30/08/2018

Introduction
◦ Emergencies can happen at any place and at any time.
◦ Especially at the dental clinic when some patients are stressed about dental
treatment.
◦ The dental assistant must always be observant of the patient and be prepared
to deal with the situation and alert the dentist.
◦ Every clinic /practice should have established emergency protocols and
guidelines so that the response is automatic and there is no confusion
regarding what to do and who should do it.
◦ It is ideal that all members of the dental team should be trained in basic CPR
and the Heimlich maneuver.

Common dental emergencies

◦ Syncope / fainting
◦ Postural Hypotension
◦ Allergic reaction
◦ Anaphylactic reaction
◦ Hyperventilation
◦ Asthma
◦ Epilepsy
◦ Hypoglycemia
◦ Angina pectoris
◦ Myocardial infarction/ Heart attack
◦ Stroke
◦ Choking

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o Syncope (fainting): Most common emergency in the dental office. Caused by decreased
blood flow to the brain. Usually due to emotional or physical stress. When the pt is stressed
more blood flow is directed to the arms and legs to facilitate “fight or flight”. Since the pt is
not moving, the blood pools in the extremities and the brain has less oxygenated blood and
the pt becomes unable to respond to sensory stimulus and unconscious.
Pre syncope symptoms include dizziness, nausea, weakness, feeling faint. Signs include paleness,
sweating, shallow breaths.
• If the pt is conscious: quickly sit the pt down and lean his/her head forward between the
knees until the dizziness passes away.
• If the pt is unconconcious but breathing normally, place him/her in the Trendelenburg
position. This position allows the blood to flow back to the head.
• Full revival should occur in a few minutes. If not, start CPR and call for help.
If the pt feels weak on revival, it is better to reschedule the appointment and contact someone
to take the pt home.

◦ Postural hypotension: Occurs when an individual feels dizzy or loses consciousness when
rapidly rising to an upright position after lying down for a period of time. It occurs from a
lack of blood flow to the brain and lasts only a few seconds. It is advisable to have the
pt rise up slowly and sit in the chair for a few minutes before standing up. Pregnant
patients are also prone to this.
◦ Allergic reaction: allergy to drugs, latex, dental materials, cleaning materials etc. Can
occur immediately or after several hours. It is the body’s immune reaction to an
offending antigen/allergen. It may be localized or cover the entire body. It can range
from a mild skin irritation to severe breathing difficulty. Skin reaction (dermatitis)-
swelling, redness, rash, itchiness.
◦ Anaphylactic reaction/ shock: It is a severe allergic reaction that is life threatening.
Occurs when the person is extremely sensitive to a particular allergen, eg. Bee sting,
peanuts, latex. On exposure, the BP drops and there is constriction of the airways
(bronchospasm), swelling of the tongue and the throat causing difficulty in breathing.
Rapid pulse and stomach pains also occurs. Symptoms and deterioration of the pt is
rapid so injection epinephrine/ adrenaline should be administered immediately.
Pt who know that they are extremely sensitive to a particular allergen
often carry epinephrine in the form of EpiPen with them.

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◦ Hyperventilation: Treatment fear & anxiety can cause the pt to subconciously breathe
deeply & rapidly leading to loss of Carbon dioxide (CO2) in the blood causing
increased alkalinity leading to numbness and more breathlesness. This triggers a panic
attack that worsens the breathing. Calm the pt, sit upright and ask him/her to breath in
hold for a few seconds before exhaling. Continue breathing into cupped hands or a
paper sack to increase the flow of CO2 into the lungs.
◦ Asthma: Reccurrent attacks of breathlessness accompanied by wheezing while
breathing. This is due to narrowing of the airways in the lungs. Often caused by an
allergic substance like dust, pollen, smoke etc. Pt usually has a inhaler and would use it.
If not, the dentist would have to administer antihistamines.
◦ Epileptic Seizure: When there is an unorganized and chaotic electrical excitation of the
brain, it can result in epilepsy or fits. In susceptible persons, the seizures may be
spontaneous or a response to an external stimuli such as stress, flashing lights, drugs,
etc. Often the etiology is unknown and is sometimes hereditary. Other causes can
include brain tumours, head injury, infection, stroke, drug/ alcohol withdrawal or
overdose etc.
During an epileptic fit, make sure the pt is not harming himself. Once the fit is over, put
the pt in recovery position and make sure the pt is resting comfortably.

