Transforming and Supporting Patient Care - Health Professions ...

206Chapter 8 – Profession of Dental HygieneNitrous Oxide and OxygenProtocols and guidelines have been well established for the administrationof nitrous oxide and oxygen for conscious sedation and HPRAC does notthink that these protocols should be treated lightly. They encompass notonly requirements for the maintenance of equipment, but for theparticipation of health professionals and emergency preparation. HPRACrecommends that dental hygienists should not be authorized toindependently administer nitrous oxide/oxygen conscious sedation.Local AnaestheticsHPRAC heard significant concerns about the proposed administration byinjection of local anaesthetics performed by dental hygienists. At the bestof times, this is a delicate task, requiring significant training and skill. Painmanagement courses of limited duration do not prepare dental hygienists toperform this task. The dental hygienist is well qualified to identify the needfor an anaesthetic and to make a referral to an appropriate healthprofessional to perform the procedure.Salivary StimulantsPilocarpine, a cholinergic agonist, can be used to stimulate salivation.However, this drug may also have serious cardiovascular effects, forexample, slowing of the heart rate. HPRAC is of the opinion that there are anumber of OTC medications that can safely address this issue and this drugneed not be authorized for prescription by dental hygienists.Smoking CessationHPRAC acknowledges that dental hygienists, along with a number of otherhealth professionals who are committed to health promotion, play animportant role in smoking cessation and that they should be encouraged tocontinue in this role. HPRAC is also of the opinion that there are sufficientOTC medications, such as gums, patches, sprays, and lozenges, to assistwith smoking cessation and that access to antidepressants (buproprion) isnot necessary and poses significant risks to the patient.Sedative-hypnoticsSedative-hypnotics include benzodiazepines such as diazepam (Valium).They can be used to relieve anxiety and to cause mild sedation prior tomedical procedures. In this case, HPRAC is concerned about the risk ofsedation, overdose and abuse. In addition to the risk of usingbenzodiazepines themselves, there is also a risk of significant druginteractions, particularly with other CNS-active agents.AdrenalsSimilar to the concerns about the use of antivirals and antifungals, HPRACdoes not recommend that topical corticosteroids such as triamcinoloneshould be authorized at this time. Although prudent use of topicalcorticosteroids can relieve temporary pain and inflammation, these agentsHPRAC Critical Links January 2009