DLA 1203, Exam 6

1. Medical Emergencies
in the Dental Office
CONTINUED

2. Cardiovascular Emergencies

3. Angina Pectoris
 Latin meaning “strangling in the chest”
 Pain in chest area, neck, and radiates to the jaw
 Jaw pain is the first indication of heart disease
 Normally five-minute duration
 Person wants to remain motionless
 Increased blood pressure and pulse
 Feeling of impeding doom
 Pale and clammy skin
 If this is not the first indication, then the person may be under a
physicians care, and have nitroglycerin pills or spray

4. Angina Pectoris
 Administration of nitroglycerin
Dilates coronary arteries
Heart receives oxygen
Rapid action drug
 Pills: placed sublingually to allow them to dissolve and be
absorbed rapidly
 Spray: translingually into the oral cavity
 Each patient is given a specific dosage because some
individuals are more susceptible to the drug.

5. Angina Pectoris
 If the condition arises in the office, all dental tx stops.
 The dental team remains calm and reassures the patient.
 Any items that may increases stress for the patient are removed from sight
 Oxygen can be administered while the patient takes the first dosage of
nitroglycerin.
 A second dose can be administered 3-5 minutes following the second dose.
 If the pain is not alleviated the dental team can assume that the patient is
experiencing a myocardial infarction and emergency help should be summoned to
transport the patient to a medical facility
 Procedure 16-12

6. Myocardial Infarction: Heart Attack
Caused by blocked or narrowed arteries
Symptoms similar to angina, but not relieved
with nitroglycerin
Causes sudden dealth of part of the heart
tissue and may be precipitated by angina
pectoris, or may occur in a person who never
had any prior symptoms.

7. Myocardial Infarction
 One-third of heart attack victims die
 Risk factors include:
Males are more likely to exhibit heart attacks than females
Smokers have a higher incidence of heart attacks than nonsmokers
Increased age; specific diseases such as a diabetes mellitus; and
heredity are uncontrollable factors
Diet, stress level, high blood pressure, and exercise levels are
controllable factors

8. Treatment of Myocardial Infarction
 Remain calm
 Stop all dental tx
 Reassure and reposition patient (head elevated slightly)
 Remove any items that may increase stress
 Call 9-1-1
 Administer oxygen
 Administer nitroglycerin
 Administer 160 to 325 milligrams (mg) chewable aspirin

9. Congestive Heart Failure (CHF)
 As the heart weakens, a person may experience CHF
Inability of heart to pump
 When a person stands or sits for long periods, fluid collects around
ankles and legs
 The person may appear with swollen ankles and legs, and report
indigestion and difficulty breathing.
 May older patients show signs of heart weakening,
 When they lie in bed, these patient report difficulty breathing and
need to have large pillows to keep the head and heart elevated.
This occurs because the fluids from the feet, legs, and other parts
of the body gravitate toward the heart and lungs.

10. CHF
 Medical tx for this condition is diuretic drugs that rid the
body of excess fluid by increasing the output of urine.
 In some cases, these patients take other drugs to strengthen
the contractions of te hear.
 While CHF may not result in a medical emergency, the DA
should be alert to how to make this patient more
comfortable when receiving dental treatment.
Be sure the these patients are seated with their heads elevated to
eliminate discomfort, and reduce undue stress
Allow them to visit the restroom as needed

11. Stroke/Cerebrovascular Accident (CVA)
 Leading cause of death and disability in U.S.
 Sudden onset caused by cerebral infarction
 interruption of blood supply to brain
 Cerebral embolism (blood clot)
 Cerebral hemorrhage (rupture of a blood vessel)
 Occur at all ages, but primarily in older people
 Person may have intense headache, loss of speech, unexplained dizziness, hemiplegia (weakness,
numbness, or paralysis on one side of the body), and loss of consciousness.
 An average of 200 people per 100,000 suffer strokes annually.
 Number rises with age
 Men have more strokes than women
 African Americans suffer more than Caucasian
 Having Diabetes mellitus increases likelihood

12. Stroke
 Controllable risk factors include:
Smoking
High blood pressure
Heart disease
 Some people experience transient ischemic attacks (stroke-like
symptoms that disappear within 24 hours).
They should seek medical attention because they are strong
predictors of impending stroke
Person may be given blood thinners to prevent blood clots from
forming, and thus preventing a stroke

13. Stroke
 Damage to an area of the brain may impair body sensation,
function or movement.
 The cerebral hemisphere in the brain on th eleft side controls
the functions on the body’s right side and vice versa.
 This one-sided weakness or paralysis is known as hemiplegia
and is one of the most common effects of a stroke.
 If a patient has had a stroke the dental assistant may observe
the patient walking with an abnormal gait.

14. Stroke
 If the patient has not indicated anything on the medical history about
this, the DA can request information from the patient.
 The patient may not understand that this information is important to
his or her dental tx and may feel that he or she is making a strong
recovery, thus thinking that it is insignificant to his or her dental
medical history.
 It’s not only important that they gather this information, but also they
must observe the patient when seating the patient.
 The doctor does not have this opportunity to view the patient as he or
she is coming in for treatment.

