Dental Emergencies

By | September 17, 2013

Dental medical emergencies may be encountered. To resolve the issue by putting the patient immediately under treatment is sensible. This helps in minimizing the risks of complications involved in dental emergencies. Each emergency requires a correct diagnosis for effectiveness of management.

Fainting
It is the most common dental emergency that cause loss of consciousness. It is more common in young people, and is caused because of uncommon smell and sights, nervousness, panic and tension.

  • Symptoms and signs of Fainting
    • Light headed feeling
    • Warm, sweaty feeling
    • Skin cool to touch
    • Loss of consciousness
  • Immediate attention
    • Lie patient flat with head below heart (modern dental chairs are ideal)
    • Examine the pulse.
    • Windows should be opened soon.
    • Speak to patients as much as possible to prevent unconsciousness.
    • Dental treatment should be continued later.

Collapse of a diabetic patient
If a diabetic patient collapses they might be affected by hypoglycaemia, that is they suffer from low blood sugar. Avoid giving them which might result in more than desirable level of blood glucose (hyperglycaemia). Seek immediate attetion by medical professionals.

  • Symptoms of hypoglycemia
    • Blood sugar low
    • Irritable behavior
    • Moist skin
    • Normal or rapid breathing
  • Symptoms of hyperglycemia
    • Blood sugar high
    • Drowsiness
    • Dry skin
    • Deep breathing
    • Immediate attention
      • If conscious make the patient lie patient flat
      • Administer glucose

If unconscious or uncooperative

    • Administer 50 ml of 50% glucose IV or 1 mg glucagon
    • Urgent transfer to hospital

Acute chest pain
Chest pain does not necessarily indicate cardiac disease. Chest pain in dental situations can be caused by rapid breathing, pulmonary embolism (blockage of artery), angina pectoris (also known simply as chest pain) and can be a myocardial infarction (heart attack). Rapid breathing can be caused by fear and stress.

  • Symptoms
    • Radiations to arm, neck or jaw
    • Angina normally relieved by tablet or spray
    • Myocardial infarctions likely if pain is accompanied by ; nausea – vomiting – loss of consciousness – weak/irregular pulse – hypotension
  • Immediate attention
    • Give patients own anti angina medications or spray.
    • Do not lie flat as this increases feeling of breathlessness and panic.
    • Administer nitrous oxide and oxygen (50/50) as pain relief.
    • Establish verbal encouragement of patient.
    • Administer oral aspirin (one tablet) as anti platelet agent.
    • Urgent transfer to hospital.

Cardio-respiratory Arrest
It is one of the serious emergencies that may occur during dental situations

  • Symptoms and signs
    • Loss of consciousness
    • Absence of central arterial pulse
    • Absence of breath sounds/ chest movements
  • Immediate attention
    • Shaking the patient gently and shouting are you alright to see whether the patient is responding.
    • Feel and look for normal breathing.
    • Check for signs of a circulation at the pulse.
    • If there is evidence of a circulation, give rescue breaths until the patient is able to breath unaided.
    • If there is no evidence of a circulation, start chest compressions at the rate of 100 per minute; after 15 compressions, give 2 effective breath and continue compressions and breaths in ratio of 15:2.
    • Immediately call 911.

Anaphylactic Shock
Anaphylactic shock or reactions if occurs during dental emergencies can be a major risk to the patient. Generally it occurs after any drug administration or if the patient is allergic to the materials used in dental treatment.

  • Symptoms and signs
    • Facial flushing
    • Itching of skin
    • Wheezing
    • Abdominal pain and nausea or vomiting
    • Blood pressure is low and unrecordable
  • Management
    • Lay patient flat and raise the legs.
    • Administer high flow oxygen.
    • Establish IV access and administer chlorphenamine 10-20 mg diluted in a syringe with 10-20 ml of blood or saline. Urgent transfer to hospital. All patients with such reactions must be admitted under medical supervision for up to 72 hours because relapse is common.

Asthma
Asthma is the most chronic childhood disease. The underlying problem is that of a respiratory tract hyper reactivity with resultant broncho-spasm.

  • Symptoms and signs
    • Breathlessness
    • Wheezing
    • Panic and fear
    • If severe, in ability to speak
  • Management
    • Give reassurance but don’t crowd the patient.
    • Allow patient to use his/her inhaler or supply a salbutamol inhaler. The patient should assume the most comfortable position (usually erect)
    • Give nebulised salbutamol (2.5 mg), if a portable nebuliser is available
    • Obtain IV access and give hydrocortisone 100-200mg IV
    • Urgent transfer to hospital.

Adrenal crisis
This emergency is less likely to occur in dental situations. But the dentist should have knowledge about this emergency to manage it efficiently.

  • Symptoms and signs
    • Rapid loss of consciousness
    • Pallor of skin
    • Rapid, weak pulse
    • Hypotension
  • Management
    • Lay patient flat and raise the legs.
    • Administer high flow oxygen.
    • Establish IV access and administer 200 mg of hydro-cortisone IV.
    • Urgent transfer to the hospital.

Epilepsy
Epilepsy effects brain and causes fits (seizures) repeatedly. It may present in many different forms. Properly controlled, patients with epilepsy present no management problems to the dental surgeon.

  • Symptoms and signs
    • Rapid loss of consciousness
    • Extended body and jerking and flailing movements
    • Drowsiness and desire to sleep follows
  • Management
    • Administer diazepam emulsion [(diazemuls) sedative], normally at a dose of 10-20 mg IV, to abort the attack
    • Administer high flow oxygen
    • Check blood sugar
    • Urgent transfer to hospital

Conclusion
Management that is appropriate will deal with medical emergencies effectively. It is important that each member of the dental team should know what his/her role be in the event of a medical emergency. Training should be updated regularly or yearly basis.

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