Copyright © 2016 WREB

All rights reserved. No part of this manual may be used or

reproduced in any form or by any means without prior

written permission of WREB.

Visit us online at www.wreb.org to find the following:

Information for Anesthesia, Hygiene and Restorative Candidates

Exam Locations, Schedules and Fees

Policies and Procedures

• Refunds and Cancellations

• Special Accommodations Information and Request

Forms

• Appeals Process and Forms

Exam Site Information for Candidates

Dental Hygiene Clinical Examination Tutorial

Candidate Guides

• Local Anesthesia

• Dental Hygiene

• Restorative

• Policy Guide

Candidate Forms

• Exam Forms

• Remediation Forms

Request Scoring Information/Reports

Frequently Asked Questions and Advice

• Administrative

• Anesthesia

• Dental Hygiene

• Restorative

• Application Policies and Procedures

Links

• Dental/Hygiene Organizations

• Credentialing Services

• Other Regional Testing Agencies

• Dental Supplies – Equipment

WREB Information

Member States

Exam Schools

Latest News

History of WREB

Current Newsletters

Published Articles and Position Papers

Table of Contents

General Information ------------------------------------------------- 1

Local Anesthesia Candidates ------------------------------------ 1

Local Anesthesia Written Examination ----------------------- 2

WREB Enrollment ------------------------------------------------ 2

Taking the Written Examination at Prometric --------- 2

Written Examination Retakes ------------------------------------ 4

Helpful Links ------------------------------------------------------- 4

Local Anesthesia Clinical Examination ----------------------- 5

Equipment and Materials -------------------------------------- 5

Clinic Tour -------------------------------------------------------------- 5

Forms----------------------------------------------------------------- 6

Patient Criteria ---------------------------------------------------- 6

Examination Procedures ------------------------------------------- 8

Examination Schedule ----------------------------------------- 8

Clinical Preparation --------------------------------------------- 8

Clinical Examination -------------------------------------------- 9

Positive Aspiration -------------------------------------------- 10

Performance Expectations -------------------------------------- 11

Critical Aspects of Injection -------------------------------- 11

Less Critical Aspects of Injection ------------------------ 14

Completion of Examination ------------------------------------- 15

Notification of Result ---------------------------------------------- 15

Retake Examination On Site ------------------------------------ 16

References ------------------------------------------------------------ 18

Summary of Dental Local Anesthetic Drugs -------------- 19

Candidate Examination Schedule ---------------------------- 20

1

GENERAL INFORMATION The purpose of the WREB Local Anesthesia Examination is to

evaluate a Candidate’s ability to utilize professional judgment and

knowledge to safely and competently administer both a posterior

superior and inferior alveolar nerve block injections to a Patient.

The Written Examination is a computerized multiple-choice exam.

Overall successful completion of the WREB Local Anesthesia

Examination requires passing scores in both the Written and the

Clinical portions of the examination.

The Candidate Guide contains the necessary information to prepare

for the WREB Dental Hygiene Local Anesthesia Examination. The

Policy Guide contains information pertaining to examination policies

and protocols.

The mandatory Candidate Clinical Orientation is designed to review

the Clinical Examination process and procedures. Only enrolled

Candidates are allowed to attend the Orientation. Prior to the

Orientation, a tour of the clinic is provided to familiarize Candidates

with clinic procedures, school policies and equipment, school infection

control policies and emergency protocols, proper disposal of

biohazardous or pharmaceutical materials and sharps.

LOCAL ANESTHESIA CANDIDATES The Local Anesthesia Examination is a two-part examination; Written

and Clinical. Overall successful completion of the WREB Local

Anesthesia Examination requires passing scores in both the Written

Examination and the Clinical Examination within a period of 12

(twelve) months. Candidates may register for the Local Anesthesia

Clinical Examination with the understanding that they are not eligible

to challenge the Clinical Examination until successfully passing the

Written Examination. Refer to the WREB cancellation policy

regarding refund deadline dates.

