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DENTAL HYGIENE PROGRAM COURSE SYLLABUS DHG 241 INTEGRATED DENTAL HYGIENE I LECTURE/LAB COURSE INSTRUCTOR Dr. Vance Shields [email protected] Office Hours: (By Appointment) DHG 241 INTEGRATED DENTAL HYGIENE I 2013 HORRY GEORGETOWN TECHNICAL COLLEGE DENTAL HYGIENE PROGRAM COURSE TITLE: CREDIT/CONTACT HOURS: SEQUENCE: LENGTH: COURSE TIME: CLASSROOM: INTEGRATED DENTAL HYGIENE I 0-3-1 FALL SEMESTER, SECOND YEAR 14 WEEKS Wednesday: 1:30-4:30pm Speir Dental Annex , Rm. 1281 & Dental Hygiene Clinic PRE-REQUISITES: 1-3-2 DHG 239 2-9-5 DHG 175 3-0-3 MAT 101 3-0-3 PSY 201 Dental Assisting for Dental Hygienists Clinical Dental Hygiene II Beginning Algebra General Psychology CO-REQUISITES: 2-0-2 DHG 2-3-3 DHG 2-0-2 DHG 1-12-5 DHG General & Oral Pathology Public Health Dentistry Dental Pharmacology Clinical Dental Hygiene III 140 230 143 255 REQUIRED TEXT: Bassett, Local Anesthesia for Dental Professionals, Current Edition REFERENCE TEXT: Fehrenbach, Anatomy of the Head and Neck, Current Edition CATALOG COURSE DESCRIPTION: This course provides for the integration of the basic and dental hygiene sciences with current concepts of clinical dental hygiene practice. COURSE PURPOSE: This course will provide the student the opportunity to establish the theory and clinical skills necessary to establish competency in infiltration anesthesia for dental hygiene procedures. COURSE CONTENT: Pain control concepts o Local anesthesia in dentistry o Fundamentals of pain management o The neuroanatomy and neurophysiology of pain control Pharmacology of local anesthetic pain control o Pharmacology basics o Dental local anesthetic drugs o Vasoconstrictors in dentistry o Dose calculations for local anesthetic solutions o Topical anesthetics Injection fundamentals o Local anesthetic delivery devices o Sharp’s management DHG 241 INTEGRATED DENTAL HYGIENE I 2013 o Dental safety syringes and needles o Steps of loading syringes o Needle recapping techniques Patient assessment for local anesthesia o ASA physical status classification o Stress reduction protocols o Modifications to local anesthesia for common medical conditions o Medical conditions and/or drug therapy requiring modifications of anesthesia Fundamentals for administration of local anesthetic agents Clinical Administration of local anesthesia o Maxillary pain control o Palatal pain control o Mandibular pain control o Supplemental pain control o Troubleshooting inadequate anesthesia o Local anesthesia complications and management Insights for the fearful patient COURSE OUTCOMES/OBJECTIVES: At the completion of the lectures and the reading assignments for this course, the student will be able to: 1. Describe the psychology of pain management. 2. Discuss the physiology of pain control via infiltration anesthesia. 3. Identify the anatomic landmarks on both a skull and a patient for infiltration of various teeth. 4. Discuss medical emergency management associated with infiltration anesthesia. 5. Discuss the importance of a comprehensive medical history review prior to administering infiltration anesthesia. 6. State conditions for which antibiotic prophylaxis is required and the current AHA guidelines for the antibiotics. 7. State the rationale behind the selection of a particular anesthetic agent when providing dental hygiene care. 8. Discuss the pharmacology of the various anesthetics utilized for infiltration anesthesia. 9. Calculate the maximal safe dose of each local anesthetic agent and vasoconstrictor for various patients. 10. Calculate the anesthetic and vasoconstrictor dose utilized during various patient scenarios. 11. Discuss the difference between block and infiltration anesthesia. 12. Define and demonstrate the appropriate injection techniques. 13. Assemble, disassemble, and properly maintain the armamentarium required for the administration of local anesthetics. 14. Identify the local complications that may result from the administration of anesthetic agents and the proper management of these complications. 