Pierce College Dental Hygiene DHYG 326 Pain Management I Local Anesthesia I

Transcription

1 Pierce College Dental Hygiene DHYG 326 Pain Management I Local Anesthesia I Course Title Course Syllabus Summer 2016 COURSE INFORMATION Course Credits 3 Credit Hours (2 Lecture, 2 Lab) Pre-requisites Course Description Location Days and Times Enrollment as a student in good standing in the dental hygiene program and successful completion of Biological Structures I & II, General Pathology, Pharmacology, Medical Emergencies and basic dental hygiene clinical courses. This course will introduce the fundamentals and basic science for the safely and comfortably administration of local anesthetic agents used in dentistry. Students will be expected to apply knowledge gleaned from previous Biological Structures, Pharmacology, Medical Emergencies and basic dental hygiene clinical courses. Lecture CAS 125 * Lab CAS 129 clinic Thursdays Schedule varies between 8 AM and 6 PM Consult Summer weekly schedule for specific dates and times Professors Course Lead Kathy Bassett, BSDH, RDH, MEd Clinical Instructors: Sheila Norton, BS, RDH, Melinda Davis, BS, RDH Supervising Dentist: Keavin McIntosh DMD Office Hours Contact Information Required Texts Course Lead Office: Office Hours: Required Text and Video: Kathy Bassett, BSDH, RDH, MEd Pierce College (FS), Room CAS minutes following each class session, by appointment kbassett@pierce.ctc.edu (preferred method of contact) TEXT - Local Anesthesia for Dental Professionals by Bassett, DiMarco and Naughton, 2 nd Edition, 2015, Pearson Higher Education. Book ISBN: (2 nd Edition oversight corrections will be posted on Canvas) VIDEO - Successful Local Anesthesia for Dental Professionals by Royer and Paarmann, 1 st Edition, 2012, Pearson Higher Education. DVD ISBN: (Bundle: text with video = ISBN: ) Page 1

2 Instrument Issue: Miltex, Aspirating Syringe, Type "A" Grip Rite Miltex Petite Aspirating Syringe Jenker Needle Stick (recapping device) Safe-D-Needles (1 pk each 25g long, 27 ga short) (dispensed in class) Recommended References: Study skulls are required at all class sessions and labs. Dental Hygiene Course Textbooks - Head and Neck Anatomy (review anatomical structures and nerve innervation), Medical Emergencies; Basic Pharmacology (review local anesthetics and medications implicated in potential interactions and compilations with administrations of local anesthetics); and Management of the Medically Compromised Patients. Pierce College Dental Hygiene Program - Infection Control Policies and Procedures Current (including post-exposure follow-up procedures). Course Topics Course Objectives 1. History of local anesthesia 2. Anatomical considerations 3. Patient pre-evaluation 4. Neurophysiology and pharmacokinetics of anesthetic agents 5. Armamentarium and devices for local anesthesia deliver 6. Pharmacology of local anesthetic and vasoconstrictor drugs 7. Local and systemic complications 8. Basic injection techniques and clinical applications 1. Attend and participate 100% of the time in all classroom, group instruction and lab sessions Complete assigned reading and outside preparation for lecture and lab Complete and submit all assignments on time Practice clinical skills on partners with close supervision Participate in small group problem solving situations related to lessons and goals Utilizes appropriate sources of information to organize and review concepts of head & neck anatomy in order to correctly apply anatomical factors of the administration of local anesthetic agents for dental pain management Utilizes appropriate sources of information to organize and review concepts of pharmacology in order to correctly select appropriate local anesthetic agents for dental pain management Relates new information to baseline knowledge and experience from previous clinical dental hygiene, restorative and medical emergency courses Applies concepts of variations in head and neck anatomy to problem solving injection techniques. Adhere to following Pierce College Dental Hygiene policy and procedures: 1.2. Standards of Applied Dental Hygiene Practice (Student Policy Manual) 1.3. Principles of Ethics of the American Dental Hygiene Association (Student Policy Manual) 1.4. Student Conduct code (Student Policy Manual) Respect, understand and maintain the policies established by the Department and Page 2

