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GDHA LOCAL ANESTHESIA FOR DENTAL HYGIENIST’S CERTIFICATION COURSE

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On June 1, 2023, local anesthesia for Georgia dental hygienists went into effect. Under Georgia Board of Dentistry Rule 150-5-.07,
a dental hygienist under the direct supervision of a Georgia licensed dentist may administer local anesthesia for hygiene purposes, including intraoral block anesthesia, soft tissue infiltration anesthesia, or both, to a non-sedated patient who requires local anesthesia for pain management and who is 18 years of age or older if the following criteria are met.

Kathy Bassett.jpg

Kathy Bassett, BSDH, RDH, MEd, QOM

COURSE DIRECTOR, Kathy Bassett, BSDH, RDH, MEd

Kathy has served 34 years as a Professor of Dental Hygiene at Pierce College, Lakewood, WA; and as an Affiliate Professor in the Departments of Oral Health Sciences and Periodontics at the University of Washington, School of Dentistry, Seattle, WA. Kathy has served as course director for CODA approved initial training in local anesthesia for dental hygiene students and as a clinical instructor for dental students.  As local anesthesia rules were adopted in northeastern states, she facilitated initial training and contracted “Train-the-Trainer” education for dental hygiene faculty throughout the Northeast, and corporate clinical educators.  She is a co-author of the textbook Local Anesthesia for Dental Professionals (current Revised 2nd Edition) and has authored numerous dental hygiene textbook chapters on local anesthesia including Clinical Practice of Dental Hygiene by Esther Wilkins, Mosby’s Dental Hygiene: Concepts, Cases, and Competencies, and numerous articles including issues of Dimensions of Dental Hygiene, Decisions in Dentistry, Dental Advisor, Todays RDH, and others.  Additionally, Kathy has presented hundreds of CE lectures and workshop courses on dental local anesthesia at numerous dental hygiene and dental conferences nationally and internationally, including co-presenting with other dentist educators and speakers.  Kathy also has 43 years of experience as a restorative expanded functions dental hygienist whose primary duties included administering local anesthesia for all types of dental procedures to include restorative, periodontal, endodontic, and oral surgery.

Course Information
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PREREQUISITES:

To register for this course, participants must:

  1. Be able to participate as both clinicians and patients*.

  2. Provide a copy of their current dental hygiene license.

  3. Provide a copy of their current CPR certification.

  4. Provide a copy of their current malpractice insurance.

*Accommodations for participants with medical conditions that may preclude them from safely sitting as patients, will be considered on a case-by-case basis, and addressed as possible in consultation with the supervising dentists.

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COURSE OBJECTIVES:

After completing this course, participates shall:

  1. Integrate facts and concepts related to neurophysiology, pharmacology, pharmacokinetics and pharmacokinetics, and mechanism of action in to the safe selection of dental local anesthetic agents and accurate calculation of drug doses.

  2. Recognize anatomical facts and concepts related to common dental local anesthetic injection techniques in the orofacial complex including bony and soft tissue landmarks, muscles, vasculature, and pathways of the facial and trigeminal nerves.

  3. Communicate patient health factors impacting drug selection, the safe administration of dental local anesthetic drugs and prevention of adverse events to dental and healthcare professionals, and patients.

  4. Demonstrate clinically acceptable armamentarium management and injection techniques for safe and effective administration of dental local anesthetic agents.

  5. Manage common local and systemic adverse events and potential medical emergencies related to the use of local anesthesia in dentistry.

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COURSE POLICIES:

To receive documentation of course completion, participants must:

  1. Read and be familiar with the Participants Course Curriculum Guide/Syllabus prior to the first class session (provided to Participants upon registration).

  2. Provide a current comprehensive medical history and list of any medications taken, and medical release if indicated for participation in the clinic portion of this course.

  3. Complete an Informed Consent to sit as a patient for the clinical component of this course. 

  4. Read all assigned materials (including but not limited to the assigned textbook chapters) prior to participation in the clinical component of this course. 

  5. View all assigned video and recorded materials prior to participation in the clinical component of this course. 

  6. Complete all assignments and study guides as defined in the Participants Course Curriculum Guide/Syllabus (provided to Participants upon registration) prior to participation in the clinical component of this course. 

