Pain and Anxiety (DENT 5201)
Course Syllabus, Spring Session 2009
2-620 Moos Tower
Course Director
Administrative Information
Dr. Deepak Kademani
1.2 credits
Division of Oral and Maxillofacial Surgery
Lecture Location: 2-620 Moos Tower
7-174 Moos Tower
14 lecture hours, 2 separate laboratories
Office Phone: 612-624-7133
E-mail: cock0023@umn.edu
Office hours: By appointment only; contact by phone or email to schedule.
Note
This didactic course is combined with separate local anesthesia and nitrous oxide labs.
Information about the labs will be sent out at a future time.
 Friday April 10, 2009, 1:00-5:00 – Local Anesthesia Lab – 8 South (all students)
 Thursday May 28, 1:00 – 5:00 – Nitrous Oxide Lab – OMS Clinic (all students)
Course Purpose
This course offers a multi-disciplinary introductory level course to the diagnosis and
management of pain and anxiety control in dentistry.
Course Objectives
Upon completion of the course, the student will understand the basic principles of:
1. The definition of pain mechanisms
2 Neuropathic pain of dental and non-dental origin
3. Chronic pain
4. Local anesthesia: Pharmacology and dosing
5. Local anesthesia: Armamentarium and maxillary blocks and techniques
6. Local anesthesia: Mandibular blocks and techniques
7. Local anesthesia: Complications
8. Anxiolysis/sedation techniques
9. Nitrous oxide sedation: State practitioner regulations and office considerations
10. Nitrous oxide sedation: Complications
11. Nitrous oxide sedation: Clinical uses and controversies procedures
12. Postoperative pain management
13. Developing an anesthetic treatment plan
School of Dentistry Competencies Addressed in this Course
1.1:
1.2:
1.3:
Selecting, obtaining, and interpreting patient data, information and radiographs to be
able to use these findings to accurately assess and treat patients. (major part of course)
Formulating a comprehensive diagnosis and treatment and or referral plan for the
management of patients. (minor part of course)
The prevention, assessment, and management of medical and dental emergencies.
(major part of course)
1.6:
Managing the medically, physically and/or mentally compromised dental patient. (major
part of course)
1.7:
1.11:
Preventing and managing pain and anxiety in the dental patient. (minor part of course)
Applying universal infection control guidelines for all clinical procedures. (minor part of
course)
2.1:
Apply appropriate communication skills in providing patient-centered health care to a
diverse population. (minor part of course)
Pain and Anxiety Spring Session 2008, Course Syllabus
3.1:
4.2:
4.4:
Apply appropriate ethical and legal standards in providing patient centered care within
the individual’s scope of competence. (minor part of course)
Maintaining and utilizing dental records. (minor part of course)
Understanding and demonstrating principles of risk management, including compliance
with state and federal regulations. (minor part of course)
Course Textbooks (Required)
Handbook of Local Anesthesia. Malamed, Stanley F. 5th Ed. CV Mosby Co, 2004.
Management of Pain & Anxiety in the Dental Office, Dionne, Phero, Becker, W.B. Saunders
Company, 2002
***************Reading assignments according to lecture schedule***************
See lecture schedule for reading assignments. Reading assignments should be
studied prior to lecture.
Grading and Evaluation Policies
There will be a mid-term and a final examination. The mid-term and final examinations will
consist of a format to be determined by the course director. The examinations will include
questions from both lecture material and textbook reading assignments. Many of the questions
will be based on case-based scenarios similar to cases presented at lecture.
The midterm will consist of questions related to lectures given before that date. The final will
consist of questions related to lectures given after the midterm.
The final grade is based upon the following:
Midterm: 60%
Final:
40%
100%
The grading scale is as follows:
90-100 = A
80-89.9 = B
70-79.9 = C
< 70 = F
Student Expectations
Since attendance at these lectures is viewed to be important, the course director or instructors
may record attendance, institute assigned seating, administer quizzes, ask questions in class,
or give written assignments. These tools may be used to motivate students or measure
progress in the assimilation of the required material.
Student’s evaluation of the course and the participating faculty are considered to be a
mandatory requirement for the successful completion of this course and are used to help
improve the course each year. Students will be required to complete evaluations on line (using
CourEval) before a grade will be given in this course.
