Pain Management in Dental Hygiene
Chapter Exam Questions
Course Introduction
This course explores the principles and techniques of pain management essential for dental hygienists, emphasizing both local anesthesia and non-pharmacological methods to enhance patient comfort during dental procedures. Students will study the physiology of pain, assessment strategies, pharmacology of commonly used anesthetic agents, and safe administration practices. The curriculum also covers patient-centered strategies to address anxiety and special considerations for managing pain in diverse populations. Clinical experiences and case discussions prepare students to deliver effective, safe, and ethical pain management within the dental hygiene scope of practice.
Recommended Textbook
Local Anesthesia for the Dental Hygienist 1st Edition by Demetra D. Logothetis
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Chapter 1: Local Anesthesia in Dental Hygiene Practice: an Introduction
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Sample Questions
Q1) The use of anesthesia as needed is an important key to what?
A) Understanding why patients are fearful of dental appointments
B) Preventing fear associated with pain
C) Ensuring patient comfort and adequate care
D) B and C
Answer: D
Q2) The first objections to the use of inhalation sedation included which of the following?
A) It was viewed as a religious offense
B) It was viewed as an unethical practice
C) It was viewed as a retardant to the health process
D) All of the above
Answer: D
Q3) Procaine
A)ester (E)
B)amide (A)
C)inhalation drug (I)
Answer: A
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Page 3
Chapter 2: Neurophysiology
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Sample Questions
Q1) As the action potential moves down the line,its strength decreases as it moves from one neuron to the next.The action potential in myelinated axons does not propagate as waves as in unmyelinated axons.
A) Both statements are true.
B) Both statements are false.
C) The first statement is true; the second statement is false.
D) The first statement is false; the second statement is true.
Answer: D
Q2) Nerve fiber type _____ ,the largest nerve fiber with the fastest conduction velocity,is responsible for what type of pain?
A) A alpha; pain related to temperature
B) A delta; sharp pain
C) B; touch and pressure pain
D) C; dull, aching pain
Answer: B
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Chapter 3: Pharmacology of Local Anesthetic Agents
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Sample Questions
Q1) What is another name for the elimination of the local anesthetic from the blood and tissues?
A) Tachyphylaxis
B) Dissociation constant
C) Half-life
D) Distribution barriers
Answer: C
Q2) Intravascular injections significantly increase the possibility of an overdose.
A)True
B)False
Answer: True
Q3) What factor/factors determine the severity of an overdose reaction to local anesthetic?
A) Degree of drop in blood pressure
B) Time lapse between the administering of the local anesthetic to the overdose
C) Number of symptoms patient experiences
D) All of the above
Answer: B
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Chapter 4: Pharmacology of Vasoconstrictors
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Sample Questions
Q1) Why might it not be safe to administer epinephrine to a patient taking MAO inhibitors?
A) Because epinephrine creates a hemostasis environment
B) Because the action of epinephrine is terminated by monoamine oxidase concentrated in the liver
C) Because epinephrine is a synthetic sympathomimetic amine that exerts its action predominately on alpha receptors
D) Because patients taking MAO inhibitors should have a physician consult before local anesthetic is administered
Q2) Why are vasoconstrictors added to local anesthetics?
A) To increase the potency of the local anesthetic
B) To inhibit the oxidation of the local anesthetic
C) To counteract the vasodilating properties of the local anesthetic
D) All of the above
Q3) Once epinephrine is absorbed,what happens to the action of the epinephrine?
A) It is activated in order to provide vasoconstriction.
B) It is deactivated in order to provide hemostasis.
C) It is altered due to the presence of enzymes.
D) It is terminated by reuptake by adrenergic nerves.
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Page 6
Chapter 5: Local Anesthetic Agents
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Sample Questions
Q1) What is the solution that is added to the cartridge of local anesthetic to prevent oxidation of the vasoconstrictor called?
A) Vasoconstrictor preservative
B) Sodium hydroxide
C) Sodium chloride
D) Methylparaben
Q2) What is the term used to describe the persistent anesthesia or the altered sensation of tingling or itching beyond the expected duration of local anesthetic?
A) Paresthesia
B) Paralysis
C) Prolonged anesthesia
D) None of the above
Q3) What is the name of the only topical amide anesthetic currently on the dental market in the United States?
A) Levonordefrin
B) Lidocaine
C) Benzocaine
D) Butacaine
Q4) Which two local anesthetic agents have the least vasodilating properties?
