Logothetis: Local Anesthesia for the Dental Hygienist

Chapter 01: Local Anesthesia in Dental Hygiene Practice: An Introduction

Test Bank

MATCHING

Match the following word or phrase with the correct drug category.
ester (E)
amide (A) 
inhalation drug (I)

1.	Ether
2.	Lidocaine
3.	Prilocaine
4.	Procaine
5.	Nitrous oxide
6.	Halothane
7.	Mepivacaine
8.	Novocaine
9.	Causes more allergic reactions
10.	Patients experience fewer allergic reactions

1.	ANS: I	REF:	Page 4
2.	ANS: A	REF:	Page 4
3.	ANS: A	REF:	Page 4
4.	ANS: E	REF:	Page 4
5.	ANS: I	REF:	Page 4
6.	ANS: I	REF:	Page 4
7.	ANS: A	REF:	Page 5
8.	ANS: E	REF:	Page 4
9.	ANS: E	REF:	Page 4
10.	ANS: A	REF:	Page 4

MULTIPLE CHOICE

1.	The first objections to the use of inhalation sedation included which of the following?
a.	It was viewed as a religious offense	
b.	It was viewed as an unethical practice	
c.	It was viewed as a retardant to the health process	
d.	All of the above	

ANS:	D
Objections to operating on an unconscious patient included all of the above. Some viewed it as offensive to their religious beliefs; some viewed it as an ethical matter; and some objected because they believed that the relief from pain might actually retard the health process.

REF:	Page 4

2.	Who was the first dentist to use “laughing gas” for dental procedures?
a.	William Clarke	
b.	Horace Wells	
c.	Henry Beecher	
d.	Nils Lofgren	

ANS:	B
Horace Wells was the first dentist to use “laughing gas” for dental procedures.

REF:	Page 4

3.	A highly effective analgesic and antipyretic compound, introduced in 1899 and still used today, is commonly referred to as what?
a.	Aspirin	
b.	Alcohol	
c.	Novocaine	
d.	Opium	

ANS:	A
A new compound, introduced as aspirin in 1899, proved to be remarkably safe and well tolerated by patients. It is a highly effective analgesic and antipyretic.

REF:	Page 4

4.	Early methods of pain control included which of the following?
a.	Use of opium	
b.	Scaring off of demons	
c.	Roots, berries, and seeds	
d.	All of the above	

ANS:	D
Early methods of pain control included all of the above: the use of opium, religious techniques of scaring off demons; and the use of plants and herbs for treating pain.

REF:	Page 4

5.	Pain threshold is best described as which of the following?
a.	The physical and emotional response to a particular situation.	
b.	The relationship between human need fulfillment and human behavior.	
c.	A neurologic experience of pain.	
d.	The point at which a sensation starts to be painful and discomfort results.	

ANS:	D
Pain threshold is best described as the point at which a sensation starts to be painful and discomfort results.

REF:	Page 3

6.	The neurologic experience of pain is referred to as what?
a.	Pain control	
b.	Pain threshold	
c.	Pain perception	
d.	Pain reaction	

ANS:	C
Pain perception is the neurologic experience of pain. It differs little between individuals.

REF:	Page 8

7.	An unpleasant sensory and emotional experience is called what?
a.	Pain	
b.	Pain control	
c.	Pain threshold	
d.	Pain reaction	

ANS:	A
Pain is an unpleasant sensory and emotional experience.

REF:	Page 3

8.	The personal interpretation and response to the pain message is called what?
a.	Pain	
b.	Pain control	
c.	Pain threshold	
d.	Pain reaction	

ANS:	D
The personal interpretation and response to the pain message is called one’s pain reaction. It is highly variable among individuals.

REF:	Page 3

9.	The creation of the loss of sensation in a circumscribed area, without loss of consciousness, best defines which of the following?
a.	Inhalation anesthesia	
b.	Local anesthesia	
c.	General anesthesia	
d.	All of the above	

ANS:	B
Local anesthesia creates a numbing feeling or the loss of sensation in a circumscribed area, without loss of consciousness.

