Different types of medical emergencies in dental practice: A review

Introduction

Medical emergency can occur in dental practice. The dentist should be well known to recognize the medical emergency in the initial period and start with the initial treatment before the emergency turned in to any serious complication.1 These type of medical emergency can happen to any patient, it can happen to the dentist itself or to any dental assistant or to the person who is accompanying the patient itself. Before going to any dental routine procedure, one should go thoroughly through the medical history of the patient. Literature revealed that more than 54 percent of the medical emergency occurs soon after giving the local anesthesia or during the administration of the local anesthesia.2, 3, 4

These medical emergencies can happen from minor emergency to life threating medical emergency.

Risk assessment medically

Medical risk assessment should be done of each and every patient before undergoing any dental procedure.5, 6, 7 Medical risk assessment should be done by the dentist in person via questionnaire method, through having a proper blood investigation report if the patient is undergoing any minor or major oral surgical procedure, having a thorough information of if the patient is on any medication or not.8

Most commonly occurring medical emergency in dental practice are as follows:

In the management of some common medical emergency, basic life saving drugs are as follows:

Some of the medical equipment’s required in the clinic are as follows:

Survey if any medical emergency happens

First of all if any medical emergency happens in the clinic, stay calm, ensure that the patient along with the doctor should be in safe position, means the patient should not fall over the ground or the dentist should not fall, there should be no sharp instruments near the patient or near the dentist, that may cause further harm to the patient or to the dentist. After than inspect the patient, if the patient looks unwell ask the patient if he or she is fine or not, if the patient is conscious ask the patient is he or she is alright and if the patient does not respond or unconscious, shake the patient gently and repeat the questions again. If the patient responds normally, it is clear that patient is having a clear air way and if the patient does not respond clearly or any stridor is present means air way is blocked and need to do things that way.4, 8, 9

Specific responses for the medical emergencies:

Vasovagal Syncope

Syncope is defined as transient or sudden loss of consciousness with recovery to the normal that is spontaneous. Syncope is commonly provoked by anxiety, low blood pressure, long standing. This response is mediated neurally. In vasovagal syncope there is involvement of reflex bradycardia that too with or without peripheral vasodilation. It usually don’t occur when the patient is lying in supine position. If the patient goes in vasovagal syncope, signs and symptoms of syncope are pallor, loss of consciousness, sweating and nausea. Initially lie the patient in supine position with his or her legs elevated, oxygen can be administer and let the patient in supine position only until the patient becomes conscious. To maintain the proper airway head lift chin tilt procedure can be performed. Loosening of clothes, collars or ties to main the air way should be done as well as use of aromatic ammonia is very much helpful in waking up the patient from the unconsciousness. 3, 4, 8, 9, 10, 11, 12

Postural Hypotension

Postural hypotension is the second most common cause of loss of consciousness in the dental practice. In any dental procedure when the patient is lying in a supine position during the treatment that may lasts for 1 to 2 hours and then suddenly the chair reclined from supine position to the stand position or when the patient stand quickly leads to a condition known as postural hypotension.11, 12, 13, 14

Some of the other causes of postural hypotension are intake of certain drugs, prolonged convalescence period or inadequate reflex postural or during late stage of pregnancy.

Angina

It results due to imbalance between the blood supply of myocardium and oxygen demand. Typically angina is precipitated by any type of exertion, stress or exposure to cold. It usually lasts for 1 minute to five minute and relieved by taking rest or by the administration of GTN.

Management

If any sign and symptom of angina occurs in the patient, for e.g. patient says pain in the chest or says radiating pain from the chest to the shoulder, immediately stop the procedure and instead of lie the patient in the supine position make the patient to sit upright position, administer oxygen to the patient, give GTN tablet sublingually wait for 10 minutes and if the patient does not recover transfer the patient immediately to the hospital for the medical treatment.

Management

Clinical signs and symptoms comes in the form of rashes, itching , swelling on the face, bronchospasm, initially detect the cause and remove the cause, lie the patient in the supine position with his or her legs elevated with administration of high flow of oxygen should be administer. And if the symptoms does not subside start administrating adrenaline 0.5 mg through intramuscular or intravenous route.

Conclusion

Dentist should have a thorough knowledge of basic life supporting drugs and without wasting a time should start with the initial treatment process of the patient. Dentist should have a basic life supporting drugs in the clinic and other than the dentist, the other staff should also be known with the life saving drugs.

Source of Funding

None.

Conflict of Interest

None.