3 College to protect the safety of patients, students, faculty and staff at all times Infection Control Policy and Procedures 1.6. Clinic Policy and Procedures 1.7. Clinical AIS Grading Criteria 1.8. Accurately self-evaluate performance, participation and adherence to all applicable policy and procedures Seek self-improvement in skills and knowledge of the profession by applying instructor feedback. 2. Demonstrate knowledge and proficiency in the following topic areas: 2.1. Describe anatomy of the head and neck region pertinent to intraoral injections of dental local anesthetics Demonstrate knowledge of the pharmacology and mechanism of action of local anesthetic and vasoconstrictors agent commonly used Describe common local anesthetic complications, their prevention and treatment Accurately calculate doses of all drugs discussed for any given patient Identify appropriate drug doses for all local anesthetic and vasoconstrictors agents commonly used Demonstrate on a patient clinically acceptable technique for all routinely used dental injections Demonstrate proper symptomatic treatment of medical emergencies related to local anesthesia procedure Demonstrate knowledge of all components of the dental local anesthetic armamentarium, including safe and effective handling, use, and maintenance. This includes manual, safety and computerized delivery syringes Discuss the evolution of the use of local anesthetics and benchmark products Identify and discuss relevant anatomy pertinent to dental local anesthesia injections including bony and soft tissue landmarks, muscles, vasculature, and pathways of the Facial and Trigeminal nerves Demonstrate knowledge of the pharmacology and mechanism of action of local anesthetic agents and commonly used vasoconstrictors Given a health history and treatment plan, accurately evaluate the patient for suitability for local anesthesia Demonstrate correct selection of local anesthetic agents and accurate calculation of drug doses for given drugs and patient histories Discuss and demonstrate knowledge of all components of the local anesthetic armamentarium and devices Discuss and demonstrate effective patient-operator positioning, safe handling, use, and maintenance of the dental local anesthetic devices Describe and demonstrate principles for administering safe and effective dental local anesthesia to patients including proper soft tissue retraction, effective fulcrums, hand positioning, and aspiration with during delivery of local anesthetic drugs Demonstrate clinically acceptable techniques for each injection introduced in lab Describe and identify common local anesthetic complications and their prevention and treatment Identify proper symptomatic treatment of medical emergencies related to local anesthesia procedure. Page 3

4 Methods of Instruction Methods of Assessment Required Lab Preparation and Materials 1. Class and lab activities 2. Individual assignments, exercises and projects 3. Group assignments, exercises and projects 4. Lab practice 1. Participation in class and lab activities - Self Evaluation (Rubric) 2. Individual assignments, exercises and projects - Self Evaluation, Instructor Evaluation (Feedback) 3. Mid-term Written Exam - Instructor Evaluation 4. Group assignments, exercises and projects - Self Evaluation, Peer Evaluation (Feedback) 5. Discussion Boards - Instructor Evaluation (Rubric) 6. Final Written Exam/Final Lab All students are required to sign a Human Subject Informed Consent Statement to participate in lab/clinic activities. This form is provided with the course materials and is due the first day of class. If you have any medical conditions that may interfere with your ability to receive local anesthetic injections or drugs, notify the course lead as soon as possible to complete any necessary medical consultations and determine appropriate lab modifications. The following are required for all class/lab sessions: 1. Appropriate clinic attire and PPE is for clinicians and patients 2. Operatories set up before the start of each AM or PM session (when includes a labs) 3. Basic tray setups minimally include: mouth mirror, locking cotton pliers (or hemostat), 2x2 gauzes, cotton-tip applicators, anesthetic syringe/device, one-handed needle capping method, sharps containers 4. Anesthetic supplies - topical anesthetic (benzocaine gel or lidocaine cream), mepivacaine 3% injectable (volumes listed on lab instructions for each session) 5. Needles - appropriate length and gauge for each injection (consult course notes and technique guide for each assigned injection) 6. Other items - patient chart with current medical history (BPs will be taken Week 1 and repeated at each lab session for any student with HBP or changes in medications). When applicable, written medical clearance to receive local anesthetics must be in the chart prior to the first lab session. Student Conduct Policy Due to the rapid progression of this course and difficulty in duplicating sessions, promptness and full participation is expected for all scheduled class sessions and assigned activities. In case of an emergency contact the lead instructor immediately and arrange for a classmate to take notes of any in class announcements. Preparation, Attendance and Participation. Adequate preparation requires completion of all assigned reading, study questions and activities PRIOR to classroom sessions. Preparation is also be reflected by the on-time completion and submission of all assignments. Deficiencies in any of these areas will be reflected in the student's final course grade: Page 4