15. Recognize and assist in the management of systemic complications that may result from the administration of local anesthetics. TEACHING METHODS: Lectures, audiovisual presentations, case studies, clinical demonstrations, coordinated with laboratory/clinical practice in infiltration anesthesia. DHG 241 INTEGRATED DENTAL HYGIENE I 2013 LINKED CORE ABILITIES: 1. Reading – textbook assignments and handouts 2. Listening – note-taking 3. Writing – completing essay and short answer test questions 5. Problem solving/Critical thinking skills – recognition of anatomical landmarks in infiltration anesthesia, calculating dosage requirements, etc. INSTRUCTOR COMMUNICATION: Students are to check Wavenet at least weekly for messages via their e-mail accounts or other message boards that are available. Rather than the instructor making individual phone calls, students will be informed of necessary information via the Internet and their Wavenet accounts. The course syllabus and the handouts for each lecture will be uploaded to your Wavenet or D2L accounts. Students are to bring the handout to class. The instructor WILL NOT have extra copies of the handout available at the lecture. STUDENT RESPONSIBILITIES: Take ownership and responsibility for one’s learning. Students must have the understanding that all course material cannot be covered during lecture/laboratory time. Show respect for others. Engage in classroom activities. Exhibit respect for college property. Show respect for authority. Realize and understand the College’s Student Code of Conduct Please refer to Program Manual for further explanation of Student Responsibilities. ATTENDANCE: ATTENDANCE IS MANDATORY. Attendance will be taken at the beginning of each class. If a student is not present when attendance is taken, they will be counted absent even if they show up late. CELL PHONES ARE NOT ALLOWED IN THE CLASSROOM. They may be kept in your purse/bookbag, but MUST be turned off during lecture or lab. The only exception is if you have a sick family member that you must stay in contact with. In the event of a serious illness that exceeds the 10% policy (for this class, it will be a total of 5 hours), a credible excuse must be presented that states the reason for the absence and the length of time the student must be away from class. There are no excused or unexcused absences. Any time out is an absence, no matter the excuse. For each absence, the student MUST call the course instructor prior to the scheduled class time. Personal appointments MUST be scheduled outside of class time. For any absence, the student is responsible for the material covered in class. DHG 241 INTEGRATED DENTAL HYGIENE I 2013 MAKE-UP POLICY: Students are expected to be present for all tests. Make-up exams will be provided only in those exceptional cases where the student is able to provide clear and convincing evidence of a severe illness or emergency. The burden of proof rests with the student requesting the make-up exam. If the student has an exceptional circumstance and is going to miss an exam, the student must call the course instructor before the class meets. The final decision on whether or not to allow a make-up exam is at the professor’s discretion. Should the student be given the opportunity to take a make-up exam, IT MUST BE THE DAY THAT THE STUDENT RETURNS TO SCHOOL. If the student wishes to take their written test at the testing center, an appointment must be made with the testing center. Appointments MUST be made 24 hours in advance. The testing center will not accept same day appointments. It is the student’s responsibility to make the appointment and inform the instructor of the appointment time. This means the student must contact the Testing Center the day before returning to school to take the test within the required time frame as previously stated. Missed points on all make-up exams will be deducted from 92% instead of 100%; therefore, the highest possible grade on a make-up exam will be 92%. REMEDIATION/ENRICHMENT In order to keep the student on track and assist with maintenance of the required grade point average and course academic requirements for the Dental Sciences Department, the faculty will be tracking assignments and test grades. If any assignments/grades fall below a 77 (“C”), the student will be referred to the course instructor or the SSTC (Student Success and Technology Center) for guidance and assistance. ASSESSMENT MEASURES: Course Requirements: 1. In order to receive a passing grade for the course, the student must achieve a “C” or higher in both the clinical and the theory components of DHG 241. Grading Scale: 93-100 A 85-92 B 77-84 C 76-69 D 68 or below F 2. The numerical course average will be determined according to the following: DIDACTIC Quizzes Tests Final Exam 60% 30% 40% 30% DHG 241 INTEGRATED DENTAL HYGIENE I 2013 CLINICAL 40% 2 required “practice” injections 2 clinical competency injections 