Pain and Anxiety Week 1

Question 1

The pre-anesthetic assessment consists of

Answer 1

1) complete medial/dental history
2) physical examination
3) psychological examination

Question 2

List what should be included in the complete medical/dental history

Answer 2

1) current conditions
2) past conditions
3) OTC drugs, supplements
4) adverse reactions to meds
5) problems with previous dental treatment

Question 3

What are concomitant meds?

Answer 3

2+ meds taken on same day which can alter efficacy and safety of LA’s

Question 4

Physical examination includes

Answer 4

1) visual exam
2) BP
3) Pulse and RR
4) patient’s weight

Question 5

The patient’s weight is used to determine the ____________ ____________ _________ of LA’s

Answer 5

maximum recommended dose (MRD)

Question 6

What does stress increase?

Answer 6

Pulse rate
Respiratory rate

Question 7

What do LAs increase?

Answer 7

BP

Question 8

BP of 140-159/90-94

Answer 8

Consider N2O for stress reduction

Question 9

BP of 160-199/95-114

Answer 9

Retake; refer for med consult before tx

Question 10

BP of >200/>115

Answer 10

Retake; refer for med consult before tx

Question 11

T/F: We have to decrease the MRD for children because they have immature livers

Answer 11

True

Question 12

Acceptable HR’s for adults and children

Answer 12

Adult: 60-100
Child: 75-100
Toddler: 120-160

Question 13

Acceptable RR’s for adults and children

Answer 13

Adult: 12-20
Child: 18-30
Toddler: 25-32

Question 14

Unfounded fear of dental tx associated with traumatic, painful past dental tx

Answer 14

Dental phobia

Question 15

What are some signs of moderate anxiety?

Answer 15

1) stiff posture
2) nervous “play”
3) “white knuckle” syndrome
4) sweating
5) “too cooperative”
6) nervous conversation
7) quick answers

Question 16

What are 3 things we can do for stress reduction protocol?

Answer 16

1) adequate pain control
2) decrease pain of injection
3) select LA of appropriate duration

Question 17

How does stress affect the body in regards to pain?

Answer 17

It decrease the pain reaction threshold

Question 18

Risk assessment ABCDE

Answer 18

A → antibiotics; anesthesia; anxiety; allergy
B → bleeding
C → chair positioning
D → drugs; devices
E → equipment; emergencies

Question 19

An unpleasant often strong emotion caused by anticipation or awareness of danger

Answer 19

Fear

Question 20

What % of people in the population avoid dental care b/c of fear?

Answer 20

6-14%

Question 21

Not eliminated as easily, tends to be a learned response from personal experience or from the experience of others

Answer 21

Anxiety

Question 22

T/F: Fear is long-term

Answer 22

False! it’s short-lived

Question 23

Anxiety is from ______________ or thought of dentistry

Answer 23

anticipation

Question 24

Fear refers to the ___________ occurring in the dental office

Answer 24

rxn

Question 25

What are the most relevant routes of drug administration in dentistry?

Answer 25

oral, topical, subcutaneous, inhalation

Question 26

Technique of communication between the dentist and the pt that creates a bond of trust and confidence

Answer 26

Iatrosedation

Question 27

Non-drug psychosedative techniques

Answer 27

Hypnosis, acupuncture, audioanalgesia

Question 28

Which drug is most effective and most popular drugs for anxiety management in dentistry

Answer 28

benzodiazepenes

Question 29

These are good for mild to moderate pre-treatment anxiety

Answer 29

Benzodiazepenes

Question 30

Which benzos are the most common anxiolytic agents?

Answer 30

Diazepam and triazolam

Question 31

Nitrous oxide documentation MUST include...

Answer 31

1) Informed consent obtained and documented in chart 2) Percentage of N2O administered 3) Length of time the patient was sedated 4) Flow rate of gases during administration

Question 32

Nitrous oxide documentation SHOULD also include...