Grade Disputes
Grade disputes will follow University and SOD policies listed in the student handbook. All grade
disputes must first be addressed to the course director.
Pain and Anxiety Spring Session 2008, Course Syllabus
Remediation Policy
Remediation will be determined on an individual basis and could include a retest of some
portion of the course or could include the retaking of the course at the suggestions of the course
director.
All student failures are reviewed by the Scholastic Standing Committee and the ultimate
decision for remediation for students in academic difficulty lies with that committee.
Make-Up Exam Policies
A make-up exam will be offered to a student with a documented legitimate excuse for missing
the exam. The following events excuse an absence from the exam: documented illness, family
emergency, School of Dentistry sponsored event, an act of nature causing the closure of the
University or local roads, an event considered significant enough to be excusable by the course
director. Students absent from the exam without an excused absence will be offered the makeup exam, but the final grade will be reduced by one letter grade (i.e. B to C).
Attendance
Students are expected to promptly attend all lectures. Students will be responsible for all
material distributed at or discussed during lectures. Much of the information presented in the
course is related to clinical background and may not be found in the textbook.
If you are unable to attend class due to a medical or family emergency, you should contact the
Academic Affairs attendance office at 612-624-3300 or dentars@umn.edu.
Student Integrity
Scholastic misconduct is broadly defined as “any act that violates the right of another student in
academic work or that involves misrepresentation of your own work. Scholastic dishonesty
includes, (but is not necessarily limited to) cheating on assignments or examinations,
plagiarizing, which means misrepresenting as your own work any part of work done by another;
submitting the same paper, or substantially similar papers, to meet the requirements of more
than one course without the approval or consent of all instructors concerned; depriving another
student of necessary course materials; or interfering with another student’s work.
Academic dishonesty in any portion of the academic work for a course shall be grounds for
awarding a grade of F or N for the entire course.
Communication
All individual and full class communication will be through your University of Minnesota e-mail
account. Announcements intended for the whole class will be sent by e-mail. It is a
requirement of the course to check your e-mail daily. While in class, please turn off all pagers
and cellular phones.
Disabilities
It is University policy to provide, on a flexible and individualized basis reasonable
accommodations to students who have documented disability conditions (e.g., physical,
learning, psychiatric, vision, hearing, or systemic) that may affect their ability to participate in
course activities or to meet course requirements. Students with disabilities are encouraged to
contact Disability Services and their instructors to discuss their individual needs for
accommodations. Disability Services is located in Suite 180 McNamara Center, 200 Oak
Street. Staff can be reached by calling 612-626-1333 voice or TTY.
Pain and Anxiety Spring Session 2008, Course Syllabus
Faculty Course Lecturers
Dr. Pamela Hughes – 612-624-7133
Dr. David Basi – 612-625-7133
Dr. James Swift - 612-624-9959
Dr. Mike John – 625-6521
Dr. Deepak Kademani – 624-7133
Course Times and Rooms
Note times and locations under each lecture.