Candidates have two registration options for the Local Anesthesia

Examination:

1. Written-Only Registration: Attempt the Written

Examination within the specified timeframe (an immediate 45

[forty-five] day window). Successful Candidates must then

2

register separately for an available Clinical Examination by

the stated application deadline on the WREB website.

2. Simultaneous Local Anesthesia Written & Clinical

Registration: Attempt the Written Examination within the

specified timeframe attached to the Clinical Examination (60

- 15 days prior to the Clinical Examination). Successful

Candidates then proceed to their scheduled Clinical

Examination.

Candidates may register for the Local Anesthesia Examination via

the WREB website. All Candidates must be cognizant of the

WREB deadline dates for enrollment.

LOCAL ANESTHESIA WRITTEN EXAMINATION WREB ENROLLMENT Candidates must first register for the Local Anesthesia Written

Examination via WREB’s website. Once enrolled, the Candidate will

receive an email with an attachment letter that authorizes them to

contact Prometric. Information must be carefully reviewed. The

Eligibility Number is a 10 – digit number that appears on the

attachment letter. Information should not be misplaced, as it will be

required to schedule the Prometric Examination.

TAKING THE WRITTEN EXAMINATION AT PROMETRIC For testing center locations, identification requirements and

appointment scheduling, please visit Prometric’s website at

www.prometric.com/en-us/clients/wreb/Pages/landing.aspx

Candidates taking the WREB Examination, agree to the following

non-disclosure agreement:

I will not, at any time, directly or indirectly, use or

disclose to any person or entity, except WREB and

WREB’s duly authorized officers and employees, any of

the information regarding this exam and agree to keep

all such information confidential.

3

Examination questions are both discipline-based and case-based and

address knowledge, application and problem-solving skills. Up to five

(5) field test questions are included and will not be counted in the

Candidate’s final score.

Candidates are allowed 60 (sixty) minutes to complete the

examination. The questions are multiple choice and will only have

one correct answer.

Multiple test forms are used to ensure the integrity and security of the

examination. To address any possible variation in difficulty level

among the various examination forms, equating procedures are used

to ensure that Candidates of comparable proficiency will be equally

likely to pass the examination.

A score of 75 (seventy-five) is the minimum score required to pass the

Written Examination.

Subject matter includes:

• Anatomy (head and neck) and physiology

• Pharmacology of anesthetic agents and vasoconstrictors,

including the clinical actions and maximum recommended

doses of specific agents, method of delivery of local

anesthesia, including armamentarium, selection of injection

type, and administration technique

• Medical history interpretation; prevention, recognition, and

management of possible complications, and life support

Examination results will be posted on the WREB website

approximately one (1) week after the completion of the examination.

Examination results can be accessed using the Candidate’s login

(username and password). It is very important that all login

information is saved to be able to access examination results.

Candidates will receive an email notification once examination results

are posted online. Upon passing the Written Examination, a Candidate

is eligible to take the Local Anesthesia Clinical Examination.

4

WRITTEN EXAMINATION RETAKES Candidates must successfully pass the Local Anesthesia Written

Examination prior to challenging the Local Anesthesia Clinical

Examination. Candidates who do not pass the Written Examination

will have an Individual Performance Review posted on the WREB

website which can be accessed via WREB’s Candidate login.

Candidates may register for a retake examination if it can be

completed within the appropriate timeframe (of their scheduled

Clinical Examination, if applicable) and, if the Candidate does not

have three (3) previously unsuccessful Written Examination attempts.

The retake fee is $105.

Candidates are required to register for the Local Anesthesia Written

Retake Examination through the WREB website. Once enrolled, the

Candidate will receive a letter authorizing them to contact Prometric

to schedule the retake examination. The retake examination must be

scheduled and completed during the individual assigned timeframe.

Candidates who fail the Written Examination, without adequate

time for a retake are at risk for losing their Clinical Examination

fee, if applicable. Please review WREB’s Refund Policy for further

details.

