Emergency Procedures for Dentists

Introduction

The best management of a dental office medical emergency is prevention. A reliable medical history, appropriate physical examination, and proper consultation may prevent the on-set of a life-threatening situation.

Dental practitioners must be prepared to treat not only the seemingly well patient but also patients with complex medical needs. When patients experience physical reactions to care, the dental team should react quickly, efficiently and competently. The dental office should have a written emergency plan in place with specific staff duties and adequate armamentarium to meet emergencies.

Patients with complex medical needs may not be able to communicate distress other than the physical signs and symptoms that the dentist sees. In these cases, it is particularly important that the dentist and staff remain constantly aware of the patient's responses and reactions.

General Principles of Emergency Care

Emergencies in the dental office are frequently caused by the patient's inability to withstand physical or emotional stress, reactions to drugs, or preexisting systemic disease.

In all emergencies, basic BLS or ACLS protocol should be implemented. Dental staff should, at a minimum, maintain current certification in BLS protocol.

Key Points to Remember in Case of Medical Emergency

1. Quick recognition and diagnosis of signs and symptoms
2. Early response time (4 to 6 minutes without oxygen leads to irreversible brain damage)
3. Airway clearance (circulation meaningless without oxygen)
4. Proper monitoring of vital signs
5. Continued monitoring of patient status
6. Assurance that patient receives proper medical care

Potential Causes of Medical Emergency

I. Aspiration or Swallowing of a Foreign Object

Cause: Foreign body in larynx or pharynx

Signs & Symptoms:

1. Coughing or gagging associated with the aspiration of a foreign object
2. Possible cyanosis from airway obstruction
3. Violent respiratory effort
4. Suprasternal retraction
5. Rapid pulse

II. Local Anesthesia Drug Toxicity

Causes:

1. Too large a dose of local anesthetic per body weight
2. Rapid absorption of drug or inadvertent IV injection
3. Slow detoxification or elimination of drug

III. Allergic Reactions

A. Mild Allergic Reactions

Symptoms:

1. Mild pruritus (itching)-slow appearance
2. Mild urticaria (rash)-slow appearance

B. Severe Allergic Reactions

Symptoms:

1. Skin reactions

a. Rapid appearance. Severe pruritus (itching)
b. Severe urticaria (rash)

2. Swelling of lips, eyelids, cheeks, pharynx and larynx (angioneurotic edema)

3. Anaphylactic shock

a. Cardiovascular - fall in blood pressure
b. Respiratory - wheezing, choking, cyanosis, hoarseness
c. Central nervous system - loss of consciousness, dilation of pupils

III. Convulsions

Causes:

1. Syncope
2. Drug reactions
3. Insulin shock
4. Cerebrovascular accident
5. Seizure disorder

IV. Hyperventilation

Causes:

1. Excess loss of CO2
2. Respiratory alkalosis

V. Unconsciousness

Causes:

1. Cerebral hypoxia

Reference

Adapted in part from Little, J., Falace, D., Miller, C., & Rhodus, N. (2002). Dental management of the medically compromised patient (6^th ed.). St. Louis: Mosby (pp. DM-77-87).