MIDTERM EXAMINATION
Date: February 19, 2009
Time: 8:00-8:50
Location: 2-620Moos Tower
REVIEW OF COURSE CONTENT – Students ask questions of instructor
Date: April 23, 2009
Time: 8:00-8:50
Location: 2-620 Moos Tower
FINAL EXAMINATION
Date: May 7, 2009
Time: 08:00-10:00
Location: TBD
Pain and Anxiety Spring Session 2008, Course Syllabus
Lectures for Pain and Anxiety- Winter Session (DENT 5201)
LOCAL ANESTHESIA PHARMACOLOGY/ DOSING
CHAPTERS 1 - 4 (HANDBOOK OF LA, MALAMED)
Date:
JANUARY 8, 2009, THURSDAY
Time:
8:00-8:50
Room:
2-620 Moos Tower
Presenter:
Dr. Deepak Kademani
 Pharmacology of LA
 Pharmacology of vasoconstrictors
 Contraindications/ medically compromised patients
 Pediatric dosing
The student will:
• review the theoretical mechanism of action of local anesthetics in relation to nerve conduction
• review the molecular structure of amide/ ester local anesthetics
• review common local anesthetic agents including topical agents
• discuss the Henderson-Hasselbach equation in regards to onset of action, effects of pH on
action of agents
• review the contents of a local anesthetic carpule- including preservatives, vasoconstrictor
• provide examples of calculation of anesthetic dose contained in glass carpules including local
anesthetic, epinephrine as well as modifications in dose (i.e. “cardiac patient”)
LOCAL ANESTHESIA ARMAMENTARIUM, MAXILLARY ANESTHESIA
CHAPTERS 5 - 13 (HANDBOOK OF LA, MALAMED)
Date:
JANUARY 15, 2009, THURSDAY
Time:
8:00 – 8:50
Room:
2-620 Moos Tower
Presenter:
Dr. Pamela Hughes
● Armamentarium
 Maxillary anatomy
 Review maxillary blocks, infiltration
 Complications associated with maxillary anesthesia
The student will:
• review different syringe/ needle systems commonly used for the delivery of local
anesthesia
• discuss use of aspirating syringe, benefits of aspiration
• review common anesthetic blocks including infraorbital, PSA, palatine, V2, local
infiltration
MANDIBULAR ANESTHESIA
CHAPTERS 14 - 15 (HANDBOOK OF LA, MALAMED)
Date:
JANUARY 22, 2009, THURSDAY
Time:
08:00-08:50
Room:
2-620 Moos Tower
Presenter:
Dr. James Swift
 Mandibular anatomy
 Review types of mandibular blocks, infiltration
 Complications associated with mandibular anesthesia
The student will:
• review common mandibular blocks including- V3, long buccal, inferior alveolar,
Gow-Gates, Akinosi closed-mouth technique, mental
Pain and Anxiety Spring Session 2008, Course Syllabus
COMPLICATIONS OF LOCAL ANESTHESIA
CHAPTERS 16 - 19 (HANDBOOK OF LA, MALAMED)
Date:
JANUARY 29, 2009, THURSDAY
Time:
08:00-08:50
Room:
2-620 Moos Tower
Presenter:
Dr. Deepak Kademani
● Review common complications & management
 Review anesthesia toxicity- signs and symptoms
 Discuss chemical neurotoxicity
The student will:
• illustrate common complications and their management including hematoma,
block failure
• review local anesthesia overdose- signs and symptoms
• provide examples of calculations for safe dosing of common local anesthetic agents
• discuss the potential for nerve damage from local anesthesia (i.e. articaine)/
administration techniques
NITROUS OXIDE PHARMACOLOGY
CHAPTERS 11, 12, 14 (MGMT OF PAIN & ANXIETY..., DIONNE ET AL)
Date:
February 5, 2009, THURSDAY
Time:
08:00-08:55
Room:
2-620 Moos Tower
Presenter:
Dr. James Swift
 Discuss MAC, blood/ gas coefficient
 Nitrous oxide properties: concentration effect, second gas effect, diffusion
hypoxia
 Describe cardiovascular events related to nitrous oxide use
 Armamentarium and clinical uses
 Complications
The student will:
• review cardiac cycle, normal blood flow through right and left sides of heart
• review pulmonary function, alveolar gas exchange
• discuss ventilation vs oxygenation and the normal respiratory response to CO2 (to be
contrasted with O2 drive in later lecture reviewing long term effects of COPD)
• illustrate normal expiratory function as part of ventilation; FEV1 (to be compared to asthma
patient in later lecture)
• discuss concept of MAC, blood/ gas partition coefficient (compare nitrous to other
anesthetic agents)
• define properties of nitrous oxide in relation to pharmacology including concentration effect,
second-gas effect, diffusion hypoxia
