CHATTANOOGA STATE COMMUNITY COLLEGE
CHATTANOOGA, TENNESSEE
ALLIED HEALTH DIVISION
COURSE SYLLABUS
DH 255 Dental Hygiene Pain Management
Instructor: Hartly Varnell; Michelle Mould Credit Hours: 4
Angie Maida; Judy Mabe
Phone: (423) 697-4768 Semester: Summer
E-mail: hartly.varnell@chattanoogastate.edu Room: 2031 & 2007 HSC
Catalog Course Description:
This course is designed to prepare dental hygiene students to safely and competently administer local
anesthetic agents and nitrous oxide sedation to control dental related pain with a minimum of patient
discomfort. Included are content areas in anatomy, physiology, pharmacology, and emergency
management as they relate to the administration of local anesthetics, nitrous oxide, and pain control.
Laboratory sessions are structured to develop actual experiences in administration of local anesthetics
and nitrous oxide. Various mechanisms for pain control are also covered; Satisfactory/Non-Satisfactory
grading; Lab 6 hours;
Prerequisites:
Completion of DH 132,135,142,145
Students must hold current CPR certification (AHA Healthcare Provider Level)
Textbook/Materials:
Handbook of Local Anesthesia (current addition)-Malamed
Dental syringe (aspirating style)
Student Learning Outcomes (Program Student Learning Outcomes & Course Student Learning
Outcomes)
PSLO #1: The dental hygiene program exists to prepare graduates to protect him/herself and
their patient from harm during assessment, planning, implementation and evaluation procedures.
CSLO 1-1: Recognize potential emergency situations and respond according to
established protocols.
CSLO 1-2: Practice in accordance with the state rules and regulations that govern the
practice of dental hygiene.
CSLO 1-3: Comply with OSHA infection control guidelines to control the spread of
infectious diseases.
PSLO #2: The dental hygiene program exists to prepare graduates to assess a patient’s medical
and dental history and oral soft and hard tissues using systematic data collection and analysis.
CSLO 2-1: Assess a patient’s medical and dental history employing principles of
pharmacology.
PSLO #3: The dental hygiene program exists to prepare graduates to plan realistic treatment and
prevention goals and strategies using effective decision making procedures.
PSLO #4: The dental hygiene program exists to prepare graduates to treat dental diseases by
providing dental hygiene care, recommending dental treatment, and evaluating outcomes.
CSLO 4-1: Manage a patient’s dental pain with an understanding of the physiological,
psychological, and pharmacological implications of various drugs and their interactions
with the human body.
PSLO #5: The student will prevent dental diseases by providing patient care services and
planning, and implementing community health programs.
PSLO #6: The dental hygiene program exists to prepare graduates who exhibit the values and
skills necessary for life-long learning, self-improvement, and professional development.
Instructional Activities
Lecture
Collaborative group activities
Role play scenarios
Information and Technology: internet, audio, video
Clinical/laboratory applications
Required Assessments:
A. Daily Quizzes:
1. Armamentarium for Local Anesthetic Administration (PSLO 1;CSLO 1-3)
2. Basic Injection Techniques and Anatomical Considerations (PSLO 4;CSLO 4-1)
3. Pain (Neurophysiology & Behavior Management (PSLO 4;CSLO 4-1)
4. Pharmacology of Local Anesthetic Agents (PSLO 4; CSLO 4-1)
5. Pharmacology of Vasoconstrictors (PSLO 4;CSLO 4-1)
6. Patient Evaluation & Communication (PSLO 2;CSLO 2-1)
7. Local & Systemic Complications (PSLO 1;CSLO 1-3)
8. Administration & Monitoring of Nitrous Oxide (PSLO 4;CSLO 4-1)
9. Supplemental Techniques (PSLO 4;CSLO 4-1)
10. General Legal Considerations and State Practice Act (PSLO 1;CSLO 1-2)
11. Analgesics (PSLO 4;CSLO 4-1)
12. Anti-anxiety Drugs (PSLO 4;CSLO 4-1)
