Management of Medical Emergencies in the Dental Office: Conditions in Each Country, the Extent of Treatment by the Dentist

Abstract

Dentists must be prepared to manage medical emergencies which may arise in practice. In Japan, a study was conducted between 1980 and 1984 by the Committee for the Prevention of Systematic Complications During Dental Treatment of the Japan Dental Society of Anesthesiology, under the auspices of the Japanese Dental Society.1 The results from this study showed that anywhere from 19% to 44% of dentists had a patient with a medical emergency in any one year. Most of these complications, approximately 90%, were mild, but 8% were considered to be serious. It was found that 35% of the patients were known to have some underlying disease. Cardiovascular disease was found in 33% of those patients. Medical emergencies were most likely to occur during and after local anesthesia, primarily during tooth extraction and endodontics. Over 60% of the emergencies were syncope, with hyperventilation the next most frequent at 7%. In the United States and Canada, studies have also shown that syncope is the most common medical emergency seen by dentists.2,3 Syncope represented approximately 50% of all emergencies reported in one particular study, with the next most common event, mild allergy, represented only 8% of all emergencies. In addition to syncope, other emergencies reported to have occurred include allergic reactions, angina pectoris/myocardial infarction, cardiac arrest, postural hypotension, seizures, bronchospasm and diabetic emergencies. The extent of treatment by the dentist requires preparation, prevention and then management, as necessary. Prevention is accomplished by conducting a thorough medical history with appropriate alterations to dental treatment as required. The most important aspect of nearly all medical emergencies in the dental office is to prevent, or correct, insufficient oxygenation of the brain and heart. Therefore, the management of all medical emergencies should include ensuring that oxygenated blood is being delivered to these critical organs. This is consistent with basic cardiopulmonary resuscitation, with which the dentist must be competent. This provides the skills to manage most medical emergencies, which begin with the assessment, and if necessary the treatment of airway, breathing and circulation (the ABCs of CPR). Usually, only after these ABCs are addressed should the dentist consider the use of emergency drugs. Drugs that should be promptly available to the dentist can be divided into two categories.4 The first category represents those which may be considered essential. These drugs are summarized in Table 1. The second category contains drugs which are also very helpful and should be considered as part of the emergency kit. These supplementary drugs are summarized in Table 2. The precise composition of the drug kit can vary as the presence of the drugs in this latter group may depend on the nature of the dental practice. Table 1 Essential Emergency Drugs Table 2 Additional Emergency Drugs