Prevention of Medical Emergencies In Dental Office

   Medical emergencies in the dental office are, fortunately, relatively rare. The ambulatory nature of dental practice is partially responsible. However,  the primary reason for the limited frequency of emergencies in dental offices is the nature of dental education, which prepares practitioners to recognize potential problems and manage them before they cause an emergency.
   A study by Malamed of patients in the dental school setting revealed that hyperventilation, seizures and hypoglycemia were the three most common emergency situations occurring in patients before, during, or soon after general dental care. These were followed in frequency by vasovagal syncope, angina pectoris, orthostatic hypotension and hypersensitivity (allergic) reactions.
  
The incidence of medical emergencies may be higher in patients receiving ambulatory oral surgery when compared with those receiving nonsurgical care because:
-    Surgery is more often stress-provoking
-    A greater number of medications is administered to patients undergoing surgery
-    Longer appointments may be necessary when surgery is performed.
Other factors known to increase the potential for emergencies are the age of the patient (very young and old patients being at greater risk), the ability of the medical profession to keep relatively unhealthy people ambulatory and able to seek dental care, and the increasing variety of drugs dentists are able to administer in their offices.

Prevention of medical emergencies is the cornerstone of their management. The first step is risk assessment. This begins with a careful medical evaluation that, in the dental office, primarily involves accurate taking of a medical history of the patient. Vital signs should be recorded, and physical examination, tailored to the patient’s medical history and present problem, should be performed. (about techniques of this I’ll write in time…)
Although any patient can have a medical emergencies at any time, certain medical conditions predispose patients to medical emergencies in the dental office. These conditions are more liable to turn into an emergency when the patient is physiologically or emotionally stressed. The most common conditions affected or precipitated by anxiety are angina pectoris, asthmatic bronchospasm, acute adrenal insufficiency, severe hypertension, myocardial infarction, thyroid storm, insulin shock, hyperventilation and epilepsy. Once those patients who are likely to have medical emergencies are recognized, the dentist can prevent most problems from occuring by modifying the manner in which dental care is provided.