HELPFUL LINKS WREB:

www.wreb.org

Prometric:

www.prometric.com/en-us/clients/wreb/Pages/landing.aspx

5

LOCAL ANESTHESIA CLINICAL EXAMINATION EQUIPMENT AND MATERIALS Candidates must be prepared to furnish the armamentarium for

administering anesthesia.

1. Aspirating syringes (non-threading and self-aspirating

syringes are not allowed)

2. Needles (self re-capping needles are not allowed)

3. Local Anesthetic. Long-acting local anesthetics and high

concentration vasoconstrictors are not allowed. (i.e.

bupivacaine and solutions with 1:50,000 vasoconstrictors)

4. Hemostat or locking forceps (must be present on tray)

5. Blood pressure cuff or measuring device

6. Candidate and Patient appropriate protective eyewear. (As

defined in the WREB Policy Guide; page 4, item 2)

7. Patient napkin holder (chain, clips or disposable)

The school is requested to provide the following expendable

materials: surface disinfectant, paper towels, soap, face masks, gloves,

Patient napkins, headrest covers, tray covers, chair covers, cotton

swabs, air/water syringe tips, standard saliva ejectors, 2" x 2" gauze

squares, mouthwash and plastic wraps. If a Candidate prefers to use

a specific brand they must bring the item(s) with them to the

examination site.

Schools have the option of providing local anesthetic, needles and

topical anesthetic. Refer to the WREB website (Exam Site

Information for Candidates) for availability of supplies.

CLINIC TOUR Prior to the Candidate Clinical Orientation a tour is provided by a

school representative to familiarize Candidates with clinic procedures,

school policies and equipment, infection control, emergency

protocols, and disposal of biohazardous or pharmaceutical materials

and sharps protocol.

6

FORMS Patient Medical History/Patient Consent form (recorded pulse and

blood pressure are taken not more than one hour before the Candidate’s

assigned clinic time). The information on the Medical History/Patient

Consent form should reflect current conditions on the day of the

examination. The Patient Consent form must be completed by the

Patient prior to the examination.

At Candidate Orientation, the Candidate will receive the following:

• Candidate ID Badge

• Anesthesia Information Sheet

Instructions will be given on how to complete the Anesthesia

Information Sheet.

There will be an opportunity to ask questions at the end of the

Candidate Orientation. Individual concerns or questions should be

addressed with the Chief Examiner.

PATIENT CRITERIA Patients cannot be shared for this examination. A Patient who is

apprehensive, hypersensitive or uncooperative should not be selected.

Dental Hygiene Educators are not eligible to be a Patient for the

examination.

For Patient acceptance the following criteria must be met:

1. 18 (eighteen) years of age or older

2. Have right and left maxillary second molars and at least one

premolar in each mandibular quadrant

3. Obtain written clearance from an appropriate healthcare

provider if a Patient is pregnant. The medical clearance must

be written on official letterhead.

4. Obtain written clearance from a healthcare provider if the

Patient has had a heart attack, stroke, or cardiac surgery

within the past six (6) months. The medical clearance must be

written on official letterhead.

5. No orofacial herpes at the vesicle or ulcerated vesicle stages

or during the prodrome stage.

7

6. No intraoral sores or puncture marks in any of the four (4)

potential penetration sites.

7. Have a systolic blood pressure reading of 159 or below and a

diastolic blood pressure reading of 99 or below. A Patient

with a systolic blood pressure reading between 160 and 180

or a diastolic blood pressure reading between 100 and 110

will only be accepted with written consent from the

Patient’s physician or health care provider. The medical

clearance must be written on official letterhead.

WREB does not allow a Patient with a systolic reading of

greater than 180 or a diastolic reading of greater than 110.

Preoperative blood pressure and pulse must be recorded on

the Patient Medical History/ Patient Consent form and taken

on the Patient no more than one hour prior to the scheduled

Clinical Examination time.