20% each 30% each STUDENTS WHO DO NOT MEET THE MINIMUM STANDARDS FOR THE COURSE WILL NOT BE ALLOWED TO PROGRESS IN THE DENTAL HYGIENE PROGRAM. REQUIRED SUPPLIES AND EQUIPMENT: Provided by the Program: Sterile packs, saliva ejectors and air/water tips Aspirating syringe and needle Various topical anesthetics Various injectable anesthetics Portable oxygen delivery unit Medical emergency kit Autoclave, infection control materials Skull Provided by the Student: (THESE WILL BE REQUIRED EACH TIME YOU ARE IN LAB) Blood pressure kit (you will take vital signs prior to each injection) Exam kit (Mirror and explorer) Protective eyewear, gloves, masks, and lab coat (HAIR MUST BE UP AND NO JEWELRY) Calculator Completed medical history and record of treatment page PREPARATION REQUIREMENTS FOR THE COURSE: 1. Make sure you have a completed medical health history for yourself. Throughout the course, you and your partner will anesthetize each other. 2. Revalidate your foundation knowledge of the following: Major features of the maxilla and the mandible Muscle of mastication Major divisions and the functional endpoint innervations of Cranial Nerves VII and IX Major features associated with the mandibular and maxillary divisions of the Trigeminal nerve, Cranial Nerve V Major blood vessels that supply the oral cavity and facial muscles Major salivary glands, ducts and site of entry into the oral cavity Gingival divisions: free gingiva, attached gingival, mucogingival junction CPR techniques Know the etiology, precipitating factors and signs/symptoms for the following medical emergencies: o Syncope o Acute adrenal insufficiency DHG 241 INTEGRATED DENTAL HYGIENE I 2013 o Hyperventilation o Acute asthmatic attack o Emphysema o Airway obstruction o Seizures o Diabetic emergencies o Stroke o Myocardial infarct o Angina pectoris o Anaphylaxis Know the appropriate management of the medical emergencies listed above. STUDENT REQUIREMENTS THROUGHOUT THE COURSE: 1. Arrive on time and be prepared. 2. Keep up with the weekly readings. 3. Know answers to the objectives at the beginning of each chapter. 4. Know answers to end-of-chapter questions. 5. Bring any questions to the next class for discussion. 6. Have all appropriate equipment for lab days. NOTE 1: Grades earned in courses impact academic progression and financial aid status. Before withdrawing from a course, be sure to talk with your instructor and financial aid counselor about the implications of that course of action. D’s, F’s W’s, WF’s and I’s also negatively impact academic progression and financial aid status. The ADD/DROP Period is the first 5 days of the semester for full term classes. ADD/DROP periods are shorter for accelerated format courses. The following week of the semester is Financial Aid Attendance Verification period. You must attend at least one meeting of all your classes during that period. If you do not, you will be dropped from the course(s) and your Financial Aid will be reduced accordingly. DHG 241 INTEGRATED DENTAL HYGIENE I 2013 COURSE CALENDAR (Subject to change) DATE 8-21-13 Lecture 8-28-13 Lecture 9-4-13 Lab 9-11-13 Lecture 9-18-13 Lecture 9-25-13 Lab 10-2-13 Lecture 10-9-13 Lecture TOPIC COURSE INTRODUCTION Pre-Test – Anatomical Landmarks History of Local Anesthetics Pain Management Neuroanatomy QUIZ 1 Review Neuroanatomy & Neurophysiology Pharmacology Dental Anesthetic Drugs (Lidocaine, Mepivacaine) TEST 1 Construct Needle Recapping Device Review OSHA/CDC Guidelines Armamentarium & Loading Sharp’s Disposal QUIZ 2 Dental Anesthetic Drugs cont’d. Vasoconstrictors QUIZ 3 Review Dental Anesthetic Drugs Review Vasoconstrictors Dose Calculation Topical Anesthetics Practice Injections Applying Topicals Maxillary Infiltration Review Palatal Infiltration TEST 2 Review Dose Calculation and Topical Anesthetics Patient Assessment Medical History Review Contraindications Trouble Shooting Inadequate Anesthesia QUIZ 4 Review Patient Assessment, et. al. Local Anesthesia Complications & Management Mandibular Arch Infiltration Fundamentals for Local Anesthetic Administration Mandibular Arch Infiltration Review Chap. 1-10 Review for Lab Competency QUIZ 5 Nitrous Oxide Sedation COMPREHENSIVE LAB COMPETENCY MAXILLARY ANESTHESIA COMPREHENSIVE LAB COMPETENCY MANDIBULAR ANESTHESIA NO CLASS THANKSGIVING 10-16-13 Lab 10-23-13 Lecture 11-6-13 Lecture 11-13-13 Lab 11-20-13 Lab 11-27-13 12-4-13 TBA COMPREHENSIVE FINAL EXAM Lab days are highlighted in yellow DEV. 8/03 ASD REV. 8/12 VS/ASD ASSIGNMENT Chap. 1-3 Chap. 4-5 Chap. 9 Chap. 5-6 Chap. 5-6 (Review) Chap. 7-8 Chap. 12-13 Chap. 7-8 (Review) Chap. 10 & 16 Chap. 10 & 16 (Review) Chap. 17 & 14 Chap. 11 Handouts DHG 241 INTEGRATED DENTAL HYGIENE I 2013 LECTURE OBJECTIVES Upon completion of the lectures and the reading assignments, the student will be able to: Local Anesthesia in Dentistry: Past, Present, and Future 1. Define and discuss the key terms in the chapter. 