The document discusses various medical emergencies that may occur in a dental practice setting. It classifies life-threatening emergencies into categories such as unconsciousness, respiratory distress, altered consciousness, drug reactions, chest pain, and seizures. For each type of emergency, it describes signs and symptoms and provides guidance on initial management and treatment. Common emergencies discussed in detail include syncope, hyperventilation, stroke, hypoglycemia, anaphylaxis, adrenal crisis, angina, and myocardial infarction. The document emphasizes the importance of dental practitioners being prepared to recognize and respond appropriately to medical emergencies.

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©M. S. Ramaiah University of Applied Sciences
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MEDICAL EMERGENCIES IN DENTAL
PRACTICE
DR SEJAL K M
READER
DEPTOF ORAL& MAXILLOFACIAL SURGERY

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MEDICALEMERGENCIES
Goldberger 1990, “When you prepare for an emergency,
the emergency ceases to exist.”

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CLASSIFICATION OF LIFETHREATENING EMERGENCIES
• UNCONSCIOUSNESS
– VasodepressorSyncope
– Postural Hypertension
– Acute Adrenal Insufficiency

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CLASSIFICATION OF LIFETHREATENING EMERGENCIES
• RESPIRATORY DISTRESS
– Foreign Body Airway Obstruction
– Hyperventilation
– Asthma
– Myocardial Infarction or Angina

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CLASSIFICATION OF LIFETHREATENING EMERGENCIES
• ALTERED CONSCIOUSNESS
– Diabetes Mellitus: Hyperglycemia and Hypoglycemia
– Cerebro vascular Accident
• SEIZURES

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CLASSIFICATION OF LIFETHREATENING EMERGENCIES
• DRUG RELATED EMERGENCIES
– Drug OverdoseReactions
– Allergy
• CHEST PAIN
– Angina Pectoris
– Acute Myocardial Infarction

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ANXIETY
Symptomsofanxietydisorderinclude:
• Feelingsofpanic,fear, anduneasiness.
• Problemssleeping.
• Coldor sweatyhandsand/orfeet.
• Shortnessofbreath.
• Heartpalpitations.
• Aninabilitytobestillandcalm.
• Drymouth.
• Numbnessor tinglinginthehandsor feet.

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SYNCOPE
 Vasovagal syncope
 Simple faint is the most common medical emergencyseen in dental
practice.
 Loss of consciousness duetoinadequate cerebral perfusion
 Mediated by autonomic nerves.

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SYNCOPE
• Fainting can beprecipitated by
Psychogenicfactors
• Fright
• Anxiety
• Emotional stress
• Receipt of unwelcome news
• Pain especially sudden &unexpected
• Sight of blood/ surgical/ dental instruments
• (e.g.local anesthetic syringe)

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Non psychogenicfactors
• Erect sitting orstanding posture
• Hunger from dieting or a missed meal
• Exhaustion
• Poor physical condition
• Hot, humid, crowded environment
• Male gender
• Agebetween 16 and 35 years

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• Warm feeling in face and neck.
• Pale orashen coloration.
• Sweating.
• Feels cold.
• Abdominal discomfort, Nausea and/or vomiting;
• Lightheaded ordizziness.

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• Mydriasis (Pupillary dilatation.)
• Yawning.
• Increased heartrate initially later bradycardia
• Steady orslight decrease in blood pressure.
• Seizures
• Loss ofconsciousness

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Stress
Catecholamines release
peripheral vascular resistance & ↑blood flow to peripheral muscles
↓venous return
↓circulatory blood vol. & fall in arterial B.P.
Reflux bradycardia develops (< 50)
Significant drop in cardiac output associated with fall in B.P below the critical
level
Cerebral ischemia & loss of consciousness

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 Treatment for fainting involves the following:
1. Lie the patient flat and raise the legs trendlenburgposition.
2. A patent airway must be maintained.
3. If recoveryis delayed, oxygen (10litres) should beadministered.

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TRENDLENBURGPOSITION

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SYNCOPE
• Aromatic ammonia has a noxious odour and irritates the mucous
membranes of the upper respiratory tract, stimulating the respiratory and
vasomotor centres of the medulla. This action in turn increases
respiration andblood pressure.

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HYPERVENTILATION
• It is defined as ventilation in excess of that required to maintain normal
blood pa O2 (arterial oxygen tension) and pa CO2 (arterial carbon
dioxide tension).
• Thereis increase in frequency ordepth of respiration, orboth.
• Commonest emergency in dental office always occurs as a result of
extremeanxiety.

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Anxiety
Increased rateand depth of respiration
↑exchangeof O2 & CO2 by lungs
↑ blowing off of CO2 and paCO2 decreases
Hypocapnia
↑in blood pH
Respiratory alkalosis

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Recognizeproblem (rapid , deep,uncontrolled breathing)
P –Position patient comfortably, usually upright
A → B→C–Basic life support as needed
D –Definitive care:

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 Prevention:
Through prompt recognition and management of anxiety.
Stress reduction protocol is the primary means of preventing
hyperventilation.

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• Removedental materials from patient’s mouth
• Calm patient
• Correctrespiratoryalkalosis – instructed to breathe 7% CO2 & 93% O2
orto rebreathe the exhaled air.
• Initial drug management –Benzodiazepines
• Dental caremay continue if both doctor and patient agree
• Discharge patient

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STROKE
Stroke:
• Stroke may beeither hemorrhagic orembolic.
• Signs and symptoms varyaccording to the site of brain damage.
• Loss of consciousness andweakness of limbs on one side of the body.

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FAST

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• Oneside of the face may becomeweak.
• As stroke causes an upper motor neuron lesion, the forehead muscles of
facial expression will be unaffected.
• Speechmay becomeslurred.