Recovery position: If a person is unconscious but is breathing and has no other life-threatening
conditions, they should be placed in the recovery position. This will keep their airway clear and
open and prevent them from choking on their tongue or any fluids. It allows for fluid to drain
from the mouth if the person vomits.
• Kneel next to the person.
• Remove any glasses and bulky objects, such as keys, from his or her pockets.
• Place the arm closest to you at a right angle to the body, with the elbow bent at 90 degrees
and the palm upwards. With your one hand, bring the furthest arm across the chest and
place the back of the hand against the nearest cheek.
• With the other hand, pull the far leg into a bent position and pull it so that the person gently
rolls towards you so that the back of the hand of the arm that was across the chest is now
supporting the head.
• Adjust the leg so that the hip and knee are bent at right angles. This will support the body.
• Tilt the head up slightly. Make sure that the hand is under the cheek to support the head.
• Regularly monitor that the airway remains open.
• Place a blanket over the person and stay close until
pt recovers or help arrives.
Epileptic patients are on daily anticonvulsants. Take a detailed
history of when they took the last medication and when was the
last episode.

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◦ Hypoglycemia: Happens when a person has too little sugar/ glucose in the blood. Can
happen to any one but more especially in diabetic patients who are on treatment and who
have taken the medication but not had a meal. Stress also compounds the fall in blood
sugar level. Signs are trembling , weakness and sweating. Stop treatment and immediately
give them a sugar source like juice, candy or sugar solution.
◦ Angina Pectoris: Pain in the chest that radiate from the base of the neck to the jaw area.
Often lasts about 5 minutes and is relieved by placing nitrogycerin tablets under the tongue.
Oxygen should also be administered. Often the patient feels better with treatment and the
pills can be administered up to three times every 15 minutes. If the patient does not recover,
assume that the patient is having a heart attack. Call for medical emergency help.
◦ Myocardial infarction/ Heart attack: Occurs when arteries that supply the heart muscles are
narrowed severely or blocked. This leads to damage to the heart muscles in that area. Signs
are similar to that of Angina pectoris but pain is not relieved and might even increase even
after administration of nitroglycerin pills. Remain calm reassure the patient, administer
oxygen. If the patient loses consciousness, start CPR and continue until help arrives.
◦ Stroke: Occurs when there is a sudden interruption to the blood supply to any area of the
brain due to a blood clot or rupture of a blood vessel. Signs are headache, dizziness, slurred
speech, weakness or paralysis on one side of the body. Stop treatment and call for
emergency help. If the patient loses consciousness start CPR.

◦ Cardiopulmonary resuscitation (CPR):

• Use gloves and resuscitation mouth piece
• If the patient is non responsive, check carotid pulse.
• If there is no pulse, start chest compressions- 30 compressions @the rate of100/min
• Position your hands over each other & position your shoulders over your hands.
• Place your hands in the center of the pt’s chest on the lower half of the sternum
(breastbone)
• Check airway- tilt head, lift chin. Check breathing. If not breathing, close nose with the
thumb and index finger and alternate 30 compressions with 2 slow breaths though the
barrier device.
• Continue till patient revives, breathes unassisted or until help arrives.
• Document everything.
• CAB: Compression, Airway, Breathing

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◦ Choking: Airway obstructions can occur during dental treatment from extracted or lose
teeth, cotton rolls, lose crowns, endo instruments, composite, amalgam, impression
material etc. The patient may begin choking and clutching the throat. Stop treatment,
sit the patient upright and ask him to cough. If the foreign body is not dislodged, go
behind the patient and perform the Heimlich maneuver.
◦ Heimlich Maneuver:
Position yourself behind the patient and wrap your arms around the patients abdomen.
Make a fist in one hand and wrap your other hand over it.
Place the thumb side of the fisted hand against the middle of the patients abdomen
above the umbilicus and give quick upward thrusts until the object is dislodged.

If the patient stops breathing or loses consciousness start CPR and call for help.

Conclusion
Emergencies can happen at any time and at any place. The dental assistant must
always be observant and be ready to deal with an emergency.

Dental assistant’s role:

◦ Carefully review pt’s medical history & note any allergies, recent changes in health or
medication & alert the dentist.
◦ Closely observe the pt while escorting to and from the treatment room and also during
treatment.
◦ Look out for difficulty in standing up ,moving, talking, breathing or responding to
commands.
◦ Have knowledge in CPR, administration of oxygen and how to monitor vital signs.
◦ Make sure the emergency equipment and drug kit is well stocked and easily
accessible.
◦ Know what role to play and who to call in case of emergency.