2. List early pharmacological agents used for pain. 3. Discuss problems with the use of cocaine as a local anesthetic drug. 4. Discuss the benefit of using epinephrine with local anesthetic drugs. 5. Discuss the significance of the local anesthetic agent procaine. 6. List the names and dates of development of the five common local anesthetic drugs in dentistry. 7. Discuss the evolution of syringes for delivery of local anesthetics. 8. Discuss future advances in dental local anesthesia. Fundamentals of Pain Management 1. Define and discuss the key terms of the chapter. 2. Discuss the value of pain as a protective response. 3. Discuss factors that can contribute to an individual’s response to a painful experience. 4. Discuss the tree general types of pain. 5. Differentiate between acute and chronic pain. 6. Explain the differences between pain perception and nociception. 7. discuss the physiological reactions of the sympathetic nervous system related to pain. 8. Discuss anxiety and fear as they relate to successful anesthesia. 9. Give examples of strategies that can help patients cope with fear and anxiety. 10. Discuss the influence of previous pain experiences on the ability to administer local anesthetic injections. The Neuroanatomy and Neurophysiology of Pain Control 1. Define and discuss the key terms of the chapter. 2. Explain the normal mechanisms of nerve impulse generation and conduction. 3. Define the events in successful nerve impulse generation, including the resting state, slow depolarization, firing threshold, rapid depolarization, and recovery. 4. Describe and explain the significance of Schwann cell sheaths and nodes of Ranvier on the ability of local anesthetic agents to work. 5. Describe the significance of the anatomical differences between sensory and motor neurons. 6. Identify and discuss the different types of nerve fibers, the differences in how they relate to pain perception, and be familiar with those that normally transmit pain sensations from dental and periodontal structures. 7. Differentiate anatomically and functionally between myelinated and unmyelinated nerves. 8. Discuss what is meant by anatomic barriers to the diffusion of anesthetic solutions and those that present the greatest challenges to diffusion. 9. Define the term dental plexus and describe where these structures are located. 10. Discuss the actions and effects of local anesthetic drugs on neural membranes. DHG 241 INTEGRATED DENTAL HYGIENE I 2013 Pharmacology Basics 1. Define the key terms in the chapter. 2. Discuss the pharmacologic properties of local anesthetic drugs and vasoconstrictors. 3. Discuss the specific receptor theory and membrane expansion theory. 4. Explain why tissue inflammation affects the success of local anesthesia. 5. Discuss the clinical relevance of pH and pKa. 6. Discuss the pharmacodynamics and pharmacokinetics of local anesthetic drugs. 7. Discuss the effects of local anesthetics on the central nervous system. 8. Discuss the effects of local anesthetics on the cardiovascular system. 9. Discuss the biotransformation pathways of amides and esters and the concept of elimination half-life. Dental Local Anesthetic Drugs 1. Define and discuss the key terms of the chapter. 2. Discuss similarities and differences between dental local anesthetic drugs. 3. Apply this knowledge to clinical situations in which the choice of local anesthetic and/or vasoconstrictor may directly affect safety and success. 4. Discuss and determine some situations in which specific drugs are indicated or contraindicated. 5. Discuss which local anesthetic solutions work reasonably well without vasoconstrictors and why they are more effective in those clinical situations. 6. Discuss when and why solutions with epinephrine and levonordefrin are indicated or contraindicated. Vasoconstrictors in Dentistry 1. Define and discuss the key terms in the chapter. 2. Discuss the overall similarities and differences among vasoconstrictors. 3. Discuss clinical situations in which the choice of vasoconstrictor may directly affect anesthetic success. 