8. ASA I or II. ASA III status that does not alter dental hygiene

care or pose a risk to the Candidate or Patient in a testing

environment.

The Patient must not have or have had any of the following:

1. Active tuberculosis. Clinical symptoms would include: a bad

cough that has lasted longer than two (2) weeks, pain in the

chest, coughing up blood or sputum. A Patient who has

tested positive for TB, or is being treated for TB but does

not have the clinical symptoms, is acceptable.

2. A known latex allergy or a sensitivity to latex

3. Intravenous bisphosphonates therapy

4. Used cocaine or methamphetamine drugs within the past 24

(twenty-four) hours.

5. Any health history condition, medication or drug history

that might be adversely aggravated by the length or nature of

the examination procedures.

Failure of the examination will result if the Patient is rejected for any

of the above reasons.

If the first Patient submission is rejected for having intraoral lesions,

active orofacial herpes, or high blood pressure no penalty is

8

incurred. However, subsequent Patient submissions are subject to all

Patient criteria for acceptance. If the Candidate is unable to submit a

back-up Patient, they will be registered as a “No Show Candidate.”

The Candidate has the following options:

Submit a different Patient. A new Patient Medical

History/Patient Consent, Anesthesia Information Sheet must

be completed.

If a back-up Patient cannot be submitted, the Candidate will

remain registered as a “No Show Candidate”, and forfeit the examination attempt and examination fees.

NOTE: According to the American Heart Association, antibiotic prophylaxis

is not required for the administration of local anesthesia.

EXAMINATION PROCEDURES

EXAMINATION SCHEDULE Refer to the published examination schedule for Clinical Examination

times. The examination schedule is posted to each Candidate’s secure

login three (3) weeks prior to the examination.

CLINICAL PREPARATION Candidates must be present at the scheduled examination time. No

exceptions will be made. Candidates will be directed into the clinic at

the scheduled time to prepare for the examination and should be

prepared to be at the examination site 30 (thirty) minutes prior to the

scheduled time.

Before seating the Patient, the following forms must be completed:

• Patient Medical History/Patient Consent form

• Anesthesia Information Sheet

Candidates must have a syringe(s) loaded with the chosen anesthetic.

Do not loosen the needle cap until instructed by the Examiners. Plan

to have additional cartridges, needles and/or loaded syringes available

at chair-side. However, no more than two (2) syringes should be

present on the tray.

9

CLINICAL EXAMINATION The Clinical Examination consists of the evaluation of the

Candidate’s technique while administering two (2) nerve block

injections:

1. Inferior Alveolar Nerve Block (IA) (The lingual and long

buccal injections are not included in the IA section of the

examination)

2. Posterior Superior Alveolar Nerve Block (PSA)

Candidates will be instructed to perform the IA nerve block injection

first. The IA and PSA may be performed on the same side or on

either side of the mouth.

Two (2) Examiners observe the Candidate’s technique. In order to

pass the examination, both injections must be performed to

examination specifications.

Prior to administering the first injection the following are

checked:

• Landmark teeth

• The four (4) potential penetrations sites (presence of sores

and/or puncture marks)

• Patient Medical History/Patient Consent form

• Anesthesia Information Sheet

• Local Anesthetic Expiration Date

The Examiners may interrupt and stop any procedure that may pose a

health or safety risk. The Examiner who sees the error will say “Stop

and Hold” and state the error. Stop immediately and hold the position.

The other Examiner will have the opportunity to view the error. If

the needle has penetrated the tissue, the Candidate will be instructed

to withdraw.

Topical is not mandatory, but is recommended for Patient comfort.

Examiners will instruct the Candidate when to apply topical to the

injection sites.

10

The bar code on the cartridge must be rotated (toward the small

window) and should not obstruct the Candidate’s or Examiner’s

ability to see a positive aspiration.