B. Written Competency Examinations
1. Comprehensive Local Anesthesia Final (PSLO 1;CSLO 1-1,1-2,1-3/PSLO 2;CSLO 2-
1/PSLO 4;CSLO 4-1)
2. Comprehensive Nitrous Oxide Final (PSLO 1;CSLO 1-1,1-2,1-3/PSLO 2;CSLO 2-1/PSLO
4;CSLO 4-1)
C. Additional Graded Activities: Satisfactory or Non-satisfactory
1. Administration of PSA & MSA injections (PSLO 1;CSLO 1-1,1-2,1-3/PSLO 2;CSLO 2-
1/PSLO 4;CSLO 4-1)
2. Administration of ASA injection (PSLO 1;CSLO 1-1,1-2,1-3/PSLO 2;CSLO 2-1/PSLO
4;CSLO 4-1)
3. Administration of GP & NP injections (PSLO 1;CSLO 1-1,1-2,1-3/PSLO 2;CSLO 2-1/PSLO
4;CSLO 4-1)
4. Administration of M injection (PSLO 1;CSLO 1-1,1-2,1-3/PSLO 2;CSLO 2-1/PSLO 4;CSLO
4-1)
5. Administration of the IA(L) & LB injection (PSLO 1;CSLO 1-1,1-2,1-3/PSLO 2;CSLO 2-
1/PSLO 4;CSLO 4-1)
CSLO/Assessment Alignment
Course
DH 255
CSLO 1-1
CSLO 1-2
CSLO 1-3
Local & Systemic Complications
Comprehensive Local Anesthesia
Final
Comprehensive Nitrous Oxide Final
Administration of PSA & MSA
injections
Administration of ASA injection
Administration of GP & NP injections
Administration of M injection
Administration of the IA(L) & LB
injection
State Practice Act
Supplemental Techniques &
General Legal Considerations
Comprehensive Local
Anesthesia Final
Comprehensive Nitrous Oxide
Final
Administration of PSA & MSA
injections
Administration of ASA injection
Administration of GP & NP
injections
Administration of M injection
Administration of the IA(L) & LB
injection
Armamentarium/Local
Anesthetic
Comprehensive Local
Anesthesia Final
Comprehensive Nitrous Oxide
Final
Administration of PSA & MSA
injections
Administration of ASA injection
Administration of GP & NP
injections
Administration of M injection
Administration of the IA(L) & LB
injection
CSLO 2-1
CSLO 4-1
Patient Evaluation & Communication
Comprehensive Local Anesthesia
Final
Comprehensive Nitrous Oxide Final
Administration of PSA & MSA
injections
Administration of ASA injection
Administration of GP & NP injections
Administration of M injection
Administration of the IA(L) & LB
injection
Basic Injection Techniques and
Anatomical Considerations
Pain (Neurophysiology &
Behavior Management)
Pharmacology of
Vasoconstrictors
Pharmacology of Local
Anesthetic Agents
Basic Injection Techniques and
Anatomical Concerns
Administration & Monitoring of
Nitrous Oxide
Analgesics
Anti-anxiety Drugs
Comprehensive Local
Anesthesia Final
Comprehensive Nitrous Oxide
Final
Administration of PSA & MSA
injections
Administration of ASA injection
Administration of GP & NP
injections
Administration of M injection
Administration of the IA(L) & LB
injection
Course Grading Policy
All Chattanooga State dental hygiene clinical applications courses are graded on a satisfactory/non-
satisfactory basis. No letter grade is given. To receive a "satisfactory" in DH 255 Dental Hygiene Pain
Management, you must,
Attend ALL scheduled classes and clinic sessions. This course introduces new injections and
evaluates previously introduced injections each week. As you will actually be injecting a drug into
another person, you will not be allowed to administer local anesthetic injections or nitrous oxide in
the clinic/lab if you have not attended the associated lecture. With only 6 weeks in the semester,
there will not be time for make-up sessions. TN State Law requires mandatory attendance in
all course and clinical work related to the administration of local anesthesia and nitrous
oxide to be eligible for certification.
Satisfactorily perform all injections (3 attempts given). Critical errors in technique will result in no
credit for a specific attempt. See your advisor if competency is in question.
Earn at least a cumulative score of 80% on the 10 daily quizzes. Half of the quizzes will be taken
on your own. Half will be taken in small randomly chosen groups. These quizzes are given at the
beginning of each lecture over that day's module.