Answer 32

1) Indication for use 2) Pt response/tolerance

Question 33

What are some features of nitrous that allow it to provide ideal sedation? (5)

Answer 33

-produces analgesic and anxiolytic effects -rapid onset of 2-5 mins -wide safety margin -quick recovery -no hangover effect

Question 34

T/F: Nitrous has low solubility in the blood

Answer 34

True

Question 35

T/F: Nitrous can't cross the placenta

Answer 35

FALSE; it can which is why you need a med consult if you have a pregnant pt

Question 36

At what % can nitrous oxide induce unconsciousness?

Answer 36

70% or higher

Question 37

Nitrous oxide has no effect on....

Answer 37

HR and BP

Question 38

What is nitrous oxide equivalent to?

Answer 38

Therapeutic dose of morphine

Question 39

Nitrous oxide is excreted ____________ through the _________, so it is ___________ in blood

Answer 39

unchanged; lungs; insoluble

Question 40

Indications for nitrous oxide

Answer 40

1. Anxiety 2. Tendency to faint 3. Strong gag reflex 4. Medically compromised pts (angina pectoris, post MI, most CVA) 5. Long procedures 6. Inadequate local anesthesia

Question 41

Administration of drug increases the possibility of a life threatening situation

Answer 41

Absolute contraindication (do NOT administer under any circumstances)

Question 42

Administration of drug is preferably avoided due to possible adverse reactions

Answer 42

Relative contraindication (administer judiciously)

Question 43

Absolute contraindications of nitrous oxide

Answer 43

1. Nasal Obstruction 2. Vitamin B12 Deficiency (can render B12 inactive) 3. Alcoholic / Recovering Addict 4. Uncommunicative (disability or language barrier) 5. Patient Refusal

Question 44

Relative contraindications of nitrous oxide (9)

Answer 44

1. Middle ear infection 2. Balance disorder 3. Susceptibility to Motion Sickness 4. Claustrophobia 5. Pulmonary Diseases (med consult) 6. Immunocompromised (med consult) 7. Pregnancy (med consult) 8. Psychiatric Disorders/Bipolar (med consult) 9. Marijuana or Hallucinogenic Drug Use

Question 45

Most common side effects of nitrous

Answer 45

Nausea, vomiting, headaches

Question 46

What are some risks of long term exposure to nitrous oxide?

Answer 46

Bone marrow suppression Reproductive system disturbances (spontaneous abortion, premature delivery, infertility) Neurological defects (numbness, difficulty concentrating, etc) Hepatotoxicity

Question 47

What color is oxygen on nitrous oxide equipment?

Answer 47

Green

Question 48

What color is nitrous on nitrous oxide equipment?

Answer 48

Blue

Question 49

When does the nitrous pressure gauge start to fall?

Answer 49

Once all the liquid is gone and only gas remains

Question 50

Which button is used for over sedation and fills the reservoir bag?

Answer 50

Flush button

Question 51

Name the safety feature: N2O flow terminated if O2 delivery pressure falls

Answer 51

Oxygen fail safe mechanism

Question 52

What is the minimum % of oxygen?

Answer 52

30%

Question 53

What is the maximum % of nitrous oxide?

Answer 53

70%

Question 54

Name the safety feature: Allows atmospheric air in if flow of gases stops

Answer 54

Emergency air inlet

Question 55

Name the safety feature: Rapid delivery of high flow O2 to patient (over sedation)

Answer 55

Oxygen flush button

Question 56

Name the safety feature: Cannot inadvertently reverse tanks

Answer 56

Pin index safety system

Question 57

Steps of nitrous oxide administration

Answer 57

1. Select proper sized nasal hood 2. Flush reservoir bag (start w/ 5-6 L/min flow rate of 100% O2) 3. Place nasal hood; pt. adjusts for comfort; tighten 4. Tell pt. to breathe normally; adjust flow rate 5. Gradually titrate in 10% intervals; watching for signs of sedation 6. Typical pt requires 50% N2O/50% O2 7. When tx is over, put N2O to zero and increase O2; 100% O2 for 5 mins 8. Document procedure 9. NEVER leave pt. unattended!!!