Because this is a demonstration of clinical skill, it is not necessary

for a Candidate to describe the technique. However, there are four (4)

times that a Candidate is required to stop and inform the Examiners

when reaching each critical aspect of the injection.

After each critical phase, one (1) Examiner will say, “I see,” and the

other Examiner will say, “Proceed.” Both Examiners must be able to

fully observe all four (4) aspects of the injection.

1. Initial Penetration. After the needle has penetrated the

tissue, stop and hold the position. Inform the Examiners upon

reaching the penetration site. The Candidate must wait until

instructed to proceed.

2. Angle and Depth. Advance to the deposition site, stop and

hold the position. Inform the examiners when at the optimum

depth and angle. The Candidate must wait until instructed to

proceed.

3. Aspiration. Aspirate and announce if the aspiration is

positive or negative. If the aspiration is negative, the

Candidate will be instructed to proceed and deposit the

anesthetic solution. WREB requires that a Candidate aspirate

on one (1) plane. There is no penalty if aspiration is on two (2)

planes.

4. Deposition Rate. Once instructed to proceed, inform the

Examiners when beginning to deposit the anesthetic. It is not

necessary to deposit the entire cartridge since the Patient is

not being anesthetized for clinical procedures. The Candidate

will be instructed when to stop and withdraw.

Upon completion of the IA nerve block either make the needle safe by

securing the cap or immediately proceed to the PSA nerve block.

POSITIVE ASPIRATION Should a positive aspiration occur, a Candidate should use

professional judgment to determine whether to aspirate again, or

withdraw and replace the cartridge. A Candidate must be able to

adequately assess subsequent aspiration(s).

11

Obtaining a positive aspiration on two (2) attempts does not

automatically result in a failure. All aspects of the injection technique

will be evaluated. Do not discard cartridges until the completion of the

examination.

PERFORMANCE EXPECTATIONS Each aspect of the injection is classified as critical or less critical.

CRITICAL ASPECTS OF THE INJECTION All seven (7) critical aspects of the injection have an (*) asterisk and

must be performed to examination specifications to successfully pass

the Clinical Examination. One (1) critical aspect validated by both

Examiners, results in failure of the examination.

1. Proper Utilization of Medical History, Anesthetic and Syringe

Selection

Medical History • No contraindication(s) to local anesthetic

• No health history contraindications

Anesthetic Appropriate

• No long-acting anesthetics and high concentration

vasoconstrictors

Syringe Type is Correct

2. Syringe Preparation and Handling (less critical aspects)

Armamentarium

Syringe Properly Prepared

Syringe Handling

3. Penetration Site

Needle Contamination The needle is contaminated if it touches any surface,

facial anatomy or intra oral object (gauze, glove)

prior to penetration. Proceeding with a contaminated

needle results in failure of the injection.

Three Penetrations Allowed Three (3) penetrations are allowed to reach the

optimum angle and depth. If the third penetration

attempt results in a first positive aspiration, a fourth

penetration is permitted.

*

*

12

Optimum IA Penetration Site

The penetration site is at the area bordered medially

by the pterygomandibular raphe, laterally by the

internal oblique ridge, and at the height of the

coronoid notch.

Errors: • Too superior

• Too inferior

• Too medial

• Too lateral

Optimum PSA Penetration Site The penetration site is at the height of the vestibule in

the mucobuccal fold posterior to the zygomatic

process of the maxilla (visually, this approximates the

distal facial root of the 2nd molar).

Errors:

• Too anterior

• Too posterior

• Not in mucobuccal fold

4. Optimum IA Angle and Depth At the point when optimum depth is achieved, the

barrel of the syringe is positioned over the premolars

on the contralateral side and the needle is parallel to

the occlusal plane of the mandibular teeth.

The depth of insertion is 20 to 25 mm

(approximately 2/3 the length of a long needle or

4/5 the length of a short needle).

