Copyright © 2016 WREB
All rights reserved. No part of this manual may be used or
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written permission of WREB.
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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
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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