Pain Control Midterm: Intro + Neurophysiology
1. means a dental procedure for which a dental assistant has received special training in a
course of study approved by the Board: Expanded duty
2. A dental hygienist authorized by the board to perform this advanced proce- dure may..: administer
nitrous oxide
3. Direct supervision: The supervisory dentist is in the dental office, personally examines the
patient, diagnoses treatment, authorizes procedures to be preformed by DH and evaluates
results before patient is dismissed
4. Indirect supervision: The supervisory dentist is in the dental office, personally examines the
patient, diagnoses treatment, authorizes procedures to be preformed by DH but will evaluate
results within a reasonable amount of time
5. General supervision: Means the supervising dentist has previously diagnosed any conditions
to be treated, authorized procedures for DH, and will review results in a reasonable time
6. Direct visual supervision: Means the supervisory dentist has direct ongoing visual oversight
which shall be maintained at all times during any procedure autho- rized to be performed by a
dental assistant or an oral maxillofacial surgery assistant.
7. Are dental assistants allowed to administer nitrous oxide?: No!
- they are only allowed to monitor Nitrous oxide administration
8. What do you need to include on documentation when administering nitrous oxide?: Informed
consent
Indication for N2O Flow
rate
Pre and post op vitals
Start and stop time Post
sedation oxygen
Condition on discharge and any complications
9. Written consent is required for both children and adults for nitrous oxide and require in
room: escort/witness
10.Characteristics of nitrous oxide:: Odorless, sweet smelling, tasteless, and non-flammable
(but, will support combustion)
11.Analgesia: Elimination of pain in a conscious patient
12.Anxiolysis: relief of anxiety
13.Other inhalation drugs provide skeletal muscle relaxation, whereas N2O has minimal effect and
is therefore safe to use in patients withered/family hx of :: malignant hyperthermia
14.Why should we not give N2O to pts with recent head trauma?: N2O increas- es cerebral blood
flow and increased intracranial pressure
, Pain Control Midterm: Intro + Neurophysiology
15.Why does N2O make one feel as if they need to use the restroom?: It can distend bladder
because N2O rapidly diffuse into air filled spaces (the bladder) and triggers baroreceptors to fire
16.What intensifies pain response?: Anxiety, fear, apprehension
17.Local anesthesia: Elimination of sensations, especially pain, in one part of the body by
topical application or regional injection of a drug
18.Conscious: capable of an appropriate response to a command, with protective reflexes
intact, including the ability to maintain a patent airway
19.Sedation: calming a nervous, apprehensive individual through the use of drugs without
inducing the loss of consciousness
20.Rapid onset of action (IV): 1 min
21.Onset of inhalation (N2O): 2-3 min
22.Onset of IM: 10-15 min
23.Onset of oral/rectal: 30 min
24.Advantages of inhalation sedation: Rapid peak effect Rapid and
complete recovery
Control of depth Control
of duration Titratable
No injection
No adverse affects on organs Parental
acceptance
25.Disadvantages of inhalation sedation: Not a potent agent Patient
dependent cooperation
Training required
Chronic exposure risk (occupational health considers) Equipment
cost/maintenance
N2O availability
Nausea and vomiting can occur
26.Goal of Nitrous Oxide: - reduce or eliminate fear and anxiety
- instill positive attitude towards dental care
- help control hyperactive gag reflex
- raise pain threshold
- decrease patient fatigue and increase operator efficiency
27.Indications for use of Nitrous Oxide: Anxious patient Strong gag
reflex interfering with dental care
A patient for whom profound local anesthesia cannot be obtained A
cooperative child undergoing a lengthy dental procedure
, Pain Control Midterm: Intro + Neurophysiology
28.Contraindications for N2O: - first trimester of pregnancy
- current upper respiratory infection
- cystic fibrosis
- psychologic impairment
- patient intoxicated with drugs or alcohol
- current or recovering drug addiction
- middle ear disturbances (otitis media, tympanic membrane graft)
- eye surgery
- COPD
- severe asthmatics
- pre-cooperative age (under 3 yo)
- MTHFR gene polymorphism
- Bleomycin sulfate patients
- Claustrophobic patients
29.Conducting zone: Transports gases from outside to repiratory zone (nose)
30.Anatomy of conducting zone: Nasal passages Pharynx
(nasopharynx, oropharynx, hypo pharynx) Larynx
Trachea
Bronchi
Bronchioles
31.Respiratory zone: Portion of lung where exchange of gases occurs between blood and air
32.Anatomy of respiratory zone: Respiratory bronchioles Alveolar
ducts
Alveolar sacs
Alveoli
33.Unit in which the actual gas exchange occurs: Alveolus
34.Inhaled gases travel through zone to zone: conducting and respira- tory
35.How do gases get into the alveolus from outside the body?: Based on differences in
pressure within the respiratory system
36.Concentration effect: Higher concentrations cause more rapid uptake of N2O
-Diffusion gradient from lungs into blood results in greater uptake of gas into lungs
37.Second gas effect: A second anesthetic gas will also be take up more rapidly than usual
when added to N2O
- Rapid uptake of N2O produces a vacuum in alveoli pulling second gas into blood
1. means a dental procedure for which a dental assistant has received special training in a
course of study approved by the Board: Expanded duty
2. A dental hygienist authorized by the board to perform this advanced proce- dure may..: administer
nitrous oxide
3. Direct supervision: The supervisory dentist is in the dental office, personally examines the
patient, diagnoses treatment, authorizes procedures to be preformed by DH and evaluates
results before patient is dismissed
4. Indirect supervision: The supervisory dentist is in the dental office, personally examines the
patient, diagnoses treatment, authorizes procedures to be preformed by DH but will evaluate
results within a reasonable amount of time
5. General supervision: Means the supervising dentist has previously diagnosed any conditions
to be treated, authorized procedures for DH, and will review results in a reasonable time
6. Direct visual supervision: Means the supervisory dentist has direct ongoing visual oversight
which shall be maintained at all times during any procedure autho- rized to be performed by a
dental assistant or an oral maxillofacial surgery assistant.
