSION
III
Vasoconstrictors, local anesthetic and reversal
agents, clinical action of specific agents, doses and
limits, topical anesthetics
Quiz 1
Chapter 2, 3,
4, 5, 6, 8,14,
15
SESSION
IV
Complications of local anesthesia, legal and risk
management issues, intro to math for local
anesthesia, calculating doses avoiding toxicity
Chapter
9,10,11, 12,
13
SESSION
V
Medical emergencies in the dental office, math for
local anesthesia, continued
Quiz 2
Chapter 15, 8
SESSION
VI
Armamentarium for local anesthesia, anatomic
considerations, basic injection techniques
Chapter 9,
10, 11
SESSION
VII
Maxillary and mandibular injection techniques
Chapter 12,
13, 16
SESSION
VIII
Clinic session – infiltrations, distribute examination
SESSION
IX
Clinic session – infiltration and
blocks
Final Examination
SESSION
X
Clinic session – review examination, infiltrations
and blocks
SESSION
XI
Clinic session – blocks and supplemental injections
And Clinical Check Outs
Note: Chapter assignments are for reference and to enhance understanding of
material presented in lecture. Chapters may differ in updated editions of the text.
Learning Objectives
Upon completion of this local anesthesia course, the student will be able to:
Session I- One
1. Be able to describe key elements of the history and physical exam done prior to
administration of local anesthesia;
2. Be able to conduct a competent pre-anesthetic patient evaluation resulting in
appropriate risk stratification;
Session II -Two
1. Be able to discuss the physiology of nerve function, pain and the reversible
blockade of nerve impulses;
2. Be able to describe key pharmacologic properties of local anesthetics;
Session III-Three
1. Be able to compare clinically relevant properties of various local anesthetic
agents commonly used in hygiene and dental practice;
2. Discuss the benefits of vasoconstrictors in local anesthesia, their dosage limits,
cautions relative to their use and potential drug interaction
3. Identify the risks and benefits of reversal agents for local anesthesia;
4. Describe the mechanism of action of reversal for local anesthesia;
5. Articulate the difference in inferior alveolar block soft tissue anesthesia time with
and without reversal use;
6. Discuss the method of administration and dosing parameters for phentolamine
mesylate;
7. Describe a safe and effective protocol for reversal appropriate in dental hygiene
practice.
Session IV-Four
1. Be able to calculate the milligram doses of local anesthetics and vasoconstrictors
administered;
2. Be able to demonstrate safe and effective handling of the armamentarium related
to local anesthesia administration including syringes, cartridges and needles;
3. Be able to develop competency in the administration of local anesthesia by
infiltration;
4. Be able to recognize adverse reactions associated with the administration of
local anesthesia;
Session V-Five
1. Be able to assist in the management of adverse reactions and medical
emergencies in dental hygiene practice including those related to local
anesthesia solutions;
2. Be able to calculate the milligram doses of local anesthetics and vasoconstrictors
administered;
3. Be able to recognize adverse reactions and medical emergencies in dental
hygiene practice including those related to local anesthesia solutions;
Session VI-Six
1. Be able to demonstrate safe and effective handling of the armamentarium related
to local anesthesia administration including syringes, cartridges and needles;
2. Be able to describe the basic techniques of local anesthesia administration;
Session VII- Seven
1. Be able to describe the techniques for administering field blocks and nerve
blocks used in dental hygiene including inferior alveolar, mental, infraorbital and
anterior, middle and posterior superior alveolar nerve blocks;
CLINICAL SESSION OUTLINE - EACH SESSON WILL BE (4.0) HOURS
The course requirements for number of injections is thirty-two (32). All students must
be present for at least 3 of the 4 clinical sessions and are required to administer;
➢ Ten maxillary injections including infiltrations, greater palatine blocks,
nasopalatine blocks, PSA and ASA blocks and infraorbital blocks
➢ Ten inferior alveolar injections on at least 3 different “patients;”
(classmates)
➢ Twelve mandibular infiltration-type injections including five mental
injections and five long buccal injections
Session VIII, IX, X, XI
1. Set up of clinical area with appropriate armamentarium
2. Review medical history of student partner
3. Record vital signs of student partner
4. Review of basic anatomy of Cranial Nerve V
5. Administer the above listed injections on student partner
Students will administer a minimum of 5 of each of the required injections as indicated by
the NJ State Board of Dentistry. In addition, students will also be required to administer
greater palatine blocks, nasopalatine blocks, PSA and ASA blocks, and infraorbital
blocks, for a total of 32 injections.