Complete the Nitrous Oxide Process Evaluation. (with assistance)
Satisfactorily complete the DH 255 comprehensive written final examinations. **TN state law
requires a minimum grade of 75% on the written nitrous exam and a minimum grade of 70% on
the written local anesthesia exam for state licensure. Remediation and re-examination will be in
compliance with the TN state dental practice act.
Satisfactorily complete the DH 255 clinical final examination. (2 randomly selected injections
(without assistance)
Comply with all OSHA, CDC, & TN BOD personal and patient safety requirements required for
the administration of local anesthetic agents and nitrous oxide sedation.
All other required activities and activities associated with modules are graded on a satisfactory/non-
satisfactory basis and must be graded "satisfactory."
An intervention plan will be developed if it appears to your advisor that you may be at risk for an non-
satisfactory.
Students receiving a non-satisfactory will not be able to continue in the program. Their case will be
reviewed by the Dental Hygiene Re-admittance Committee regarding re-admittance into the program.
Weekly Topic and Exam Schedule
MONDAY
TUESDAY
THURSDAY
FRIDAY
8:00 - 10:00
Classroom
10:15-5:15
(One hour lunch)
Clinic
#1 Week of 5/17
8 AM
10:15 AM
Mon
First Day of Classes
Introduction
Quiz #1
Module
Armamentarium for Local Anesthesia Administration
Introduction and Review
Anatomy, Syringe Assembly, etc.
Tues
Wed
Quiz # 2
Module
Basic Injection Technique and Anatomical Considerations
Introduction to the PSA and MSA
Malamed text Chapter 13
Practice
PSA & MSA
Thur
Fri
#2 Week of: 5/24
8 AM
10:15 AM
Mon
Quiz # 3
Module
Pain (Neurophysiology and Behavioral Management)
Jeopardy Game Handout
Introduction to the ASA
Malamed text Chapter 13
Eval on PSA & MSA
Practice ASA
Tues
Wed
Quiz # 4
Module
Pharmacology of Local Anesthetic Agents
Introduction to the GP & NP
Malamed text Chapter 13
Eval on ASA
Practice GP & NP
Thur
Fri
#3 Week of: 5/31
8 AM
10:15 AM
Mon
Memorial Day - No Class
Tues
Wed
Quiz # 5
Module
Pharmacology of Vasoconstrictors
Introduction to the Mental
Malamed text Chapter 14
Documentation Exercise Due
Eval GP & NP
Practice Mental
Thur
Fri
#4 Week of: 6/7
8 AM
10:15 AM
Mon
Quiz # 6
Quiz # 7
Modules
Patient Evaluation and Communication
Local and Systemic Complications
Introduction to the IA (L) & Long Buccal
Malamed text Chapter 14
Documentation Feedback Due
Eval Mental
Practice IA (L) & LB
Tues
8:30-1:00pm Room 1087
Module
Administration and Monitoring of Nitrous Oxide
Quiz #8 (end of lecture)
(DH and DA together)
Drug Definitions Assignment Due
Wed
NO CLASS
Thur
Fri
#5 Week of: 6/14
8 AM
10:15 AM
Mon
Quiz # 9
Module
Supplemental Techniques and General Legal Considerations
Nitrous Process Eval
Eval IA/L & LB
State Practice Act: What the law says the RDH can do!
http://health.state.tn.us/Boards/Dentistry/index.htm
follow the above line to the TN BOD and search for the Dental
Hygiene Practice Act...review the rules and regulations for the
administration of local anesthesia by the dental hygienist; be
prepared for classroom discussion
Review and Practice Maxillary
Injections
Tues
Wed
Quiz # 10
Modules
Analgesics
Anti-Anxiety Drugs
**All reading assignments come from Haveles textbook-bring to
class
**Bring Drug Handbook to class
Nitrous Process Eval Continued
Review and Practice Mandibular
Injections
Thur
Fri
#6 Week of: 6/21
8 AM
10:15 AM
Mon
Comprehensive Written Final Exams
Local Anesthesia Exam - 70 questions
Nitrous Oxide Exam - 30 questions
**TN state law requires a minimum grade of 75% on the written nitrous exam
and a minimum grade of 70% on the written local anesthesia exam for state
licensure.