7. Are dental assistants allowed to administer nitrous oxide?: No!
- they are only allowed to monitor Nitrous oxide administration
8. What do you need to include on documentation when administering nitrous oxide?: Informed
consent
Indication for N2O Flow
rate
Pre and post op vitals
Start and stop time Post
sedation oxygen
Condition on discharge and any complications
9. Written consent is required for both children and adults for nitrous oxide and require in
room: escort/witness
10.Characteristics of nitrous oxide:: Odorless, sweet smelling, tasteless, and non-flammable
(but, will support combustion)
11.Analgesia: Elimination of pain in a conscious patient
12.Anxiolysis: relief of anxiety
13.Other inhalation drugs provide skeletal muscle relaxation, whereas N2O has minimal effect and
is therefore safe to use in patients withered/family hx of :: malignant hyperthermia
14.Why should we not give N2O to pts with recent head trauma?: N2O increas- es cerebral blood
flow and increased intracranial pressure
, Pain Control Midterm: Intro + Neurophysiology
15.Why does N2O make one feel as if they need to use the restroom?: It can distend bladder
because N2O rapidly diffuse into air filled spaces (the bladder) and triggers baroreceptors to fire
16.What intensifies pain response?: Anxiety, fear, apprehension
17.Local anesthesia: Elimination of sensations, especially pain, in one part of the body by
topical application or regional injection of a drug
18.Conscious: capable of an appropriate response to a command, with protective reflexes
intact, including the ability to maintain a patent airway
19.Sedation: calming a nervous, apprehensive individual through the use of drugs without
inducing the loss of consciousness
20.Rapid onset of action (IV): 1 min
21.Onset of inhalation (N2O): 2-3 min
22.Onset of IM: 10-15 min
23.Onset of oral/rectal: 30 min
24.Advantages of inhalation sedation: Rapid peak effect Rapid and
complete recovery
Control of depth Control
of duration Titratable
No injection
No adverse affects on organs Parental
acceptance
25.Disadvantages of inhalation sedation: Not a potent agent Patient
dependent cooperation
Training required
Chronic exposure risk (occupational health considers) Equipment
cost/maintenance
N2O availability
Nausea and vomiting can occur
26.Goal of Nitrous Oxide: - reduce or eliminate fear and anxiety
- instill positive attitude towards dental care
- help control hyperactive gag reflex
- raise pain threshold
- decrease patient fatigue and increase operator efficiency
27.Indications for use of Nitrous Oxide: Anxious patient Strong gag
reflex interfering with dental care
A patient for whom profound local anesthesia cannot be obtained A
cooperative child undergoing a lengthy dental procedure
, Pain Control Midterm: Intro + Neurophysiology
28.Contraindications for N2O: - first trimester of pregnancy
- current upper respiratory infection
- cystic fibrosis
- psychologic impairment
- patient intoxicated with drugs or alcohol
- current or recovering drug addiction
- middle ear disturbances (otitis media, tympanic membrane graft)
- eye surgery
- COPD
- severe asthmatics
- pre-cooperative age (under 3 yo)
- MTHFR gene polymorphism
- Bleomycin sulfate patients
- Claustrophobic patients
29.Conducting zone: Transports gases from outside to repiratory zone (nose)
30.Anatomy of conducting zone: Nasal passages Pharynx
(nasopharynx, oropharynx, hypo pharynx) Larynx
Trachea
Bronchi
Bronchioles
31.Respiratory zone: Portion of lung where exchange of gases occurs between blood and air
32.Anatomy of respiratory zone: Respiratory bronchioles Alveolar
ducts
Alveolar sacs
Alveoli
33.Unit in which the actual gas exchange occurs: Alveolus
34.Inhaled gases travel through zone to zone: conducting and respira- tory
35.How do gases get into the alveolus from outside the body?: Based on differences in
pressure within the respiratory system
36.Concentration effect: Higher concentrations cause more rapid uptake of N2O
-Diffusion gradient from lungs into blood results in greater uptake of gas into lungs
37.Second gas effect: A second anesthetic gas will also be take up more rapidly than usual
when added to N2O
- Rapid uptake of N2O produces a vacuum in alveoli pulling second gas into blood