  7. Maintain internet access for all web-based and self-instruction assignments throughout the course.

  8. Attend and complete all in-person laboratory and clinical components of this course.

  9. Both a written and clinical examination will be administered with a minimum score of eighty percent (80%) in the parenteral administration of local anesthesia and successful students shall be awarded certification. Testing accommodation will be handled on a case by case basis.

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REQUIRED TEXT AND RESOURCES

The GDHA Local Anesthesia Course Curriculum Guide and Syllabus will be provided to participants upon registration.

  1. The required* textbook for this course is: Local Anesthesia for Dental Professionals by Bassett, DiMarco and Naughton, Revised 2nd Edition, 2022 Update. Pearson Higher Education.  ISBN-13: 978-0-13-307771-1  (*not included in the course fee)

  2. The following state resources are recommended for informational purposes:

  3. Study resources include companion materials to the required textbook.  These will be provided online during the course:

  • VIDEOS - Successful Local Anesthesia for Dental Professionals by Royer and Paarmann, 2012.

  • Text study guides and worksheets

   4. Recommended References and Study Materials:

The following are strongly recommended reference materials. Students should refer to their previous dental hygiene textbooks for 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); Management of the Medically Compromised Patients; Management of the Medical Emergencies; and CDC Infection Control Guidelines (including post-exposure follow-up procedures). 

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COURSE OUTLINE [Topics]

  1. Overview of O.C.G.A. 43-11-74 and Georgia Board of Dentistry Rule 150-5-.07 [presented by GDHA].

  2. Theory of pain and anxiety control and pain-control modalities.      

  3. Anatomy, Neurophysiology and neurochemistry related to the administration of local anesthetic.

  4. Pharmacology of local anesthetics and vasoconstrictors.

  5. Armamentarium.

  6. Physical and psychological aspects of pain control.

  7. Anatomic considerations, clinical applications, and injection techniques.

  8. Local and systemic complications.

  9. Techniques of maxillary anesthesia.

  10. Techniques of mandibular anesthesia.
    Infection control.

  11. Safety Injection practices.

  12. Medical emergencies involving local anesthesia.

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COURSE CONTENT

  1. Evolution of local anesthesia and armamentarium in dentistry including the origins and principles of chemical pain control, key developers and timelines, and benchmark local anesthesia products.

  2. History of use of local anesthetics by dental hygienists.

  3. Overseeing practice act and state regulations.

  4. Indications for local anesthesia in dental and dental hygiene practice.

  5. Pain control concepts and fundamentals of pain management.

  6. Neuroanatomy and neurophysiology of nerve membranes, nerve impulse initiation, conduction and propagation, and pain control concepts.

  7. Neurophysiology of the cranial nerves responsible for sensory and motor functions in the head, neck, and orofacial complex.

  8. Pharmacological basis of dental local anesthetic drugs, vasoconstrictors, and topical anesthetics.

  9. Pharmacological properties of common dental anesthetic drugs to include onset, absorption, vasodilatation properties, duration of action, distribution, metabolism, and excretion

  10. Clinical significance of the pharmacokinetics and pharmacodynamics of local anesthetic agents

  11. Pharmacological properties impacting the clinical effectiveness of local anesthetic agents

  12. Theoretical basis for effects of local anesthetic agents in humans and perspectives on local anesthesia for dental professionals.

  13. Drug factors required for dose calculations to include vasoconstrictors, limiting drug, multiple drugs, and drug MRDs

  14. Establishing and calculating maximum recommended dosages of local anesthetics related to use in dentistry.

  15. Armamentarium, local anesthetic delivery devices and clinical supplies for local anesthesia administration to include components of delivery devices and drug cartridges.

  16. Safe and effective handling, use, and maintenance of dental anesthetic syringes to include manual, safety and computerized delivery devices.

  17. Exposure control and safety guidelines for handling needles, drug cartridges, and syringes.

  18. Pre-injection patient assessment and treatment planning for local anesthesia and management of local and systemic complications related to local anesthetic injections.

