It is the duty of every dental practitioner to ensure an effective and safe service to his patients. Dentists should not only deal with minor to major oral issues but should also anticipate any medical emergencies that will arise. This comes unexpectedly, so it is important for dentists to be prepared always.
Medical emergencies most likely occur during or after the infiltration of local anesthesia, primarily in the process of tooth extraction and endodontics. Over 60% of emergency cases are syncope. The next most frequent, which is around 7% of the cases, is hyperventilation. Other emergencies reported include myocardial infarction/angina pectoris, allergic reactions, postural hypertension, cardiac arrest, bronchospasm, seizures, and other diabetic emergencies.
The extent of treatment by dentists requires preparation, prevention, and management. Prevention is done by performing a thorough medical history with proper alterations to dental treatment as needed. The most vital aspect of almost all medical emergencies in the dental setting is to prevent or manage insufficient supply of oxygen to the heart and brain. Management of all medical emergencies must include ensuring that oxygenated blood is delivered properly to the vital organs of the body. This goes consistently with basic CPR (cardiopulmonary resuscitation), which a dentist should be competent to perform. This gives the skills in managing most medical emergencies, which start with assessment and, if needed, the treatment of the ABCs (Airway, Breathing, Circulation) of CPR. Most commonly, only after these ABCs are addressed and established will the dentist consider the use of emergency medications.
The drugs that dentists should have in their clinics are divided into two categories. The first category is composed of the essential emergency drugs, which include epinephrine, nitroglycerin antihistamine, albuterol/salbutamol, aspirin, and oxygen, that are always needed in almost all medical emergencies. The second category contains those drugs that are also very helpful and are referred to as additional emergency drugs. These supplementary drugs are glucagon, atropine, ephedrine, hydrocortisone, naloxone, morphine or nitrous oxide, midazolam or lorazepam, and flumazenil. These drugs must be included in the emergency kit of every dental clinic.
An emergency in any medical case demands immediate intervention. If a dental office has all of the emergency drugs needed and the dentist is competent and knowledgeable enough in cases of emergency, life can be saved and the worst case can be prevented. If a dentist is prepared and knows what to give to his patient, there will be greater chance of recovery.