TOPICAL OUTLINE
I. Preoperative Assessment/Physiological Considerations
A. Recording the Medical History
1. Past experiences with dental treatment
2. Anesthetic History
3. Current Medications
4. History of Allergies
B. Cardiovascular Disease
1. Ischemic Heart Disease
2. Congestive Heart Failure
3. Hypertension
4. Valvular Heart Disease
5. Cardiac Pacemakers
6. Cardiac Risk
C. Respiratory Disease
1. Asthma
2. Chronic Obstructive Pulmonary Disease
D. Liver and Kidney Disease
E. Infectious Diseases
1. AIDS
2. Hepatitis A
3. Hepatitis B
4. Hemophilia
F. Endocrine Derangements
1. Diabetes Mellitus
2. Thyroid Disorders
3. Adrenocortical Derangements
G. Epilepsy or seizures
H. Psychiatric Disorders
I. Physical Examination
1. Visual Inspection
2. Vital signs
3. Determination of Medical Risk (ASA Classification)
J. Drug-Drug Interactions
K. Malignant Hyperthermia
L. Typical Plasma Cholinesterase
M. Methemoglobinemia
II. Use of Local Anesthetics in Dental Specialties
A. Endodontics
B. Pedodontics
C. Periodontics
D. Oral and Maxillofacial Surgery
E. Fixed Prosthodontics
F. Long-Duration Local Anesthesia
G. Dental Hygiene
III. CPR review
A. Identify and describe the protocols for:
B. CPR “CABDs”
C. Assessment
D. Adult one rescuer and two rescuer CPR
E. Child one rescuer and two rescuer CPR
F. Infant one rescuer and two rescuer CPR
G. Use of Automated Electronic Defibrillator AED
H. Heimlich maneuver for conscious and unconscious adult, child, & infant
IV. Basic Life Support review
Identify and differentiate between adverse reactions for:
A. Respiratory Failure
B. Mild and Severe Airway Obstructions
C. Hyperventilation Syndrome
D. Heart Failure
E. Cardiac Arrest
F. Asthma Attack
G. Syncope
H. Shock
I. Stroke
J. Angina Pectoris
K. Myocardial Infarction
L. Adrenal Crisis
M. Insulin Reaction
N. Diabetic Coma
O. Epileptic Seizures
P. Allergic Reactions – delayed and anaphylactic shock
Q. Local Anesthesia Reactions – psychogenic, allergic, toxic
V. Neurophysiology
A. Fundamentals of Impulse Conduction
B. Mode and Site of Action of Local Anesthetics
C. Active Forms of Local Anesthesia
D. Kinetics and Duration of Action of Local Anesthetic
VI. Local Anesthetics
A. Types of Local Anesthetics
1. Amides
2. Esters
3. Others
4. Choice of Local Anesthetic
b. duration
c. dosage
d. vasoconstrictor
e. articaine
5. Topical Anesthetics
a. types
b. usage
c. contraindications
B. Types of Vasoconstrictors
Drug Interactions
C. Mechanism of Action of Local Anesthetics
D. Uptake, Distribution, and Elimination of Local Anesthetics
E. Systemic Effects of local anesthetics
1. Central Nervous System
2. Cardiovascular System
3. Local Tissue Toxicity
4. Respiratory System
5. Miscellaneous Effects
F. Reversal Agents
VII. Armamentarium for Local Anesthesia
A. Types of Syringes in dentistry
1. Nondisposable Systems
a. Breech-loading, metallic, Cartridge-type, Aspirating
b. Breech-loading, plastic, Cartridge-type, Aspirating
c. Breech-loading, metallic, Cartridge-type, Self-aspirating
d. Pressure Syringe
e. Jet injector (“needless syringe”)
B. Disposable Syringes
C. Safety Syringes
D. Computer-Controlled local Anesthetic Delivery Systems
E. Care and Handling of Syringes
1. Leakage during injection
2. Broken Cartridge
3. Bent Harpoon
4. Disengagement of the Harpoon from the Plunger
5. Surface Deposits
F. Needle
1. Types
2. Parts
3. Gauge
a. Color-coding by needle gauge
b. Minimizing Needle Deflection: Rotational Insertion Technique
4. Length
5. Care and Handling
6. Problems
a. Pain on Insertion
b. Breakage
c. Pain on Withdrawal