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Initialmanagement ofa stroke includes the following:
 Theairway should be maintained and anambulance called.
 High flow oxygen (10litres perminute) should begiven.
 The patient should be carefully monitored for any further
deterioration.

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HYPOGLYCEMIA
 Theproper casehistory- diabetic control.
 Varying blood glucose levels- hypoglycaemia.
 Treat them during morning appointment.
 Medication and food prior to appointment.

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HYPOGLYCEMIA
• Thesigns and symptoms of hypoglycemia include:
 Trembling
 Hunger
 Headache
 Sweating
 Slurring of speech

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HYPOGLYCEMIA
 ‘Pins and needles’ in lips and tongue
 Aggression and/or confusion
 Seizures
 Unconsciousness.

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Management of Hypoglycemia

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Management of Hypoglycemia

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ANAPHYLAXIS

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ANAPHYLAXIS
• „Thesigns and symptoms of anaphylaxis include:
 „Itchy rash/erythema.
 Facial flushing orpallor.
 „Upper airway (laryngeal) oedema and bronchospasm leading to
stridor, wheezingand, possibly, hoarseness.

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Management of Anaphylaxis
• Diphenhydramine Hydrochloride (Avil)
• 1:1000 Adrenaline
• Hydrocortisone 100mg

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ANAPHYLAXIS
Initial treatment for anaphylaxis includes thefollowing:
• „The ABC approach should be employed while the diagnosis is being
made.
• Airway and breathing should be managed by administering 10
litres/min of oxygen.
• Blood pressure should berestored by lying the patient flat.

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• In life-threatening anaphylaxis (hoarseness, stridor, cyanosis, dyspnoea,
drowsiness, confusion or coma), adrenaline should be administered in the
following way.
• „Administer 0.5 ml of 1 in 1000 adrenaline (epinephrine) IM and repeat
at 5minute intervals if no improvement.
• Theoptimum site for injection is the anterolateral mid-third of the thigh.

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ADRENAL CRISIS
Adrenalcrisis:
• It may result from adrenocortical hypofunction leading to hypotension,
shock anddeath.
• It maybe precipitated by stressinduced by trauma, surgery orinfection.

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Thesigns and symptoms of adrenal crisis include:
• „The patient loses consciousness.
• „The patient has a rapid, weak orimpalpable pulse.
• „The blood pressure falls rapidly.
• It is important in the history to ascertain whether the patient has recently
used oris currently using corticosteroids.

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ADRENAL CRISIS
• Acute adrenal insufficiency can often be prevented by the administration
of a steroid boost prior to treatment.
• Ruleof 2
• Invasive procedure such as oral surgical procedures or very
apprehensive patients, may requirecover.
• Patients who are systemically unwell (for eg. patients with a dental
abscess) arealso recommended.

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Thetreatment of adrenal crisis includes the following:
• „Lay the patient flat andraise his/her legs.
• „Ensure a clearairway andadminister oxygen.
• „Call anambulance.

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ANGINA / MYOCARDIAL INFARCTION
• Moderate to crushing central chest pain, radiating to left arm, neck or
mandible.
• Stop treatment, place one glyceryl trinitrate tablet 0.6 mg under tongue
orspray under tongue.
• Repeat dose in 5 minutes.
• If noimprovement after 15 minutes,
treat asacute myocardial infarction.

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Signs &Symptoms ofMyocardial Infarction

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MYOCARDIAL INFARCTION
• Chest pain similar to angina but unrelieved by up to 3 glyceryl trinitrate
tablets over10minutes.
• Call for medical help.
• Monitor vital signs.
• 100% oxygen.
• Dissolved aspirin tablet and one glyceryl trinitrate dose stat and one
repeat in 5minutes after checkof BP.

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SEIZURES
• Abnormalbrainactivity
ClinicalFeatures:
 Aura
 Tremors
 Confused
 Sleepy
 Trancelikestate
 Frothing

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ASTHAMA
• It is defined as “a chronic inflammatory disorder that is
characterized by reversible obstruction of the
airways.”

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Status asthmaticus:
• More severeclinicalform
• Experiencewheezing,dyspnea,hypoxia
• Refractoryto2–3dosesof β-adrenergicagents
• Ifnotmanagedadequately,patientmay dieduetorespiratory
distress

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Prevention:
Medical history regarding
• Lung diseases
• Allergies to drugs, food, medication, latex
• Usage of drugs, medications, natural remidies

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Clinical manifestations:
• Feeling of chest congestion
• Cough, with orwithout sputum production
• Wheezing
• Dyspnea
• Patient wants to sit orstand up
• Use of accessory muscles of respiration
• Increased anxiety and apprehension
• Tachypnea (>20 - >40 in severecases)
• Rise in B.P, Increase in heartrate (>120 bpm in severecases)

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Onlyin respiratory distress
• Diaphoresis
• Agitation
• Somnolence
• Confusion
• Cyanosis
• Supraclavicular and intercostal retraction
• Nasal flaring

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Recognizeproblem (respiratory distress, wheezing)
Discontinue dental treatment
Activate office emergencyteam
P –Position, usually upright with armsthrown forward
A → B→ C–Assess and perform basic life support as needed
D –Definitive care:

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Administer O2 and bronchodilators
(Episode continues)
Activate EMS
Dischargepatient
Administer parenteral drugs May
require hospitalisation
(Episode terminates) Dental
care may continue Discharge
patient

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Additional considerations:
Sedatives which depress respiratory system and central nervous system are
absolutely contraindicated. 5mg IV or IM diazepam may be indicated to
decrease anxiety

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