Errors: • Barrel too distal

• Barrel too mesial

• Angle too high

• Angle too low

• Too shallow

• Too deep

Optimum PSA Angle and Depth The needle is advanced upward 45 degrees to the

occlusal plane, inward at a 45 degree angle toward

the midline, and backward at a 45 degree angle to the

long axis of the second molar.

*

13

The depth of insertion is approximately 16 mm

(about 1/2 the length of a long needle or 3/4 the

length of a short needle).

Errors:

• Needle not at 45 degree angle toward midline.

• Needle not at 45 degree angle to occlusal plane

• Too shallow

• Too deep

5. Aspiration

Large window visible

Prior to aspirating, the large window must be toward

the operator

Aspiration observed

Proper Handling of Positive Aspiration Any sign of a positive aspiration must be observed

and handled appropriately.

6. Amount and Rate

Deposition of Anesthetic Prior to Aspiration Amount of local anesthetic deposited is less than 1/4

th

(one-fourth) of the cartridge.

Rate of Administration is Acceptable Acceptable rate is approximately 15 (fifteen) seconds

to administer two (2) stopper widths.

7. Excessive Trauma

Excessive trauma is defined as:

• The needle is visibly bent upon removal from

tissue.

• The degree of the bowing would likely result in

excessive submucosal soft tissue injury.

• Visible laceration of tissue upon approach or

withdrawal of the needle with or without bleeding.

• The safety and well being of the Patient is

compromised. Refer to pages 5 - 10 in the WREB

Policy Guide.

8. Handling of Sharps

Proper Recapping Technique A single handed method is required when recapping

the needle. Once the needle is protected within the

*

*

*

*

14

cap, the needle must be secured. Needles and

cartridges must be disposed of properly.

Errors: • Two (2) handed recapping

• Hand anywhere on safety shield during recapping

• Holding needle cap during recapping

Proper Disposal of Sharps

Errors: • Improper disposal of sharps

• After the completion of both injections, sharps and

cartridges are not disposed of in the appropriate

container(s) and according to school policy.

Improper handling of Sharps results in failure of both injections.

Refer to the WREB website for Exam Site Information for Candidates

with site specific information regarding disposal of sharps and

cartridges.

LESS CRITICAL ASPECTS OF INJECTION Receiving three (3) less critical aspects in Syringe Preparation and

Handling results in failure of the injection.

2. Syringe Preparation and Handling

Armamentarium

Errors:

• Appropriate protective eyewear is not worn by the

Clinician or Patient

• No hemostat or locking forceps present on tray

• Expired local anesthetic

Syringe Properly Prepared

Errors:

• Harpoon is not securely engaged

• Bubbles are not expelled from the cartridge prior

to injection

• Expelled solution is more than the width of a

stopper

Syringe Handling

Error:

• Syringe in Patient’s direct line of vision

15

COMPLETION OF EXAMINATION After the completion of both injections, the Examiners will

independently record their grades. Upon returning to the operatory,

the Candidate will be instructed to dismiss the Patient or repeat an

injection on the opposite side of the mouth.

When instructed to dismiss the Patient:

1. Record on the Anesthesia Information Sheet, the total volume of

local anesthetic (in milliliters) administered.

2. Properly dispose of contaminated sharps, cartridges and unused

anesthetic according to Exam Site Information for Candidates

found on the WREB website.

3. Promptly break down and disinfect the operatory and exit the

clinic.

4. Return the Candidate packet and Candidate ID Badge to the

designated area.

If a Candidate is taking a Dental Hygiene and/or Restorative

Examination at the same site during the same week, the Candidate

keeps their ID Badge and Candidate packet. The badge and packet

must be turned in at the completion of the last examination at this site.

Examination results will be withheld if these items are not returned.

It is WREB Policy to notify Candidates of official Clinical

Examination results as soon as possible. Official results are generally

posted within one (1) week after the last scheduled examination day.

Results will be posted on the WREB website and can be accessed via

the Candidate login (username and password). It is important that

Candidates save the login information to access examination results.