  19. ASA classifications for assessment of patient medical status prior to administration of local anesthetics.

  20. Relative and absolute contraindications to dental local anesthetic agents

  21. Local and systemic effects of local anesthetic agents on the central nervous system, cardiovascular system, peripheral vasculature and respiratory system.

  22. Anatomy relevant to the administration of local anesthetics by injection for maxillary, palatal, and mandibular pain control in dentistry.

  23. Key injections landmarks of bony structures, soft tissues, and muscles associated with anatomical barriers to successful anesthesia

  24. Vessels and nerves of the orofacial complex relevant to dental injections to include arteries, veins, branches and pathways of CN-V (trigeminal) nerve and CN-VII (facial), and structures innervated by each.

  25. Potential drug interactions with local anesthetic agents.

  26. Signs and symptoms of adverse reactions to local anesthetics to include toxicity, allergy, and idiosyncrasy.

  27. Management of complications and medical emergencies related to local anesthetic administration and anesthesia.

  28. Clinical manifestations of mild to moderate to high levels of local anesthetic toxicity.

  29. Technique implicated complications related to local anesthetic administration

  30. Fundamentals of administration of local anesthetic agents and basic steps for administering dental injections for maxillary, palatal, and mandibular pain control in dentistry.

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CURRICULUM:

This hybrid* course facilitates 30 hours of didactic studies via live synchronous webinars and/or asynchronous self-directed instruction with no less than 5 hours in-person. 15 hours pre-clinical laboratory activities, and 15 hours clinical injection experiences distributed as follows:

 

30 Hours Didactic Instruction

  • 2 Hours Scope of Pain and Anxiety Control

  • 2 Hours Management of Pain and Anxiety

  • 3 Hours Head and Neck Anatomy

  • 3 Hours Patient Medical Assessment

  • 2 Hours Pharmacology of Local Anesthesia

  • 2 Hours Pharmacology of Vasoconstrictors

  • 2 Hours Armamentarium–Infection Control

  • 8 Hours Techniques of Local Anesthesia

  • 2 Hours Local and Systemic Complications and Legal Considerations

  • 4 Hours Emergency Medical Procedures

 

15 Hours Lab - Preparation and Administration of Local Anesthetics
Includes: review of landmarks for maxillary and mandibular soft tissue infiltration and nerve block injections, handling of syringes and armamentarium, chairside factors to enhance safe handling of syringes, chairside management for drug calculations, and documenting injection procedures, alterations to care, complications, management, and follow-up.

  • Student-instructor ratio no greater than 1:5

  • Includes practical competency examination (must pass at 80%).

 

15 Hours Clinical Injections - Administration of Local Anesthetics

The administration of maxillary and mandibular soft tissue infiltration and nerve block injections for dental local anesthesia.
Includes: documenting injection procedures, alterations to care, complications, management, and follow-up.

  • Option 1: Provided in an affiliated dental educational institution hosting lab and clinic components of this course.

  • Option 2: Provided under the supervision of practicing dentist(s) in a clinic hosting lab and clinic components of this course.

  • Option 3: Provided by respective employer(s).

 

*This course is designed so it may be taken as an initial training of 60 hours in dental local anesthesia by dental hygienists, or as select modules to provide additional hours of study for dental hygienists previously trained in CODA-approved dental hygiene programs.

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EVALUATION and GRADING

  • Formative evaluation and feedback will be given for all lab and clinical activities.

  • Summative evaluation and feedback will be given for select clinical activities.

  • Didactic [Cognitive] Assessment: Participants will be evaluated by written examination.

    •  Competency examinations require a score of 80% or higher to pass this course.

  • Clinical Assessment: Participants will be evaluated by clinical lab examination in the parenteral administration of soft tissue infiltration and nerve block injections.

    • Competency examinations require a score of 80% or higher to pass this course.

  • Upon successful completion of this course, participants shall be awarded a certificate of completion for 60 hours.
     

*This course is designed so it may be taken as select modules to provide additional hours of study for dental hygienists previously trained in CODA-approved dental hygiene programs. Upon successful completion of hours and modules as needed participants may be awarded a certificate of completion commensurate with the hours and modules completed.

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