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Chapter 6: Topical Anesthetic Agents
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Sample Questions
Q1) Which of the following are considered advantages for the use of topical anesthetic agents?
1) Pain control2. Stimulation of gag reflex3. Can be purchased over the counter4. Ease of use
A) 1, 4
B) 1, 3, 4
C) 1, 2, 3, 4
D) Some other combination
Q2) Tetracaine hydrochloride has a rather slow onset of action; however,it can last approximately 45 minutes.
A)True
B)False
Q3) What is the available concentration of Oraqix?
A) 5% lidocaine and 5% prilocaine
B) 2.5% lidocaine and 2.5% prilocaine
C) 14% Benzocaine, 2% butamben, and 2% tetracaine hydrochloride
D) 20% Benzocaine and 5% lidocaine
Q4) List common forms of topical anesthetics used in dentistry.
Q5) List the methods for delivery of topical anesthetic drugs.
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Chapter 7: Preanesthetic Assessment
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Sample Questions
Q1) Patients with renal dysfunction
A)Life-threatening syndrome caused by general anesthetics
B)Avoid use of vasopressors; may lead to myocardial infarction
C)Competitively inhibits PABA in microorganisms
D)Will inhibit the reuptake of vasoconstrictor
E)Frequently prescribed for the treatment of myasthenia gravis and glaucoma
F)Increases effects of epinephrine; avoid levonordefrin
G)Use esters or amides judiciously because they may increase risk of toxicity
H)Administer prilocaine or articaine because this drug reduces liver capacity to metabolize amides
I)Administer prilocaine or articaine as these drugs decrease hepatic blood flow
J)Limit amount of vasopressor because it can increase ocular pressure
Q2) Vasoconstrictors are an absolute contraindication for a patient with uncontrolled diabetes.
A)True
B)False
Q3) Vasoconstrictors can increase a patient's blood pressure.
A)True
B)False
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Page 9
Chapter 8: Determining Drug Doses
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Sample Questions
Q1) If a patient's MRD is 240 mg and 108 mg of 3% mepivacaine has already been administered,how much more mepivacaine can the patient receive?
A) 0 mg of 3% mepivacaine; a different local anesthetic should be selected
B) 30 mg of 3% mepivacaine
C) 348 mg of 3% mepivacaine
D) 132 mg of 3% mepivacaine
Q2) Which of the following is the first step in calculating the additional dose of a different drug?
A) Calculate how many milligrams of drug #1 have already been administered.
B) Calculate MRD of drug #2.
C) Review patient's history to determine appropriateness of new drug.
D) Consult with dentist and/or physician.
Q3) What is the limiting factor for anesthetic in a compromised patient?
A) Concentration of anesthetic
B) Vasoconstrictor
C) Patient's weight
D) Length of appointment
Q4) What is the formula for calculating the milligrams of solution in one cartridge of the selected anesthetic?
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Chapter 9: Armamentariumsyringe Preparation
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Sample Questions
Q1) What should the clinician do if the harpoon does become disengaged during aspiration?
A) Seek help from the dentist.
B) Do not let the patient know and continue with the procedure, but document the incident in the chart notes.
C) Remove the syringe, remove the needle, reengage the harpoon, reattach the needle, and then continue with the procedure.
D) Gently reengage the harpoon while maintaining correct injection site position.
Q2) When does the needle become dull?
A) It does not become dull because it is disposable.
B) After three to four needle penetrations.
C) After five to six needle penetrations.
D) After it is sterilized.
Q3) According to Malamed,what kind of needles are most likely to break?
A) 30-gauge short or ultrashort needles
B) 25-gauge long needles
C) Short needles, no matter the gauge
D) Long needles, no matter the gauge
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11
Chapter 10: Anatomic Considerations for the
Administration of Local Anesthesia
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Sample Questions
Q1) Which nerve provides sensory information for the teeth and associated tissue?
A) V nerve
B) Fifth cranial nerve
C) Trigeminal nerve
D) All of the above
Q2) What is the name of the foramen located posterior to the maxillary central incisors?