Candidates will receive an email notification when examination

results are available online.

NOTIFICATION OF RESULT After completion of the Clinical Examination, results will be placed in

an envelope identified with the Candidate’s ID number. If successful,

Candidates will receive a purple Clinical Success Memo for the

Local Anesthesia Clinical Examination at that site.

16

If a Candidate is taking the Dental Hygiene Examination at the same

site and plans to administer local anesthetic, the purple Success Memo

must be posted at the Candidate’s operatory as proof of passing the

Local Anesthesia Examination at that site. (The policy for the

administration of local anesthetic is stated in the Dental Hygiene

Candidate Guide).

If a Candidate is unsuccessful, a copy of the Anesthesia Candidate

Evaluation form, listing the reason(s) for failure, will be placed in

the Candidate envelope with their examination results. Discussion

with the Examiners or WREB staff regarding Candidate performance is

prohibited.

RETAKE EXAMINATION ON SITE An onsite retake is available at each examination site for eligible

candidates. Onsite retakes are considered a separate examination and

are included in the total number of attempts. A Candidate has up to

four (4) opportunities to pass the Clinical Examination at two (2)

separate exam sites.

If a Candidate elects to retake the examination at the same

examination site, they are required to repeat only the failed

injection(s). If a Candidate elects to retake the examination at another

site, they will be required to perform both the IA and PSA Nerve

Block injections.

In order to retake the Clinical Examination at the same site, the

Candidate must do the following:

1. Inform the Site Coordinator they are registering for a retake

examination.

2. The retake examination fee is $250. The Candidate must

be prepared to provide one of the payment options listed

below:

a. A valid credit card that displays either the Master

Card, Visa, American Express or Discover logo.

b. A cashier’s check or money order made payable to

WREB. Cash and personal checks cannot be accepted.

17

3. Once processed, the Candidate will receive a new Patient

Medical History/ Patient Consent form and an Anesthesia

Information Sheet. The Site Coordinator will notify the

Candidate of their retake time.

4. Submit a different Patient. If an unsuccessful examination

attempt occurred prior to the needle entering the Patient’s

mouth (i.e. contaminating the needle), the same Patient may

be resubmitted.

18

REFERENCES Bassett, K.B., DiMarco, A.C., Naughton, D.K. (2015) Local Anesthesia

for Dental Professionals (2nd ed.). Upper Saddle River: Pearson

Higher Education.

Malamed, S.F. (2007). Medical Emergencies in the Dental Office

(6th ed.). St. Louis: Elsevier Mosby.

Malamed, S.F. (2013). Handbook of Local Anesthesia (6th ed.). St.

Louis: Elsevier Mosby.

20

CANDIDATE EXAMINATION SCHEDULE

_____ Time of Clinic Tour

_ Time of Candidate Orientation

_ Assigned Clinical Examination

• Patient Medical History/Patient Consent form,

noting the Patient’s blood pressure and pulse should

be completed prior to entering the clinic.

• Prepare to enter the clinic (approximately 30 [thirty]

minutes prior to your assigned clinic time)

• After entering the clinic, first complete the

Anesthesia Information Sheet

• Place barriers on chair and set up operatory

• Prepare syringe(s) (with chosen local anesthetic and

needles)

• Examiners will inform you when to escort your

Patient to the clinic

Time of Clinical Examination

• One Examiner will check the Patient’s oral mucosa

and the four penetration sites and landmarks

• One Examiner will check the Local Anesthesia

Information Sheet for accuracy

• Examiners will inform you when to apply topical

• Examiners will notify you when they are ready to

observe the injections

• You will be informed when to dismiss your Patient

• After completing both injections, one Examiner will

monitor your Sharps disposal

• Record total volume of local anesthetic administered

on the Local Anesthesia Information Sheet and leave

at the operatory

• Clean and disinfect the operatory

• Return Candidate ID Badge to the designated area