4. Discuss and determine situations in which specific vasoconstrictors may be indicated or contraindicated. 5. Discuss the difference in potency between epinephrine and levonordefrin. Dose Calculations for Local Anesthetic Solutions 1. Define and discuss the key terms in the chapter. 2. Define and discuss the significance of the maximum recommended doses for each local anesthetic drug and vasoconstrictor. 3. Identify and discuss the relevant information and mathematical operations required to calculate drug doses. 4. Demonstrate accurate calculations of recommended doses for local anesthetic drugs and vasoconstrictors in clinical situations. 5. Demonstrate accurate calculations of recommended doses when multiple drugs with differing concentrations are administered. 6. Define dose modification for vasoconstrictors in patients with significant cardiovascular compromise. 7. Demonstrate accurate calculations of recommended doses for local anesthetic drugs and vasoconstrictors for patients with significant cardiovascular compromise. 8. Demonstrate accurate calculation of recommended doses for children using Clark’s Rule and Young’s rule. 9. List maximum recommended doses for each local anesthetic drug and vasoconstrictor. DHG 241 INTEGRATED DENTAL HYGIENE I 2013 Topical Anesthetics 1. Define and discuss the key terms in this chapter. 2. Discuss the clinical applications of topical anesthetic drugs. 3. Discuss the most common methods of application. 4. Understand the concept of indications and contraindications of topical anesthetic drugs. 5. Discuss maximum recommended doses when provided by manufacturers and safe application habits when they are not provided. 6. Describe and recognize the signs and symptoms of adverse topical anesthetic drug reactions, both local and systemic. 7. Define and discuss eutectic mixtures including factors that determine their effectiveness. 8. Discuss what is meant by compounded drugs and proper guidelines for their use. Local Anesthetic Delivery Devices 1. Define and discuss the key terms in the chapter. 2. List and explain the purpose of each item in the basic armamentarium for anesthetic injections. 3. List and discuss the different types of syringes available for local injections. 4. Identify and explain the function of each component of a local anesthetic syringe. 5. Identify the components of a needle. 6. Discuss the factors to consider when selecting needles. 7. Describe the components of a local anesthetic cartridge. 8. List and describe the purpose of the contents in a cartridge. 9. Identify local anesthesia cartridges according to the ADA labeling system. 10. Discuss and demonstrate safe needle recapping and disposal procedures. Patient Assessment for Local Anesthesia 1. Define and discuss the key terms in the chapter. 2. Identify and discuss the responsibilities associated with the delivery of regional anesthesia. 3. Describe the ASA Physical Status Classification System categories. 4. Discuss patient assessment tools for evaluation of physical and psychological tolerance to local anesthesia. 5. Discuss the implications of patient evaluation in obtaining informed consent. 6. Identify and apply contraindications to the use of local anesthesia. 7. Discuss treatment modifications that can e made to increase patient safety and comfort with local anesthesia. 8. Discuss situations that require a medical consultation prior to treatment. 9. Identify signs and symptoms of undiagnosed medical conditions that can affect local anesthetic administration. 10. Discuss the importance of postanesthetic care. Fundamentals for Administration of Local Anesthetic Agents 1. Define and discuss the key terms in the chapter. 2. Identify and discuss key factors that impact the successful delivery of local anesthetic agents. 3. Identify and discuss the general principles and elements of informed consent. 4. Identify and discuss stress and anxiety factors that impact both patients and clinicians during the delivery of local anesthetic injections. 5. Discuss the impact of clinician/patient communications before, during, and after the delivery of local anesthetic injections. 6. Differentiate between the three basic types of injections. DHG 241 INTEGRATED DENTAL HYGIENE I 2013 7. 8. List and describe the basic steps involved in the delivery of local anesthetic injections. Identify and discuss the general principles of ergonomics during the delivery of local anesthetic injections. Injections for Maxillary Pain Control 1. Define and discuss the key terms in the chapter. 