5 1. Complete all reading and outside preparation prior to classroom sessions. 2. Participate 100% in all classroom sessions and group activities. 3. Participate in small group activities related to lessons and goals. 4. Complete and submit all assignments on time. Preparation and Participation will be evaluated weekly for classroom preparation and participation, and discussion boards (blogs) according to the Rubrics provided on Canvas. Participation is expected 100% of the time in all classroom and group activities. Students are expected to come prepared to actively participate in group activities in all class sessions and to apply concepts to contiguous units of instruction, rather than merely rely on memorization. Please refer directly to the Pierce College Student Code of Conduct and the Pierce College Dental Hygiene Program Student Handbook for the general guidelines of conduct within and related to this class. Professional behavior is expected. Please remember that you signed and agreed to all of the rules, policies, criteria, etc. set forth in the Dental Hygiene Student Handbook. The following additional grading factors will be considered: Professionalism - Students are expected to project professional conduct and communication towards faculty, staff, classmates, patients, and visitors at all times as outlined in Department of Dental Hygiene Program Policy. Deficiencies in professional conduct and communication will be reflected as a reduction in the student s final course grade Personal and Academic Honesty - Students are expected to demonstrate unquestionable honesty at all times as outlined in Department of Dental Hygiene Program Policy. Deficiencies in honesty will be reflected as a reduction in the student s final course grade. Breeches in Academic Honesty Policy may be subject to the student s immediate dismissal from the Dental Hygiene Program. Dress Code - Students are expected to adhere to appropriate Student Dress Codes during all lectures, laboratory sessions, and assigned duties as outlined in Department of Dental Hygiene Program Policy. However, students are not required to wear the specified lab attire (scrubs) during regular lab sessions for this course. Students will be notified in advance if specified lab attire will be required for a specific lab session. At all times, clinical safety policy is in force. Course Requirements & Assignments Assessment Tools See CANVAS for details and due dates: 1. Course Prep Assignments (2) 2. Anatomy Assignments (2) 3. Drug PIL and Calculations Assignments (3) 4. Study Guides (Chapter 2 17) 5. Discussion Board Posts (3) 6. Quizzes (2) 7. Final Lab Exam (MSA Injection) 8. Final Written Exam 1. Weekly Self-Evaluation Rubric 2. LAForm_0_Daily Lab Evaluation Page 5

