Pain Management
Theory of Pain Control
1. Clinical attire- scrubs
2. Cell phones off during class
3. Restrooms- by main entrance & women’s locker
room
4. Continental breakfast and snacks at 3:00 p.m.
5. Vending Machines
6. Parking- Riverside Hall lot or lot across the street
Indiana HB 1172 (Signed 3/24/08)
This bill allows dental hygienists to administer local
anesthesia under direct supervision and expands the
current law to allow prescriptive supervision in
hospitals, clinics, fixed charitable institutions,
public health settings and correctional institutions.
Under prescriptive supervision, the physical
presence of a dentist is not required, but the dentist
must have examined the patient and prescribed the
patient care within the previous 45 days.
Website to register for NERB Local Anesthesia Exam:
http://www.nerb.org/b/candidate_manuals_nerb_b.html
PAIN & ANXIETY MANAGEMENT
“Dental fear or anxiety affects approximately
three-fourths of the total world’s population.”
Darby/Walsh
Patient Anxiety and Pain
-To recognize a patient’s
anxiety and pain is an
integral component of the
dental hygiene care plan
Components of Pain
-Pain perception- neurologic
experience
-Pain reaction- interpretation and
response to the pain message
Dental Phobia
-Situation is avoided or endured with intense
anxiety
-Interferes with normal routine
Dental Fear and Anxiety
-Dental fear is defined as an unpleasant
mental, emotional, or physiologic sensation
derived from a specific dental-related stimulus
-Dental anxiety is nonspecific, unease,
apprehension, or negative thoughts about what
may happen during a dental appointment
Dental Fear and Anxiety
-The effects of fear on the body
include dilated pupils, increased
respiration, heart rate, blood pressure,
etc. These effects are a result of the
sympathetic nerve endings producing
epinephrine
Psychogenic
-A patient’s anticipation leading up to an
injection may lead to hyper-ventilation and/or
syncope
-Thorough review of medical history and
discussion with the patient may give the
professional the insight to reduce or prevent
negative psychogenic responses
Tell me about your previous
dental experiences……
• Previous bad experience.
• Fear of the needle.
• Heard of bad experiences from family or
friends.
• 50-80% of dental fear and anxiety happens
during childhood/ adolescence.
Patient Fear of
Dental Procedures
-Understanding and acknowledging a patient’s
fear of the needle or a specific dental
procedure may help to reduce their anxiety
Sensory Cues
-In treatment areas keep
instruments, needle, and the
syringe out of patient’s sight
-The syringe should be passed
behind the patient’s head so the
needle is not seen
Behavior Management Techniques
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Tell-show-do
Behavior modeling
Distraction
Relaxation therapy
Guided imagery
Progressive relaxation
Systematic desensitization
Need specialized training
Hypnosis
Management of the Patient
-Build patient trust
-Communication
-Tell-show-do
Traditional Pain Control
Methods
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Topical anesthetics
Desensitizers
Nitrous oxide-oxygen sedation
Local anesthetics
IV sedation
Sedatives/anti anxiety meds
General anesthesia
PAIN MANAGEMENT QUIZ
1. The onset of 50-80% of dental fear and anxiety
happens:
a. During childhood/adolescence
b. During adulthood
c. After the first dental procedure
d. After a person hears of bad dental
experiences from others
2. The effects of fear on the body include dilated
pupils, increased respiration, heart rate, blood
pressure, etc. These effects are a result of the
sympathetic nerve endings producing:
a. Endorphins
b. Epinephrine
c. Acetylcholine
d. Seratonin
3. Pain is always physiological, never psychological.
a. True
b. False
4. What two behavior management techniques must a
dental hygienist be specially trained for?
a. Distraction, guided imagery
b. Relaxation therapy, guided imagery
c. Systematic desensitization, hypnosis
d. Hypnosis, progressive relaxation
5. Sensory cues may cause dental fear and anxiety. What
can be done to reduce this?
a. Showing the syringe/needle to the patient
b. Not telling the patient you’re going to give them an
injection
c. Let the patient hold the syringe/needle first
d. Passing the syringe/needle behind the patient’s head
so it isn’t seen