Clinical Final Exam
Demonstrate 2 random
injections with no assistance
Tues
Wed
Remediation as indicated
Grades Due
College Policies
This class is governed by the policies and procedures stated in the current Chattanooga
State Student Handbook. Additional or more specific guidelines may apply.
ADA Statement
Students who have educational, psychological, and/or physical disabilities may be eligible for
accommodations that provide equal access to educational programs and activities at
Chattanooga State. These students should notify the instructor immediately, and should contact
Disabilities Support Services within the first two weeks of the semester in order to discuss
individual needs. The student must provide documentation of the disability so that reasonable
accommodations can be requested in a timely manner. All students are expected to fulfill
essential course requirements in order to receive a passing grade in a class, with or without
reasonable accommodations.
Disruptive Students
The term “classroom disruption” means – student behavior that a reasonable person would view
as substantially or repeatedly interfering with the activities of a class. A student who persists in
disrupting a class will be directed by the faculty member to leave the classroom for the remainder
of the class period. The student will be told the reason(s) for such action and given an
opportunity to discuss the matter with the faculty member as soon as practical. The faculty
member will promptly consult with the division dean and the college judicial officer. If a disruption
is serious, and other reasonable measures have failed, the class may be adjourned, and the
campus police summoned. Unauthorized use of any electronic device constitutes a disturbance.
Also, if a student is concerned about the conduct of another student, he or she should please see
the teacher, department head, or division dean.
Affirmative Action
Students who feel that he or she has not received equal access to educational programming
should contact the college affirmative action officer.
Academic Integrity/Academic Honesty
In their academic activities, students are expected to maintain high standards of honesty and
integrity. Academic dishonesty is prohibited. Such conduct includes, but is not limited to, an
attempt by one or more students to use unauthorized information in the taking of an exam, to
submit as one's own work, themes, reports, drawings, laboratory notes, computer programs, or
other products prepared by another person, or to knowingly assist another student in obtaining or
using unauthorized materials. Plagiarism, cheating, and other forms of academic dishonesty are
prohibited. Students guilty of academic misconduct, either directly or indirectly through
participation or assistance, are immediately responsible to the instructor of the class. In addition
to other possible disciplinary sanctions, which may be imposed through the regular institutional
procedures as a result of academic misconduct, the instructor has the authority to assign an "F"
or zero for an activity or to assign an "F" for the course.
Email Communication
Please note all communication with instructors about your course work should be through the
eLearn Email system. For assistance on how to use the eLearn Email tool go to this url:
http://river.chattanoogastate.edu/orientations/Student_PDFs/eLearn_eMail_aug09.pdf.
For all other communication the official email system used by the college is through Tiger Mail.
This is accessible by clicking the blue paw icon from the top right hand side of your Tiger Web
home page https://tigerweb.chattanoogastate.edu/cp/home/displaylogin.
The instructor reserves the right to modify this syllabus in writing during the course of the
semester.
Program Policies
FIRE PROCEDURE
The following is the procedure if the fire alarm sounds:
Classroom HSC #2031 or Clinic HSC #2007
Exit the building using the closest stairway
Walk to TTC parking lot on the far side of the pond (500 feet away from HSC building)
Do not reenter the building until notified,
MEDICAL EMERGENCY PROCEDURE
If a person in or around the dental clinic demonstrates any symptoms of a potential life
threatening situation, including chest pain, breathing difficulties, nausea, bleeding, or
lightheadedness, the following procedure should be employed:
The student should discontinue all treatment and alert a faculty member of the situation,
The faculty member should assess and do one of two things,
1. Immediately call 911 and initiate basic life support,
2. Contact (in order of availability) the Dental Hygiene Director, the Dean of Nursing and
Allied Health, or a member of the Respiratory Therapy faculty,
Under the direction of a faculty member, the student should be prepared to assume their role as
an emergency team member and be prepared to:
1. Retrieve the AED (Automatic External Defibrillator) - located in the Second Floor of
HSC (across from elevators)
2. Administer oxygen
3. Secure the emergency kit
4. Secure the first aid kit
5. Assist with CPR
Contact campus security: 605-4092 (cell), 846-0268 (pager), 697-4467 (security office) or Chief
Hill 697-4476
INJURY PROCEDURE
When a non life threatening injury occurs to anyone in or around the dental clinic or dental
laboratory alert a faculty member to the situation, then,
Eye Injury
Determine if contaminants are still in the eye,
If appropriate, secure the MSDS information for instructions (Call 1-800-451-8346)
Remove the contaminant using appropriate equipment including the eye wash station,
Percutaneous Injury
Stop any bleeding,
If appropriate, secure the MSDS information for instructions (Call 1-800-451-8346),
Clean and dress the wound as necessary,
Determine if infectious material is involved and if follow up care is necessary including
testing for blood borne pathogens or tetanus. If testing is deemed necessary, it will be
done at the student’s expense.