REF:	Page 3

10.	The newest amide to arrive on the dental market in the United States is which one of the following?
a.	Articaine	
b.	Mepivacaine	
c.	Lidocaine	
d.	Bupivacaine	

ANS:	A
The newest amide local anesthetic, introduced to the dental field in 2000, is articaine.

REF:	Page 5

11.	Lidocaine is said to have revolutionized pain control in dentistry. Why?
a.	It is more potent than prilocaine.	
b.	It is less potent than procaine.	
c.	Patients experience fewer allergic reaction with lidocaine.	
d.	Some combination of the above	

ANS:	C
Lidocaine is said to have revolutionized pain control in dentistry because it is less allergenic than procaine.

REF:	Pages 4, 5

12.	Procaine was used extensively in dentistry for a number of years; however, it was not the ideal local anesthetic. Why not?
a.	It took a long time to produce the desired anesthetic result.	
b.	It lasted for prolonged periods of time.	
c.	It had a high potential for triggering allergic reactions.	
d.	Some combination of the above	

ANS:	D
Choices a and c are correct. Procaine took a long time to produce the desired anesthetic results and it had a high potential for triggering allergic reactions.

REF:	Page 4

13.	The first local anesthetic used in dentistry was which of the following?
a.	Novocaine	
b.	Cocaine	
c.	Procaine	
d.	Lidocaine	

ANS:	B
Cocaine was the first anesthetic used in dentistry (in 1884).

REF:	Page 4

14.	The benefit of local anesthesia is not limited to pain control but could also include which of the following?
a.	Hemostasis	
b.	Time management	
c.	Patient-centered stress reduction	
d.	All of the above	

ANS:	D
The benefit of local anesthesia is not limited to pain control but could also include hemostasis, achieved via the vasoconstrictor in the anesthetic; time management, because the dental hygienist can administer the anesthesia and obviate the need for the dentist and the patient to wait for anesthesia to take effect; and patient-centered stress reduction, which addresses the relationship between human need fulfillment and human behavior.

REF:	Pages 5, 8 and Table 1-2

15.	Jon presents to your dental office in pain with an abscessed tooth. Utilizing the Visual Analog Scale (VAS), Jon indicates that his pain level measures about 95 mm in length from the left hand end of the horizontal line. What is an appropriate translation of this action?
a.	Jon is experiencing a significant amount of pain.	
b.	Jon is experiencing a moderate amount of pain.	
c.	Jon is uncomfortable but able to tolerate the pain.	
d.	None of the above because the pain scale is subjective	

ANS:	A
Operationally a VAS is usually a horizontal line, 100 mm in length. The VAS score is determined by measuring in millimeters from the left end of the line to the point that the patient indicates. Since Jon indicated that his pain threshold was close to the definitive end of 100 mm, one can assume that Jon is experiencing a significant amount of pain.

REF:	Page 8

16.	Considering the human needs paradigm, freedom from fear and stress includes which of the following?
a.	The need to receive appreciation, attention, and respect from others	
b.	The need to be free from emotional discomfort	
c.	The need to feel safe	
d.	All of the above	

ANS:	D
Considering the human needs paradigm, freedom from fear and stress includes the need to receive appreciation, attention, and respect from others. It also includes the need to be free from emotional discomfort and the need to feel safe.

REF:	Page 9

17.	An astute practitioner looks for signs of patient anxiousness. These signs may include which of the following?
a.	Overwillingness to cooperate with clinician	
b.	History of emergency dental care only	
c.	Elevated blood pressure and heart rate	
d.	All of the above	

ANS:	D
An astute practitioner looks for signs of patient anxiousness. These signs may include an overwillingness to cooperate with clinician, which could be portrayed through nervous conversations and/or quick answers; a history of emergency dental care only or a history of canceled appointments; and physical symptoms including elevated blood pressure and fast heart rate.