Question 58

Nervous system breakdown

Answer 58

-divided into CNS and PNS -CNS and PNS divided into afferent and efferent -PNS divided into somatic and autonomic -Autonomic divided into sympathetic and parasympathetic

Question 59

3 main functions of neurons

Answer 59

1) receive info 2) process info 3) send response

Question 60

Structure of a neuron

Answer 60

Cell body, dendrites, axon

Question 61

What is the terminal end of an axon that allows the impulse to travel to another neuron via NTs called?

Answer 61

Synaptic knob

Question 62

T/F: Nerves are only found in the PNS

Answer 62

True

Question 63

What is a nerve made up of?

Answer 63

Many axons, an artery, and a vein

Question 64

CT around an axon

Answer 64

Endoneurium

Question 65

Group of axons

Answer 65

Fascicle

Question 66

CT around one fascicle

Answer 66

Perineurium

Question 67

CT around group of fascicles

Answer 67

Epineurium

Question 68

Which fibers are the largest and have the fastest impulse generation?

Answer 68

Type A fibers

Question 69

What are the 4 subtypes of Type A fibers?

Answer 69

A alpha A beta A gamma A delta

Question 70

Which A fibers are the largest, fastest, efferent, and used for muscle movement?

Answer 70

Alpha

Question 71

Which A fibers are afferent and used for proprioception, touch, and pressure?

Answer 71

Beta

Question 72

Which A fibers are efferent and used for muscle tone?

Answer 72

Gamma

Question 73

Which A fibers are afferent and used for pain and temperature?

Answer 73

Delta

Question 74

T/F: Type A and C fibers can be afferent or efferent while Type B fibers are only efferent.

Answer 74

True

Question 75

Where are Type B fibers found?

Answer 75

Preganglionic ANS Vascular smooth muscle

Question 76

Describe the myelination of Type A, B, and C fibers

Answer 76

Type A = myelinated Type B = slightly myelinated Type C = unmyelinated

Question 77

Which are the smallest, most numerous, and unmyelinated fibers?

Answer 77

Type C

Question 78

Which fibers are responsible for dull, achy pain?

Answer 78

Type C

Question 79

What type of fibers are prevalent in the oral cavity?

Answer 79

Type A and Type C

Question 80

Which fibers require more anesthetic volume? Why?

Answer 80

Type A (they're larger)

Question 81

Types of stimuli that trigger nerve impulses

Answer 81

Chemical Thermal Mechanical Electrical

Question 82

Neurons maintain RMP via?

Answer 82

1) Sodium-Potassium Pump 2) closed K+ channels 3) closed Na+ channels

Question 83

What causes the absolute refractory period?

Answer 83

Inactivation of Na+ channels during repolarization

Question 84

What causes the relative refractory period?

Answer 84

Hyper-polarization before RMP is established

Question 85

T/F: An action potential cannot be generated in the relative refractory period

Answer 85

False! it can be if a larger stimulus is applied

Question 86

2 types of synapses

Answer 86

Electrical and chemical

Question 87

What are the 2 ways that LA's cause reversible local anesthesia?

Answer 87

prevents generation and conduction of impulses

Question 88

What do "membrane-stabilizing drugs" do?

Answer 88

Decrease rate of depolarization

Question 89

Small/large diameter nerve fibers are less/more sensitive to LAs

Answer 89

small; more

Question 90

Small/large diameter nerve fibers require less/more volume of LAs

Answer 90

Large; more

Question 91

What are the 2 major routes of LA delivery?

Answer 91

1) topical 2) submucosal injection

Question 92

T/F: Submucosal injections are more effective than topical

Answer 92

True

Question 93

Topical requires _______ concentrations and causes _________ chances of toxicity

Answer 93

greater; greater

Question 94

Which ion channels do LA's bind to inside the cell?

Answer 94

Na+