Complete an Injury Report form obtained from the clinic coordinator.
HAZARDOUS WASTE SPILL PROCEDURE
In the event of a hazardous waste spill in or around the dental clinic, the following procedure
should be employed;
Contact a faculty member immediately,
Identify the spilled material,
Use the MSDS information (available by calling 1-800-451-8346) to determine precautions,
Secure safety attire including gloves, glasses and gown,
Secure the hazardous waste spill kit,
Clean the spill using the material in the kit,
Dispose of the spill in the hazardous waste disposal box
BLOODBORNE PATHOGEN POLICY
See the Nursing and Allied Health Student Handbook.
PROGRAM FORMAT & PRINTING POLICY
The dental hygiene program at Chattanooga State is considered a "hybrid" program, meaning
that the format requires significant online activity. Students in hybrid courses must access
course content and assessments using the internet in order to pass the courses and successfully
progress through the program. You will need access to Microsoft Office 2007 WORD and
PowerPoint to complete required assignments and activities over the duration of the program.
Additionally, access to a high-speed internet connection is imperative.
All course materials including syllabi, learning objectives, handouts, etc. are accessed online at
http://dhonline.chattanoogastate.edu/opener.htm. Faculty are not required to supply any printed
materials to the students.
It is highly recommended, due to the amount of material, that students save documents to a flash
drive or their home computer, rather than print paper copies. The Dental Hygiene Department
cannot print documents or make copies for students. Campus printing services are available for a
fee through the library or the college print shop located in OMN 161.
CELL PHONE POLICY
Cell phones are NOT permitted in the classroom or the clinic (even if they are turned off or
set to vibrate). Please leave cell phones in your lockers. Text messaging and
making/receiving personal calls during class or clinic is not professional or acceptable. You may
check for messages at breaks, lunch, etc. In the event that someone needs to contact you during
class or clinic, please give that person the phone number of the Clinic Coordinator, Linda Sparks.
423-697-4481.She will come and get you if you receive an emergency phone call.
CONTINUATION/RETENTION POLICY
If a student receives a "D" or an "F" in a non-dental hygiene didactic course, that course must be
repeated unless the student receives a waiver from the Dental Hygiene Re-admittance Committee.
Students receiving a "D" or "F" in a dental hygiene didactic course or a "non-satisfactory" in a
dental hygiene applications course will not be allowed to continue in the dental hygiene program.
The Dental Hygiene Re-admittance Committee will review each such case and make a
recommendation regarding re-admittance. Because dental hygiene courses are only offered
once a year, re-admittance may be delayed.
Students failing first semester courses will be placed in the applicant pool for the next class and
will be considered with all other applicants. There is no guarantee a failing student will be
readmitted.
A student may only be readmitted once.
DISABILITY POLICY
Students who have educational, psychological, and/or physical disabilities may be eligible for
accommodations that provide equal access to educational programs and activities at
Chattanooga State. These students should notify the instructor immediately, and
should contact Disabilities Support Services (S-226, phone 697-4452) within the first two
weeks of the semester in order to discuss individual needs. The student must provide
documentation of the disability so that reasonable accommodations can be requested in a timely
manner. All students are expected to fulfill essential course requirements in order to receive a
passing grade in a class, with or without reasonable accommodations
ACADEMIC INTEGRITY
Students in the dental hygiene program are on their honor. In the event a student does not
respect that honor and flagrantly plagiarizes, cheats, misrepresents the truth, or any other act
considered by the academic community to be illegal, unethical or immoral, that student, at the
discretion of the faculty, may be dismissed from the program.