REF:	Page 9, Box 1-4	

18.	The best method to manage an anxious patient is by:
a.	Prevention	
b.	General sedation	
c.	Referral to an anxiety specialist	
d.	All of the above	

ANS:	A
The best method to manage an anxious patient is by prevention.

REF:	Page 9

19.	Performing a complete health history review at every appointment helps practitioners recognize stressors and health conditions that may complicate dental procedures. Taking a patient’s vital signs does not play an important role in assessing a patient’s level of apprehension.
a.	Both statements are true.	
b.	Both statements are false.	
c.	The first statement is true; the second statement is false.	
d.	The first statement is false; the second statement is true.	

ANS:	C
Performing a complete health history review at every appointment helps practitioners recognize stressors and health conditions that may complicate dental procedures. Taking vital signs also plays an important role in helping to understand a patient’s total health history and in assessing a patient’s level of apprehension.

REF:	Page 9

20.	The use of anesthesia as needed is an important key to what?
a.	Understanding why patients are fearful of dental appointments	
b.	Preventing fear associated with pain	
c.	Ensuring patient comfort and adequate care	
d.	B and C	

ANS:	D
The use of anesthesia as needed is an important key to preventing the fear associated with pain. This also ensures patient comfort so that they may receive adequate and necessary dental care.

REF:	Page 9

21.	Considerations that have the potential of influencing a dental patient’s pain reaction threshold include which of the following?
a.	Age	
b.	Culture	
c.	Fatigue	
d.	All of the above	

ANS:	D
Pain reaction threshold may be influenced by the patient’s emotional state, fatigue, age, culture, and fear and apprehension.

REF:	Page 8, Table 1-2	

22.	Patients who frequently miss dental appointments because of apprehension, often demonstrate what kind of pain reaction threshold?
a.	A lower pain reaction threshold, which means that they have a high tolerance for pain	
b.	A lower pain reaction threshold, which means that they have a low tolerance for pain	
c.	A higher pain reaction threshold, which means that they have a high tolerance for pain	
d.	None of the above	

ANS:	B
Patients who frequently miss dental appointments because of apprehension will generally demonstrate a lower pain reaction threshold, which means that they have a low tolerance for pain and they will likely experience pain more quickly and/or intensely than if they were calm.

REF:	Page 8, Table 1-2	

23.	Patients who are overly tired or stressed at the time of their dental appointment will generally demonstrate what kind of pain reaction threshold?
a.	A lower pain reaction threshold, which means that they have a high tolerance for pain	
b.	A lower pain reaction threshold, which means that they have a low tolerance for pain	
c.	A higher pain reaction threshold, which means that they have a high tolerance for pain	
d.	None of the above	

ANS:	B
Patients who are overly tired or stressed at the time of their dental appointment will generally demonstrate a lower pain reaction threshold, which means that they have a low tolerance for pain and they will likely experience pain more quick and/or intensely than if they were well rested and calm.

REF:	Page 8, Table 1-2	

24.	The difference between the legal wording that states that the dental hygienist may monitor nitrous oxide and that the dental hygienist may administer nitrous oxide is best explained by which of the following statements?
a.	When it is said that the dental hygienist may administer nitrous oxide, this indicates that the hygienist may change the nitrous oxide and/or oxygen settings during the appointment as needed.	
b.	When it is said that the dental hygienist may monitor nitrous oxide, this means that the hygienist may turn on the nitrous oxide and/or oxygen settings during the appointment as needed.	
c.	In legal terms, someone with the authority to monitor nitrous oxide may change the nitrous oxide and/or oxygen settings; someone with the authority to administer nitrous oxide may turn on the apparatus.	
d.	In state law the terms monitor and administer can be used interchangeably.	

ANS:	C
In legal terms someone with the authority to monitor nitrous oxide may change the nitrous oxide and/or oxygen settings during the appointment as needed; someone with the authority to administer nitrous oxide may turn on the nitrous-oxide/oxygen apparatus.

REF:	Page 8