15. Stroke
 If a patient has a stroke in the office, stop all treatment and
remove any items from the patients mouth
 Position the patient so that his or her head is slightly
elevated
 Administer oxygen and monitor vital signs while emergency
medical help is summoned.
 Calm the patient and provide CPR as needed.

16. Dental Emergencies
Monitoring the
Patient’s Health During
a Procedure
CHAPTER 16

17. Dental Emergencies
Abscessed tooth
Alveolitis
Avulsed tooth
Broken prosthesis
Soft tissue injury
Broken tooth
Loose crown

18. Abscessed Tooth
 Most common dental emergency
 Symptoms include:
 Pain from pressure
 Swelling
 Severe responses to heat
 The tooth has become infected, and as the abscess grows, it places a great deal of
pressure in the area because the fluid has no place to escape in the bone.
 If the abscessed tooth goes untreated long enough in this painful state, the
infection process may create a fistula in the bone and through the oral mucosa near
the root end of the tooth.
 This fistula, an abnormal, tube-like passage at the end of the tooth to the outside surface in the
oral cavity, allows the fluid to be discharged and the pressure to be released slightly.
 The fistula normally closes after the tooth is treated, after which the infection is reduced or
eliminated

19. Abscessed Tooth

20. Alveolitis
 (al-vee-o-LIGH-tis)
 AKA alveolar osteitis
 AKA dry socket
 Happens after a tooth has been removed
 Occurs when a blood clod does not form, or is washed out of the socket, allowing the nerve
endings over the bond to become exposed.
 This condition increases the chance of infection in the area
 Alveolitis causes great discomfort
 Treated by gently rinsing the socket with saline solution to remove any debris and then packing a
medicated iodoform gauze strip that is cut in a sufficient length into the socket.
 The medicated iodoform gauze treatment, which is only palliative, may have to be repeated every
day or two until the pain diminishes.
 The patient may be given analgesics to relieve additional discomfort.

21. Alveolitis
https://youtu.be/6NrutFguDls

22. Avulsed Tooth
 A patient may call the office and report that one tooth has
been forcibly misplaced or avulsed.
 This avulsed tooth (also spelled evulsed) can be replanted into
the sock at the have a fairly high success rate if handled
quickly.
 The patient should immediately wrap the tooth in clean wet
gauze, place it in the mucosa between the teeth and lip, or
place it in milk while transporting to the office.
 The area where the tooth came out can be packed with gauze
and pressure applied to control the bleeding

23. Avulsed Tooth
 The outcome correlates greatly with the time that has
elapsed.
 Getting the patient to the office and under the dentist’s care
quickly is essential.
 The dentist replants the tooth in the socket and secures it to
the adjacent teeth.
 The dentist may perform immediate root canal therapy on
the avulsed tooth prior to replanting it in the socket, or
complete endodontic treatment 6-8 weeks after
reimplantation.

25. Broken Prosthesis
 Normally, the patient is not in pain, but needs help due to
appearance concerns and loss of function.
 The broken prosthesis can be repaired in the office by the
dentist or sent to the dental lab
 Additional treatment is scheduled for a convenient time for
patient and dental office.
 The length of time for prosthesis repair varies. It may be
necessary to perform temporary repairs in the interim, until
the permanent treatment can be completed.

26. Soft Tissue Injury
 Running with sharp or blunt objects
 Falling down with something in their mouth
 Electrical buns in the oral cavity
 Biting into electrical cord (cellphone charger)
 Children fall and push newly erupted teeth back down/up into the sockets
 Traumatic intrusion
 Sports injuries
 Can also occur in the dental office
 The oral cavity is moist and slippery, the patient may move suddenly and the dental
instruments and equipment can easily become displaced, causing injury
 This is why a fulcrum is so important!

27. Soft Tissue Injury

28. Broken Tooth
 Anterior teeth are commonly fractured at drinking faucets,
on steering wheels, or on diving board
 The dental receptionist discerns whether the patient needs
to be scheduled immediately by gaining information from
the patient as to the level of discomfort, whether there are
any sharp edges, an dhow extensive the broken area is.
 In most offices, the patient is seen for an initial appointment
on an emergency basis to determine the treatment needed.

30. Loose Permanent or Temporary Crown
 A patients crown may become loose or come off, requiring
recementation
 The patient may be in discomfort if the pulp is exposed or if the
restoration has sharp edges
 If the patient is out of town and unable to get dental care, petroleum
jelly or orthodontic wax can be used to temporarily keep the crown in
place.
 The patient will have to exercise extreme care while eating.
 If the patient can get to the dental office, treatment consists of
recementing the crown with temporary of permanent cement, as
indicated.

31. Monitoring Patients During Treatment
Monitoring devices:
Pulse oximeter
Capnograph
Electrocardiogram

32. Pulse Oximeter
Measures oxygen saturation in
blood
Noninvasive
Diagnoses:
Sleep apnea
Indicator of hypoxia

33. Capnograph
Detects changes in carbon dioxide levels
Noninvasive
Usually used in critically ill patients
Can be used to detect hyperventilation

34. Electrocardiogram
Records electrical activity of heart
Noninvasive
Detects alterations in pumping of heart