emergency cases during dental procedures

1. Emergencies in
Dental practice
BY DR. ASMAA HASSAN ALI

2. 1-Fainting (Vaso-Vagal Syncope)
• Fainting is the most common medical
emergency seen in dental practice. Pain and
anxiety are predisposing factors.
• Signs & Symptoms:
• The patient may:
 Feel nauseated with a cold, clammy skin .
 Notice a visual disturbance together with a
feeling of dizziness
 Pulse initially rapid and weak becomes slow on
recovery
 Lose of consciousness.

3. Management:
• Before the patient loses consciousness, the possibility of
hypoglycemia should be born in mind, and a glucose drink may be
helpful.
▪ Lay thy patient flat (legs higher than the heart)
▪ Loosen any tight clothing around the neck
▪ Recovery is usually rapid and occasionally the patient may jerk as
they regain consciousness in a manner resembling a fit.
• Prolonged unconsciousness should lead to consideration of other
causes of collapse

4. 2- Anaphylactic Shock
• Treatment of acute anaphylactic reaction must be immediate.
▪ The patient should be:
1. Placed horizontally by appropriate adjustments of dental chair or
placing on the floor.
2. If respiratory depression is present, oxygen should be
administered or mouth to mouth respiration performed.
3. Adrenaline 0.5 ml of 1:1000 (0.1 mg/ml) adrenaline solution
should be injected intramuscularly (never intravenously).
4. Give hydrocortisone sodium succinate, l00mg I.V.

5. 3- Epilepsy
• Major epilepsy (grand mal epilepsy) is a convulsive disorder
characterized by
• an Aura: a disorder of sensation, Tonic phase: patient is rigid and may
stop breathing and Colonic phase: convulsions occur.
• In either phases patients may bite their tongue

6. How to deal with an epileptic patient?
a-If a patient is known to be an epileptic it is important for them to continue
medication.
b- If the patient has an attack in the dental surgery:
▪ All appliances should be removed from the mouth as quickly as possible.
▪ Whether or not dental treatment is continued can only be decided by the
operator.
c- If the patient doesn't recover in minutes and seizures occur in rapid succession
(status epilepticus), then an anticonvulsant drug must be given.

7. d- The drug of choice is the Benzodizaepines (Diazepam).
▪ The ultra-short acting barbiturate, thiopentone, will also cut short an
attack
Status epilepticus is a dangerous condition and the patient should be
taken into hospital as soon as possible

8. 4- Hypoglycemia
The diabetic patient's regime can become imbalanced and they may then
suffer from too much insulin or too little.
▪ Too much insulin will lead to hypoglycemia a reduction in blood
glucose level which is commonly met in dental practice.
▪ Too little insulin will lead to diabetic ketosis.

9. Signs & Symptoms of Hypoglycemia.
Weakness , Hunger , Sweating , Blood pressure
normal or elevated, pulse full and rapid , Patient
anxious (adrenaline) up to Coma.
▪ One characteristic feature of hypoglycemia is
that the patient may become difficult to manage
and even aggressive.
▪ If there is any doubt about the diagnosis, a few
lumps of sugar or sugar sweets will normally
correct hypoglycemia rapidly.

10. How to deal with patients who has hypoglycemia?
A hypoglycemia attack requires urgent treatment as
prolonged hypoglycemic coma lead to irreversible brain damage.
a- If the patient is able to swallow : give him sugar sweets.
b- If the patient is unable to swallow: intravenous dextrose should be
administered.
c- If a vein cannot be found: give glucagon I.M. glucagon is a hormone
secreted by the "a" cells of the pancreas. It raises plasma glucose
concentration by mobilizing glycogen stored in the liver

11. 5- Control of Bleeding
More of the following measures can be used to control bleeding:
1- Use a spint constructed before surgery (in cases with multiple extractions).
2- Pressure using gauze pack Absorbable gelatin sponge (Gelfoam).
3- Dental packing blocks: can be cut to fit and applied to bleeding site.
4- Powder: Apply to bleeding site may be:
▪ Gel foam with thrombin,
▪ Thrombogen: Powder with isotonic saline diluent (5,000-unk container with
isotonic saline). For bleeding from skin or mucosa, use solution of 100
units/ml. Do not use with Oxycel, Surgicel, or microjibrillar collagen because
they inactivate the thrombin.

12. 5-Oxidized cellulose (Oxycel)
▪ Pad: Cut to appropriate size and apply dry.
6- Tranexamic acid (Cyklokapron):
▪ Solution: 100 mg/ml in 10-ml vials; tablets: 500 mg, after surgery 25 mg/kg
orally tid.
7- Oxidized regenerated cellulose (Surgicel absorbable hemostat): lay over
extraction site to control bleeding.
8- Microfibrillar collagen hemostat: apply topically, and it adheres firmly to
bleeding surfaces.
9- Collagen hemostat pads apply directly to bleeding surface with pressure.

13. Thank you