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Effective: Summer 2013

Prerequisites: Prerequisites: D H 54 or completion of a ADA approved dental hygiene program; possession of a current CPR certificate.
Grade Type: Letter Grade Only
Not Repeatable.
FHGE: Non-GE Transferable: CSU
2 hours lecture, 1.5 hours laboratory. (42 hours total per quarter)

Student Learning Outcomes -
  • Describe the classes of anesthetic drugs used in dental hygiene
  • Describe the different nerves anesthesized in dental hygiene
Description -
Review of pharmacology, anatomy, physiology, and emergency procedures associated with local anesthetic procedures. Preparation for and administration of conduction and infiltration anesthesia in dental procedures. Laboratory and clinical experience in administration. Intended for students enrolled in the Dental Hygiene Program.

Course Objectives -
The student will be able to:
Dental Hygiene Process of Care
  1. classify local anesthetic agents by chemical class and describe the local and systemic reactions produced by each.
  2. identify all vasoconstrictive agents used in conjunction with local anesthetics and describe their local and systemic responses.
  3. describe the adverse reactions which may be elicited by these agents and describe and perform procedures utilized to overcome or minimize these reactions.
  4. describe the rationale for selection of specific anesthetic agents for dental procedures.
  5. identify the nerve anesthetized in common dental procedures; locate and identify their position and list and identify, where appropriate, all non neural structures in anatomic proximity.
Preventive, Therapeutic & Supportive DH Procedures
  1. choose the most appropriate injection for a series of dental and dental hygiene procedures and defend the choices.
  2. prepare and assemble all equipment, materials, and supplies necessary for administration of local anesthesia.
  3. administer local anesthetic agents satisfactorily to:
    1. Any infiltration site
    2. Provide the following nerve blocks:
      1. Anterior palatine
      2. Incisive palatine (naso-palatine)
      3. Mental
      4. Posterior superior alveolar
      5. Mandibular (inferior alveolar, lingual and long buccal nerves)
    Ethical & Legal Principles
    1. assess the value of the dental hygienist in the administration of local anesthesia.
    2. acknowledge the limitations of the dental hygienist in the administration of local anesthesia
    3. exhibit professionalism and enthusiasm
    4. assess the value of cultural diversity in the administration of local anesthesia

Foothill College Dental Hygiene Program Competencies
Our graduates will be competent:
  1. In assessing the oral health needs of diverse populations and providing comprehensive dental hygiene care for persons of all ages/stages of life
  2. In health education strategies for the prevention of disease & the promotion of health for individual clients and the communit
  3. In infection & hazard control procedures to prevent the transmission of infectious diseases.
  4. In the ethical & legal principles underlying the practice of dental hygiene.
Special Facilities and/or Equipment -
Lecture/lab with multi-media capabilities. Prepared skulls, full service dental clinic with operatories, autoclave, oxygen, and specific items and instruments such as anesthetic syringes,carpules of anesthetic agents,and needles.