STUDENT PREGNANCY POLICY
A student who becomes pregnant during matriculation must provide a signed statement from her
physician indicating she may continue in the program. A student will be given every reasonable
consideration. Please notify your advisor as soon as possible to discuss possible accommodations for
the semester.
With regard to exposing radiographs, according to Tennessee State law it is up to the student to make a
declaration of pregnancy. If a student makes such a declaration, she must provide a written statement
from her physician indicating that she may expose radiographs if established safety protocols are
followed.
BLOOD PRESSURE POLICY
All adult patients treated in the CHSCC Dental Hygiene Clinic have their blood pressure and pulse taken
at the beginning of every dental hygiene visit. Patients are verbally informed of these readings prior to
initiating treatment.
The table below depicts blood pressure categories utilized by this program.
BP Category
Systolic
Diastolic
Normal
< 120
< 80
Pre-hypertension
120-139
80-89
Hypertension Stage 1
140-159
90-99
Hypertension Stage 2
>160
>100
Wilkins, E.M. (2009). Clinical Practice of the Dental Hygienist, 10th Ed., Lippincott, Williams, & Wilkins;
p: 136.
Any patient with a systolic reading > 160 and/or diastolic reading > 100 will be advised to consult their
physician for further blood pressure evaluation.
If a patient with these readings is already being treated for hypertension, the student and instructor
together, will determine whether contact with the patient's physician is necessary prior to the provision
of routine dental hygiene care. This decision must be based on the treatment planned, length of
appointment, and any other medical risk factors.
If the patient is not under the care of a physician, the student, the instructor, and the supervising dentist
together, will determine if the patient may be treated at that time based on the treatment planned, length
of appointment, and any other medical risk factors. The patient will still be advised to consult a physician
for evaluation.
A blood pressure reading > 180/110 requires automatic patient dismissal and a written physician's
signed release prior to being rescheduled in the CSTCC DH Clinic. *[Wilkins, E.M. (2009). Clinical
Practice of the Dental Hygienist, 10th Ed., Lippincott, Williams, & Wilkins; p:143]
CPR POLICY
See the Nursing and Allied Health Student Handbook. A copy of your current CPR card must be given
to the clinical coordinator.
LIABILITY INSURANCE
Students are required to maintain liability insurance each semester of enrollment. The insurance is
purchased at the Bursar's office following acceptance and prior to enrollment in the first clinical course.
The insurance is in effect for one year from the date of purchase. The insurance must be renewed each
year and is required to be in place for regional clinical boards.
DRESS POLICY
The Dental Hygiene Program adheres to the Dress Code/Personal Hygiene Expectations set by the
Division of Nursing and Allied Health. A copy of these expectations is available in the Nursing and Allied
Health Student Hand Book.
Professional dress is necessary at all times, especially in or around the clinic area where patients are
being treated. Patient rapport and trust begins immediately when the patient sees you and your
classmates.
The following are specific when you are assigned to be in the clinic:
short fingernails; artificial nails and any polish (even clear) are prohibited due to infection
control
hair for males and females should be such that it is off the collar and does not fall forward
into the face or work area when the head is bent
beards for males must be short and neatly trimmed around the neck and mouth.
one pair of small stud earrings, no additional ear piercings
simple watch, no necklaces or bracelets (unless medical warnings)
no visible body piercings; tattoos must be covered
one smooth wedding band (if applicable); no stones, grooves, crevices, etc.
avoid perfume, lotion, tobacco smoke, etc. - patients may allergic
clinic shoes must be close-toed and close-heeled; they should be predominantly white and
kept clean at all times
clean and appropriately hemmed scrubs; calf-length white socks
clean clinic coat (please inspect clinic coat prior to entering clinic, if it is torn, stained, etc.
please give it to Linda Sparks and select a different coat)
PREMEDICATION POLICY
As of June 2007 guidelines regarding premedication before dental care have changed. Please go to the
following website to see the new guidelines
New Guidelines for Antibiotic Prophylaxis