6 3. LAForm_1 _Prep AK: Local Anesthetic Treatment Planning Worksheet 4. LAForm_2_Maxillary Injections Evaluation 5. LAForm_3_Palatal Injections Evaluation 6. LAForm_4_Mandibular Injections Evaluation 7. LAForm_6_MSA Proficiency 8. LAForm_8_AIS Summary 9. Pierce College Dental Hygiene Program AIS Clinical Evaluation Rubric Evaluation Criteria & Procedures Final course grades will be weighted on the following point distribution: 1. Professionalism: 20% 1.1. Participation & preparation in classroom and clinic 1.2. Supportive behaviors in classroom and clinic 1.3. Homework Assignments 2. Quizzes 20% 3. Lab Practical Exam 20% 4. Final Written Exam 40% Clinical Preparation and Proficiency will be evaluated weekly by course instructors to include: Application of Knowledge - adequate preparation for lab sessions, handling of armamentarium, demonstration of safety principles, knowledge of related anatomical structures for the assigned injection(s), complete and actuate chart entries, demonstrates understanding of specific injection criteria published in the lab manual for each assigned injection. Time Management - adequate preparation PRIOR to clinic session, preparedness for instructional time with faculty, patient chart complete and submitted by designated time. Policy and Procedures - adheres to all safety policy and procedures, adheres to specific injection criteria published in the lab manual for all injections and proficiencies Communication and Professionalism - communicates active to both instructors and peer patients, demonstrates active listen skills during injection sessions, demonstrates professionalism during all class and lab sessions, and demonstrates supportive behavior as both clinician and patient during all lab sessions. Decimal scores will be awarded according to the Pierce College Dental Hygiene Program grading scale, the lowest acceptable score for all courses in the dental hygiene department is a 75% = 2.0. All percentile scores will be converted to a final decimal course grade according to the following scale: 100 % % % % % % % % % % % % % % % % % % % % % 1.8 Page 6

7 93 % % % % % % % % % % 3.2 Lowest Passing Grade = 75%/2.0 Grades from 1.9 to 1.6 are considered probationary and grades 1.5 or below are considered failing. Final course grades below 2.0 are subject to probationary and/or dismissal actions according to the Dental Hygiene Department Academic Policy By the end of the quarter, each student will have had an opportunity to attain minimum competency in the expected course outcomes. If it is determined by the course instructor(s) that a student has not successfully achieved the student outcomes and is unable to apply the course content, one of the following actions may be taken: 1. Additional course work assigned 2. Additional course evaluation required 3. Final course grade adjusted accordingly (reduction of grade) 4. Incomplete grade (with contracted remediation assigned to determine competency in all course objectives), and/or 5. Student may be placed on academic probation, with possible dismissal from the Dental Hygiene Program as outlined in Pierce College Department of Dental Hygiene Program Policy. Students who do not achieve a passing score on an assignment or exam will be contacted by the course professor to schedule a conference within a one week time frame of the non-passing grade Minimum Competency If the instructor(s) determines that a student is not demonstrating minimum competency of the course objectives, additional course work may be assigned. All remedial assignments must meet the minimum standards set by the lead instructor. At the instructor s discretion, course work below a 2.0 may need to be retaken/resubmitted/supplemented and/or the student will be subject to academic review. ALL incomplete grades are expected to be completed within the first 3 weeks of the fall quarter. The student is responsible to schedule an appointment with both the DHYG 166 and DHYG 239 lead instructors to examine the reason the course work has not been completed and define an action plan for completion of the course. Students are expected to submit in writing their proposal for completion of requirements to the lead instructors at this meeting. If the work is not completed in the designated time, and there are no extenuating circumstances for the work to be outstanding, the final course grade may be changed to a 1.5. If the only outstanding work is the Final Written Exam, this must be complete before the first day of clinic (DHYG 239). The student must complete ALL course requirements and attain a minimum grade of 2.0 in the course to have the privilege to use local anesthesia for clinic patients summer and fall quarters, and proceed to Local Anesthesia III. Page 7