Course Content (Body of knowledge) -
This course will be organized into four modular components of varying length and structure:
  1. Component I:
    1. Physiology of nerve action and pain.
    2. Pharmacodynamics of local anesthetics (esters and amides) vasoconstrictors.
    3. Toxic, allergic and adverse responses to the local anesthetic experience.
    4. Reactive and preventive emergency procedures.
  2. Component II:
    1. Anatomy of the skull, head and neck as related to local anesthesia.
    2. Neural organization and biologic variables.
    3. Injection sites including intraoral identification.
    4. Appropriate selection of injection type and site.
  3. Component III:
    1. Armamentarium, materials and supplies for administration of local anesthesia.
    2. Preparation of the patient for administration of local anesthesia.
  4. Component IV:
    1. Description of local anesthetic injections.
    2. Demonstration of local anesthetic injections.
    3. Directed student administration of local anesthetic.
    4. Supervised clinical practice in administration of local anesthetics.
      1. Minimum Clinical Experience: 6 infiltrations, 3 mandibular blocks, 2 each: anterior palatine, incisive palatine, posterior superior alveolar, buccal, and mental blocks.
Methods of Evaluation -
  1. Written examination: student must achieve a grade of 80% or better on a written exam that reflects the objectives.
  2. Clinical proficiency, criteria:
    1. 100% of the time the student will review the medical/dental history, general assessment and oral inspection prior to treatment at each appointment (or ascertain that this has been accomplished) checking for information which contra indicates the procedure, requires alteration in the treatment plan of further investigation and/or treatment. This information will be noted either in writing or verbally and will be acted upon appropriately (e.g., dentist consulted, treatment altered, etc.).
    2. 100% of the time the student will assemble the armamentarium required for this procedure.
      1. Topical anesthetic indicated by operator.
      2. Local anesthetic indicated by operator.
      3. Correct needle length and gauge for procedure and according to operator's preference.
      4. Aspirating syringe.
      5. Disposable supplies (e.g., gauze, 2 x 2's, etc.).
      6. Mirror.
    3. 100% of the time the student will use sterile/aseptic technique according to the following criteria:
      1. Use proper handwashing technique prior to and during each appointment at the appropriate times.
      2. Protect self from cross-infection by wearing gloves and face mask.
      3. Protect patient from cross-infection by wearing gloves and face mask
      4. Use only sterile disinfected or sanitized armamentarium and equipment
      5. Recognize and correct accidental breaks in aseptic chain to restore asepsis promptly for each occurrence.
    4. 100% of the time the student will seat and position the patient comfortably, place protective drapes, remove and safely store such items as dentures, glasses, etc., explain the procedure and provide psychological support as needed.
    5. 100% of the time the student will maintain the operating field by positioning the light for maximum illumination isolating the injection site when required and removing leaded anesthetic solution and other debris routinely to provide adequate vision and patient comfort.
    6. 100% of the time the student will administer local anesthetic as indicated below:
      1. Based on the patient's pre-anesthetic evaluation and treatment plan, identify potential emergency situations, select an appropriate anesthetic solution, identify the maximum safe dosage, determine injection(s) needed and select an appropriate needle, all with consultation of the dentist as needed.
      2. Visually and by palpation, locate landmarks to determine site and pathway of injection.
      3. Prepare site of injection for cleanliness and comfort by wiping with gauze-wipe and applying topical anesthetic (and pressure anesthetic where useful).
      4. The needle will be within 1-2 mm of the target site.
      5. Aspirate at depth of injection prior to depositing solution or prior to injecting if needle has been repositioned.
      6. Whenever necessary, adapt and modify technique to each patient's anatomical structures to ensure likelihood of achieving anesthesia and minimizing physical trauma. If there is any doubt in the operator's mind about the injection, assistance will be obtained before continuing.
      7. Make maximum observable efforts to minimize patient anxiety and discomfort by implementing one or all of the following:
        1. Position patient comfortably.
        2. Explain procedure and answer questions in such a way as to ensure patient cooperation.
        3. Calmly reassure patient throughout procedure.
        4. Avoid negative verbal stimuli (e.g., hurt, pain, shot, etc.).
        5. Inject slowly (approximately 1 cc /45-60 seconds).
        6. Avoid undue tissue trauma by not relocating needle unnecessarily through tissue.
        7. Avoid unnecessary insertions of needle (maximum insertion of three).
        8. Keep needle out of patient's field of vision.
    7. 100% of the time the student will make the necessary precautions (e.g., stay with patient following injection to observe for reaction, be alert to sudden movements, etc.).
    8. 100% of the time the student will evaluate the procedure and final product to determine that they meet criteria:
      1. In nine out of ten injections, acceptable anesthesia will be achieved on the first insertion.
      2. In all injections the amount of anesthetic will cover the procedure to be performed.
      3. All principles of acceptable technique have been observed; ways to improve (e.g., when anesthesia is not achieved, will be able to re-evaluate technique and change appropriately; if patient is anxious will be able to suggest ways to improve patient comfort and reduce anxiety, etc.,) are suggested
    9. 100% of the time the student will explain the procedure and provide pertinent, individualized education to the patient.
    10. 100% of the time the student will meet ethical and legal requirement for this procedure.
    11. 100% of the time the student will make complete, accurate chart entries for this procedure (e.g., type of injection, name, strength and amount of anesthetic solution, any unusual reaction experienced, etc.).
    12. 100% of the time the student will clean up treatment area and armamentarium.
Representative Text(s) -
Logothetis, Demetra. Local Anesthesia for the Dental Hygienist. Mosby, Inc 2012.

Disciplines -
Dental Technology
Method of Instruction -
  1. Lecture
  2. Discussion
  3. Oral presentations
  4. Laboratory
  5. Demonstration
Lab Content -
  1. Required lab experiences on student partners of all injections presented in lecture.
  2. Required practical examination on a student partner of selected injections.
Types and/or Examples of Required Reading, Writing and Outside of Class Assignments -
Weekly required readings from chapters in the textbook.