Management of Medical Emergencies in the Dental Office: Conditions in Each Country, the Extent of Treatment by the Dentist

Abstract

D entists must be prepared to manage medical emer- gencies which may arise in practice.In Japan, a study was conducted between 1980 and 1984 by the Committee for the Prevention of Systematic Complications During Dental Treatment of the Japan Dental Society of Anesthesiology, under the auspices of the Japanese Dental Society. 1 The results from this study showed that anywhere from 19% to 44% of dentists had a patient with a medical emergency in any one year.Most of these complications, approximately 90%, were mild, but 8% were considered to be serious.It was found that 35% of the patients were known to have some underlying disease.Cardiovascular disease was found in 33% of those patients.Medical emergencies were most likely to occur during and after local anesthesia, primarily during tooth extraction and endodontics.Over 60% of the emergencies were syncope, with hyperventilation the next most frequent at 7%.In the United States and Canada, studies have also shown that syncope is the most common medical emergency seen by dentists. 2,3Syncope represented approximately 50% of all emergencies reported in one particular study, with the next most common event, mild allergy, represented only 8% of all emergencies.In addition to syncope, other emergencies reported to have occurred include allergic reactions, angina pectoris/ myocardial infarction, cardiac arrest, postural hypotension, seizures, bronchospasm and diabetic emergencies.The extent of treatment by the dentist requires preparation, prevention and then management, as necessary.Prevention is accomplished by conducting a thorough medical history with appropriate alterations to dental treatment as required.The most important as-