2. Describe and discuss the indications, relevant anatomy, and technique features of the injections discussed in this chapter. 3. Describe the basic technique steps for safe and effective administration for the following injections: Infiltrations Anterior superior alveolar nerve block Middle superior alveolar nerve block Infraorbital nerve block Posterior superior alveolar nerve block Injections for Palatal Pain Control 1. Define and discuss the key terms in this chapter. 2. Describe and discuss the indications, relevant anatomy, and technique features of the injections discussed in this chapter. 3. Describe the basic technique steps for safe and effective administration of the following injections: Nasopalatine nerve block Palatal anterior superior alveolar nerve block Anterior middle superior alveolar nerve block Greater palatine nerve block Injections for Mandibular Pain Control 1. Define and discuss the key terms in this chapter. 2. Describe and discuss the indications, relevant anatomy, and technique features of the injections discussed in this chapter. 3. Describe the basic technique steps for safe and effective administration for the following injections: Inferior alveolar nerve block Lingual nerve block Buccal nerve block Mental nerve block Incisive nerve block Gow-Gates mandibular nerve block Akinosi nerve block Injections for Supplemental Pain Control 1. Define and discuss the key terms in the chapter. 2. Describe and discuss the indications, relevant anatomy, and technique features of the injections discussed in this chapter. 3. Describe the basic technique steps for safe and effective administration for the following injections: Periodontal ligament Intraosseous DHG 241 INTEGRATED DENTAL HYGIENE I 2013 Intraseptal Intrapulpal Troubleshooting Inadequate Anesthesia 1. Define and discuss the key terms in the chapter. 2. Discuss the primary reasons for inadequate local anesthesia. 3. Understand the physiologic and anatomic basis of inadequate anesthesia. 4. Develop critical thinking skills to help overcome frustrating anesthetic challenges. 5. Develop strategies for addressing inadequate anesthesia. Local Anesthesia Complications and Management 1. Define and discuss the key terms in the chapter. 2. Discuss the most common adverse local and systemic events that may occur during and after local anesthetic drug administration. 3. Discuss appropriate responses and management of adverse local and systemic events. 4. Discuss protocols for the management of overdose and allergic events. 5. Define isiosyncratic events and discuss their management. Insights for the Fearful Patient 1. Define and discuss the key terms in the chapter. 2. Define and differentiate between the terms fear, anxiety, and phobia. 3. Understand the etiology and development of fear as it relates to pain and pain management. 4. Understand the primary sources for recognizing and assessing fears. 5. Understand and discuss the fundamental concepts of treatment for fearful and anxious patients. 6. Be able to relate a patient’s sense of control to his or her experienced level of fear or anxiety. 7. Explain four useful types of control for anxious patients receiving injections. 8. Be familiar with teach patients physical relaxation and coping skills, including deep breathing and muscle relaxation. 9. Be able to apply appropriate fear management strategies and coping skills to the administration of local anesthetics. 10. Understand and be prepared to explain the benefit of rehearsals, time structuring, and biofeedback to fearful patients. 11. Understand and be prepared to explain the benefit of rehearsals, time structuring, and biofeedback to fearful patients. 12. Describe benefits and techniques for testing local anesthetic effectiveness. 13. List and describe the steps involved in the protocol for anesthetic testing. Insights from Pedodontics 1. Define and discuss key terms in the chapter. 2. Apply the principles of local anesthetic drug toxicity to compute safe doses for pediatric patients based on body weight. 3. Relate effective anesthesia to the management of pediatric behavior. 4. Provide age-appropriate explanations of the local anesthesia experience for pediatric patients. 5. Describe injection technique modifications for small children. 6. Recognize and manage postanesthetic trauma. 7. Understand the supportive role of the dental auxiliary in successful anesthesia delivery for children.