A) Mental foramen
B) Infraorbital foramen
C) Incisive foramen
D) Lingual foramen
Q3) Maxillary central incisors,lateral incisors,and canines
A)Anterior superior alveolar nerve
B)Middle superior alveolar nerve
C)Posterior superior alveolar nerve
D)Greater palatine nerve
E)Nasopalatine nerve
F)Lingual nerve
G)Mental nerve
H)Incisive nerve
Page 12
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Chapter 11: Basic Injection Techniques
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Sample Questions
Q1) If the harpoon disengages during an aspiration,the clinician must remove the needle from the tissue and re-embed the harpoon in to the rubber stopper.
A)True
B)False
Q2) Why is the aspiration a necessary part of administering local anesthesia?
A) To ensure that the needle has not entered a blood vessel
B) To dramatically decrease the incidence of an intravascular injection
C) a and b
D) For patient comfort
Q3) Cartridges of local anesthetics contain 1.8 mL of solution-except articaine,which contains 1.7 mL of solution.How fast should articaine be injected?
A) At a rate of 1.7 mL per minute
B) At a rate of 1.8 mL per minute
C) At a rate of 1.8 mL per 2 minutes
D) At the rate that is comfortable for the patient
Q4) List the specific local anesthetic information that should be included in the chart documentation.
Q5) Name the four anesthetic administration techniques.
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Chapter 12: Maxillary Nerve Anesthesia
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Sample Questions
Q1) What is a good reason not to use distracters when administering maxillary anesthesia?
A) The clinician needs her fingers for retraction of the upper lip.
B) Pulpal anesthesia may be blocked.
C) Movement may cause the anesthetic not to be placed at the target area.
D) All of the above.
Q2) Pulpal anesthesia of the mesiobuccal root of the maxillary first molar in 28% of the population
A)Anterior superior alveolar injection
B)Middle superior alveolar injection
C)Posterior superior alveolar injection
D)Infraorbital
E)Nasopalatine
F)Greater palatine
Q3) Which of the following are reasons for inadequate anesthesia?
A) Deposition of the solution superior to the apex of the tooth.
B) Dense bone covers the apices of the teeth as seen in children.
C) The apex of the tooth lies beneath the maxillary sinus.
D) All of the above.
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Page 14
Chapter 13: Mandibular Nerve Anesthesia
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Sample Questions
Q1) When administering the IA block injection,what other nerve may inadvertently be anesthetized?
A) PSA
B) Facial nerve
C) Lingual nerve
D) Mandibular nerve
Q2) What area should the clinician palpate in order to determine the location of the mental foramen?
A) Directly below the mandibular notch on the ramus of the mandible
B) Between the mandibular first and second premolars
C) From the mandibular first molar to the distal surface of the canine
D) On the lingual and at the apex of the mandibular incisors
Q3) Where should the injection site for an IA block injection be located if the clinician notices a double mandibular canal on dental images?
A) Superior to the usual anatomic landmarks for the IA block
B) Inferior to the usual anatomic landmarks for the IA block
C) Slightly distal to the apex of the mandibular second premolar
D) Slightly mesial to the apex of the mandibular first molar
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Chapter 14: Local Anesthetic Complications
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Sample Questions
Q1) Which of the following are true of topical anesthetics used in dentistry?
A) Lidocaine may contain preservatives such as the parabens that could induce an allergic response.
B) Topicals with bisulfites could induce an allergic response.
C) Benzocaine is a commonly used amide topical anesthetic that can contribute to an allergic reaction.
D) a and b
Q2) Cardiovascular signs of toxicity of local anesthetic solution include which of the following?
A) Myocardial stimulation
B) Cardiac dysrhythmias
C) Cardiotoxicity in pregnancy
D) b and c
Q3) Which of the following best practices will help to prevent infection caused by the administration of local anesthetic?
A) Wipe needle with disinfectant
B) Store anesthetic cartridges in disinfectant solutions
C) Sheath needle before and immediately after injection
D) All of the above
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Chapter 15: Legal Considerations and Risk Management
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Sample Questions
Q1) How long does the qualified health care provider have to provide the employer with a written report?
A) 10 days
B) 15 days
C) 1 month
D) As long as necessary
Q2) What must the qualified health care professional consider when assessing the need for follow-up of occupational exposures?
A) Susceptibility of exposed person
B) Infectious status of source
C) Amount of fluid/tissue involved in the exposure
D) All of the above
Q3) Most states require the dental hygienist to apply for an additional local anesthesia license or certificate in lieu of the regular dental hygiene license to legally administer local anesthetics.
A)True
B)False
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