• describe cardiovascular effects secondary to nitrous oxide use (i.e. vasodilitation); compare to
other sedative agents/techniques
Pain and Anxiety Spring Session 2008, Course Syllabus
NITROUS OXIDE- STATE REGULATIONS, OSHA STANDARDS
CHAPTER 2, 3, 9, 10 (MGMT OF PAIN & ANXIETY..., DIONNE ET AL)
Date:
February 12, 2009, THURSDAY
Time:
08:00-08:55
Room:
2-620 Moos Tower
Presenter:
Dr. James Swift
 discuss pregnancy and nitrous oxide
 office ventilation/ scavenger use
 new MN regulations for nitrous oxide use
 legal considerations
The student will be able to discuss:
• pregnant patient/ pregnant office staff
• office ventilation/ scavenger use- acceptable limits of nitrous in ambient room air
• nitrous abuse
• legal considerations
MIDTERM EXAMINATION
Date: FEBRUARY 19, 2009, THURSDAY
Time: 08:00-8:50
Location: 2-620 Moos Tower
OVERVIEW OF SEDATION: DEFINITIONS, PHYSICAL EVALUATION AND PATIENT
ASSESSMENT
CHAPTERS 15 - 17 (MGMT OF PAIN & ANXIETY..., DIONNE ET AL)
Date:
FEBRUARY 26, 2009, THURSDAY
Time:
08:00-08:50
Room:
2-620 Moos Tower
Presenter:
Dr. Pamela Hughes
- discuss definitions for different levels and routes of sedation
- identify monitor and documentation required for sedation
- identify patients who are candidates for conscious sedation
The student will be able to:
 evaluate the dental patient to determine ASA status
 determine appropriateness for selection of sedation candidates
 discuss levels of monitoring and documentation required for sedation
SEDATION COMPLICATIONS, MANAGEMENT OF MEDICAL EMERGENCIES
CHAPTERS 18 - 20 (MGMT OF PAIN & ANXIETY..., DIONNE ET AL)
Date:
March 12, 2009, THURSDAY
Time:
08:00-08:50
Room:
2-620 Moos Tower
Presenter:
Dr. James Swift
● Discuss common cardiovascular complications associated with sedation techniques
 Discuss common respiratory complications associated with sedation
 Identify common reversal agents used in conscious sedation
 Discuss emergency algorithms for cardiovascular, pulmonary, endocrine and CNS
emergencies
The student will be able to identify potential complications associated with sedatives and
different treatment strategies to manage these complications.
Pain and Anxiety Spring Session 2008, Course Syllabus
CHRONIC PAIN
CHAPTERS 23, 24 (MGMT OF PAIN & ANXIETY..., DIONNE ET AL)
Date:
MARCH 26, 2009, THURSDAY
Time:
08:00-08:50
Room:
2-620 Moos Tower
Presenter:
Dr. Mike John, TMD
● Neurophysiology
 Types of chronic pain, dental and non-dental origins
 Examination of chronic pain patient
 Treatment of common chronic pain disorders
The student will:
• compare and contrast characteristics of acute versus chronic pain
• describe the biomedical and biopsychosocial models for pain
• discuss contributing factors for chronic pain
• briefly review treatment for chronic pain using the biopsychosocial mode
PAIN MECHANISMS & MANAGEMENT
CHAPTERS 21, 22 (MGMT OF PAIN & ANXIETY..., DIONNE ET AL)
Date:
APRIL 2, 2009, THURSDAY
Time:
08:00-08:50
Room:
2-620 Moos Tower
Presenter:
Dr. Pamela Hughes
 Pain definitions
 Neurophysiology
 Chemical mediators of pain
 Common medications for postoperative pain management
The student will:
• define pain and anxiety and the role of physiology, psychology, and culture on pain
and anxiety perception
• define the term, “pain threshold”
• describe normal nerve conduction
• describe the common chemical mediators of pain (i.e. prostaglandins, substance P,
etc.) and the interaction of pain and inflammation
DEVELOPING AN ANESTHETIC PLAN
Date:
APRIL 9, 2009, THURSDAY
Time:
08:00-08:50
Room:
2-620 Moos Tower
Presenter:
Dr. David Basi
 use case-based examples
 complex medical history
 prolonged cases
 anxious patient
The student will:
• review considerations related to patient age, anxiety, underlying medical condition, length and
degree of stimulation of the procedure
• consideration to office-based vs hospital or operating room setting, precautions to be taken
Pain and Anxiety Spring Session 2008, Course Syllabus
REVIEW OF COURSE CONTENT – Students ask questions of instructor
Date: April 23, 2009
Time: 08:00-08:50
Location: 2-620 Moos Tower
Presenter: Dr. Deepak Kademani
FINAL EXAMINATION
Date: May 7, 2009
Time: 08:00-9:55
Location: TBD