8 Acceptance of Late Work Students are expected to complete all course assignments on the posted due date. Grades for all assignments received or completed after the due date will be reduced by 50% for each 24 hour period it is late. This will include assignments that did not meet minimal submission guidelines and have been returned for completion, even if submitted on time. You may not opt out on any assignment. All requirements must be submitted, even if late, and will receive a score of 0". Any outstanding course requirement may be grounds for an Incomplete course grade. Failed Assessment Process Campus Safety & Security Students who do not achieve a passing score on an assignment or exam will be contacted by the course professor to schedule a conference within one week time of earning the non-passing grade. During this conference, the student and instructor will review the assignment or examination submission and determine what, if any, next steps are necessary to support the student s future academic success in the course. Call 911 and then Fort Steilacoom Campus Safety (253) Office: Cascade Building, C311 Using a campus phone dial for emergency or For escort or other non-emergent needs: (253) In response to an imminent threat to persons or property. In the event of an evacuation (intermittent horns & strobes), gather all personal belongings and leave the building using the nearest available safe exit. Be prepared to be outside for one hour and stay a minimum of 200 feet from any building or structure. So long as it is safe to do so students are expected to stay on campus and return to class after evacuations that last less than 15 minutes. Do not attempt to re-enter the building until instructed by an Evacuation Director (identified by orange vests) or by three horn blasts or bell rings. Please notify the nearest Campus Safety Officer or Evacuation Director of any one left in the building or in need of assistance. ADA, Access and Disability Statement Disclaimer (Current 2014) Your experience in this class is important to me, and it is the policy and practice of Pierce College to create inclusive and accessible learning environments consistent with federal and state law. If you experience barriers based on disability, please seek a meeting with the Access and Disability Services (ADS) manager to discuss and address them. If you have already established accommodations with the ADS manager, please bring your approved accommodations (green sheet) to me at your earliest convenience so we can discuss your needs in this course. ADS offers resources and coordinates reasonable accommodations for students with disabilities. Reasonable accommodations are established through an interactive process between you and the ADS manager, and I am available to help facilitate them in this class. If you have not yet established services through ADS, but have a temporary or permanent disability that requires accommodations (this can include but not be limited to; mental health, attention-related, learning, vision, hearing, physical or health impacts), you are encouraged to contact ADS at (Fort Steilacoom). Disclaimer This syllabus may be altered at any time during the course as deemed necessary by the lead professor. Changes requiring a schedule, or time frame, alteration will be given with sufficient notice for students to accommodate. Emergencies are the exception. Page 8

9 All Dental Hygiene courses are Web Enhanced using an online learning management system (LMS). All student instructions, schedules and course materials will be posted on the LMS providing 24/7 accessibility. It is the student s responsibility to access the course site daily and check for announcements, communications form professors, and clarifications that may not be made in class. Students are responsible for downloading course materials on a timely basis and must have access to print capabilities. If student has a computer or printer problem then it will be the student s responsibility to locate alternative resources for accessing any required materials. Course handouts are for the purpose of directing self-study and note taking. PowerPoint presentations may be provided as a courtesy only for study and review. Instructors are under no obligation to provide PowerPoint presentations for their course, nor is it required that student print presentations (unless specified in this syllabus) for class as they are frequently heavily loaded with color graphics and photographs that can be time and ink intensive to print. Students are encouraged to use a variety of note taking strategies and should consider printing only what they individually wish to have on hand in class. Using draft and grayscale print modes can conserve on ink. Faculty are not required to post multiple versions of any course materials for convenience sake, any resources shall be considered supplemental to class and an added benefit. Page 9

10 LESSON OUTCOMES In addition to the following course Objectives, Chapter Objectives and a text study guide are the primary outcomes for this course. Upon completion of the course, the student expected to define and pronounce all key terms and anatomical terms from the text. FUNDAMENTALS OF LOCAL ANESTHESIA History of Local Anesthesia 1. Discuss the non-drug methods of pain control used prior to dental anesthetics. 2. Discuss the evolution of anesthetic administration from the use of refrigerants to the present. 3. Briefly describe the origins of chemical pain control, include key developers and years benchmark products were introduced. 4. Discuss the evolution of armamentarium for delivery of local anesthetic agents. 5. Discuss the evolution of the use of local anesthetics by dental hygienists. Anatomical Considerations 1. Name and locate the following structures of the head and neck region pertinent to dental local anesthesia injections: a. Bony landmarks b. Soft tissue landmarks c. Muscles d. Arterial vasculature e. Venous vasculature 2. Describe the branches and pathways of the Facial VII nerve. 3. Describe the branches and pathways of the Trigeminal nerve, list structures innervated relevant to dental local anesthesia. 4. List and describe all anatomical structures associated with the inferior alveolar nerve block, including anatomical barriers to successful technique. 5. Consider technique alterations based on anatomical variation. Neurophysiology 1. Describe and understand the neurophysiology of the cranial nerves responsible for sensory and/or motor functions innervating the teeth and surrounding boney and soft tissue structures. 2. Compare and contrast the anatomy of a sensory and motor nerve, identify the function of each component. 3. Describe how a nerve impulse is initiated and propagated. 4. Describe the characteristics of the nerve membrane and the myelin sheath and how they relate to the steps of nerve impulse conduction. 5. Compare and contrast myelinated and nonmyelinated nerves. 6. Describe the two theories which best describe why local anesthetic agents work. 7. Describe the characteristics of the local anesthetic molecule. 8. Describe the factors which affect the diffusion and clinical effectiveness of local anesthetic molecules. 9. Describe the physical properties that affect the clinical effectiveness of local anesthetic agents. 10. Describe the factors which need to be considered prior to any re-injection of a local anesthetic agent. Page 10