d. Injury to the Patient or Administrator
G. Cartridge
1. Components
2. Cartridge Contents
3. Care and Handling
4. Problems
a. Bubble in the Cartridge
b. Extruded Stopper
c. Burning on Injection
d. Sticky Stopper
e. Corroded Cap
f. Rust on the Cap
g. Leakage during Injection
h. Broken Cartridge
H. Additional Armamentarium
1. Topical Antiseptic
2. Topical Anesthetic
3. Applicator Sticks
4. Cotton Gauze
5. Hemostat
I. Preparation of the Armamentarium
1. Assembly of the Syringe
2. Recapping the Needle
3. Placing an Additional Cartridge in a Syringe
VIII. Basic Injection Techniques
IX. Anatomical Considerations
A. Overview of the Nervous System
1. Central Nervous System
2. Peripheral Nervous System
3. CranialNerves
B. Nerves to the Oral Cavity
C. 1. Trigeminal Nerve
a. V1
b. V2
c. V3
2. Facial Nerve
D. Maxillary Osteology
E. Mandibular Osteology
X. Maxillary anesthetic Technique
A. Local Infiltration (supraperiosteal imjections)
B. Field Block
C. Nerve Block
1. Posterior Superior Alveolar (PSA)
2. Middle Superior Alveolar (MSA)
3. Anterior Superior Alveolar (ASA)
4. Greater (Anterior) Palatine Nerve Block
5. Nasopalatine Nerve Block
D. Local Infiltration of the palate
XI. Mandibular Anesthetic Techniques
A. Inferior Alveolar Nerve Block (IANB)
B. Mental Nerve Block
C. Incisive Block
D. Buccal Nerve Block
E. Local infiltrations
XII. Management of Complications and Emergencies
A. Local Complications
1. Needle Breakage
2. Persistent Anesthesia and Paresthesia
3. Facial Nerve Paralysis
4. Trismus
5. Soft-Tissue Injury
6. Hematoma
7. Pain On Injection
8. Burning On Injection
9. Infection
10. Edema
11. Sloughing Of Tissues
12. Postanesthetic Intraoral Lesions
B. Systemic Complications
1. Overdose of Local Anesthetic
2. Overdose To Vasoconstrictor
3. Allergy
a. Sodium Bisulfate Allergy
b. Epinephrine Allergy
c. Latex allergy
d. Topical Anesthetic allergy
XIII. Documentation and Legal Issues
A. Type Of Local Anesthesia
B. Calculation Of Dose of Local Anesthesia
C. With Or Without Vasoconstrictor
D. Pre And Post-Op Vitals
E. Legalities Of Proper Documentation
F. Patient Consent
G. HIPAA
H. Legal Issues of Overdose
I. Legal Issues of Allergic Reactions
J. Legal Issues of Local Reactions to Local Anesthetic Administrations
1. Lip Chewing
2. Subcutaneous Emphysema
3. Vascular Penetration
4. Neural Penetration
5. Chemical Nerve Injury
6. Drug Interactions
7. Psychogenic Reactions
K. Post Procedure Evaluations
L. Respondiat Superior
M. Statute Violations
N. Existence Of Malpractice
CLINICAL JOURNAL
Please reflect on your clinical experience
Please elaborate on strengths and weaknesses, and challenges and triumphs of the
patient session. The post will be written at a college level (writing /learning) and be void
of grammar, punctuation, and spelling errors. It will utilize appropriate professional dental
terminology.
This is no place to negotiate with clinical faculty or vent about grade or faculty.
Make sure to address the following in your entry:
What did I learn today that allowed me to formulate a realistic plan for future patient care?
How did what I learned help me to better meet goals?
How did what I learned prepare me to perform better in the future? What were the
strengths or weaknesses AND/OR challenges or triumphs of the session?
What were the areas that were improved on or needed improvement?
How did previous actions or decisions from other patient care sessions assist me in how
or why I met or did not meet goals?
Grading Criteria:
Points Grade
20 100
19 95
18 90
17 85
16 80
15 75