11 Local Anesthesia Devices and Armamentarium 1. Discuss and demonstrate knowledge of all components of the local anesthetic armamentarium. 2. Discuss the rationale behind safe and effective handling, use, and maintenance of the anesthetic syringe (manual, safety and computerized delivery devices) 3. List and describe the purpose of each of the components in the dental cartridge. Implementation 1. Name and locate intraoral soft tissue landmarks relevant to placement of topical agents and penetration sites. 2. Describe and demonstrate proper soft tissue retraction and palpation of these relevant landmarks. 3. Describe and demonstrate effective fulcrums, hand positioning, and aspiration with a loaded syringe until safety and comfort are achieved. 4. Describe and demonstrate effective principles of patient-operator positioning for local anesthesia. 5. List and describe the essential steps of basic injection technique. 6. Follow recognized exposure control guidelines during clinical sessions at all times. Patient Pre-Evaluation 1. Given a health history for a dental clinic patient, accurately evaluate and record patient suitability for routine dental treatment. 2. List the indications for local anesthesia in dental and dental hygiene practice. 3. Describe why understanding of the ASA Classification is important when assessing a patient s medical status prior to administration of local anesthetics. 4. List and explain relative and absolute medical contraindications for local anesthesia in a dental practice. 5. Describe how drug-to-local anesthetic drug interactions could be detrimental to a patient. Give specific examples of drugs. 6. Describe the significance of patients with a history of malignant hyperthermia, atypical plasma cholinesterase, and methemoglobinemia when it comes to use of local anesthetics. 7. Describe specific contraindications to the use of local anesthetic agents. 8. Demonstrate proper symptomatic treatment of medical emergencies related to local anesthesia procedures. Pharmacokinetics of Anesthetic Agents 1. Describe the differences between absolute contraindication and relative contraindication when it comes to selecting local anesthetic agents. 2. Describe the systemic effects of local anesthetic agents. 3. Describe the clinical signs and symptoms a patient may demonstrate with a mild to moderate local anesthetic overdose as well as a moderate to high overdose. 4. Describe the main effects of local anesthetic agents on the cardiovascular system, peripheral vasculature and respiratory system. 5. Describe the properties, absorption, metabolism, and excretion of the common dental anesthetic drugs and explain the clinical significance of the pharmacokinetics of these agents. 6. List the systemic properties of local anesthetics as they relate to uses in medicine and to unwanted adverse reactions. 7. Describe the actions of excessive doses of local anesthetics on the CNS, respiratory, and cardiovascular systems. 8. List the signs and symptoms of adverse reaction to local anesthetics; toxicity; allergy; idiosyncrasy. Page 11

12 Pharmacology of Local Anesthetic Agents 1. Know, or be able to compute, to the nearest cartridge, the maximum amount of local anesthetic solution recommended for: a normal healthy adult, a child of forty pounds, an elderly patient, a patient with significant cardiovascular disease, etc. 2. Define dose limiting agent and give the dose limiting agent for each of the preparations found in our clinic. 3. List the criteria for selection of anesthetic preparations for the dental office. 4. List the properties, actions, and contraindications for the commonly used topical anesthetics. List the local anesthetic drugs in common usage and explain how they differ in their properties. 5. Describe the various anesthetic agents presented in class including proprietary name, classification, duration, metabolism, excretion, and vasodilatation properties. 6. Describe the factors which affect the depth and duration of a local anesthetic agent. 7. Describe the characteristics of the topical anesthetic agents presented in class. 8. Describe factors to consider when selecting a local anesthetic drug. 9. Describe how to determine the amount of anesthetic solution in a cartridge. 10. Describe the factors which to consider in determining the maximum safe dosage of local anesthetic agent. 11. Demonstrate how to determine the maximum safe dose of a local anesthetic calculated in mg/lb. and in cartridges. 12. Demonstrate how to determine the maximum safe dose when more than one drug is used. Pharmacology of Vasoconstrictors 1. List the generic and popular trade names of the available vasoconstrictors. 2. Discuss why vasoconstrictors are added to local anesthetics. 3. Describe the factors to be considered when selecting a vasoconstrictor for use during a dental procedure 4. Broadly describe the chemical structure of vasoconstrictors. 5. Broadly describe the adrenergic receptor action of alpha and beta receptors in relation to local anesthetic agents and why it is important to understand their differing actions. 6. Describe the mode of actions for epinephrine and levonordefrin. 7. Describe how to determine the dilution of vasoconstrictor in anesthetic cartridges. 8. Describe the systemic actions of epinephrine and levonordefrin. 9. List and discuss the given contraindications to vasoconstrictor agents and discuss their use in patients with cardiovascular disease. 10. Compare epinephrine, levonordefrin and nor-epinephrine in terms of effectiveness and safety. 11. Give the recognized maximum dose for epinephrine and levonordefrin and compute the number of allowable cartridges for all available concentrations. 12. Describe toxicity to vasoconstrictors and discuss treatment. 13. Discuss the significance of the instability of vasoconstrictors in solution with regard to shelf life, presence of preservatives etc. Local Complications 1. Describe potential local complications which can occur during local anesthetic administration including their cause, the problem, management, and prevention. 2. List the possible local technique related complications which may occur as part of local anesthetic administration. 3. Know the patient and drug factors that may lead to local anesthetic overdose. 4. List the prevention, signs, and symptoms, and treatment of common technique related anesthetic complications. Page 12

13 Systemic Complications 1. Describe the meaning of Adverse Drug Reaction and explain why there has been confusion in the past regarding its meaning. 2. Describe potential adverse drug reactions (related to local anesthetic administration) and their clinical manifestations. 3. Describe predisposing factors which a patient may exhibit prior to a local anesthetic drug overdose. 4. Describe recommended procedures to minimize systemic complications. Clinical Application Local Anesthetic Administration Describe and discuss the indications, relevant anatomy, and technique features of the following injections: 1. Anterior superior alveolar (ASA) nerve blocks 2. Middle superior alveolar (MSA) nerve blocks 3. Greater palatine (GP) nerve blocks (anterior palatine) 4. Nasopalatine (NP) nerve blocks 5. Anterior middle superior alveolar (AMSA) Injection 6. Posterior superior alveolar (PSA) nerve blocks 7. Inferior alveolar (IA) nerve blocks 8. Buccal (B) nerve blocks 9. Mental nerve blocks 10. Incisive nerve blocks 11. Infraorbital (IO) nerve blocks 12. Intraligamental injection Describe and demonstrate (on clinical subjects ) acceptable, safe and effective administration technique for the following injections: 1. Anterior superior alveolar (ASA) nerve blocks 2. Middle superior alveolar (MSA) nerve blocks 3. Greater palatine (GP) nerve blocks (anterior palatine) 4. Nasopalatine (NP) nerve blocks 5. Posterior superior alveolar (PSA) nerve blocks 6. Inferior alveolar (IA) nerve blocks 7. Buccal (B) nerve blocks 8. Mental nerve blocks 9. Incisive nerve blocks 10. Infraorbital (IO) injection Page 13