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Geriatric Dentistry: Before You Call 911

Course Number: 586


A medical emergency can occur in any dental office, and managing it successfully requires advanced preparation of the entire dental staff. The dentist, with the guidance of Emergency Medical Systems (EMS) professionals, should develop a basic action plan that can be easily followed by all staff members. The main focus here is to manage the patient’s condition until he or she recovers fully or until further help arrives. As per the latest guidelines from the American Heart Association (AHA), in cases of an emergency, EMS should be activated as soon as possible followed by hands-on Cardio-Pulmonary Resuscitation (CPR), if required. The goal is to provide continuous oxygenation to the brain to minimize permanent damage. Every clinical staff member should have CPR training, and certification should be renewed every two years.48

Elderly patients, especially with complicated medical histories, are estimated to be more prone to emergencies in the waiting area as compared to a healthy adult individual. There can be some unexpected events including syncope, cardiac arrests, falls, allergic reactions, hypercapnia, asthmatic attacks, hypoglycemia etc. that require attention as soon as possible to prevent long-term complications.49 Early recognition of signs of distress by the dental staff can be critical in providing time for the emergency team to arrive and initiate rescue protocols. Every professional who is a part of the dental team should be trained in dealing with mock emergency situations on a regular basis. Simulating emergency scenarios and preparing for unexpected events are great methods for improving not only staff readiness but also developing methodical approaches required during challenging circumstances. Clear and effective communication among the members is crucial during any given emergency.

In 2002, the ADA Council on Scientific Affairs published a report in the Journal of the American Dental Association (JADA) titled ‘Office Emergencies and Emergency Kits,’ in which they covered the topic in great detail and recommended the most essential drugs to be a part of every dental clinic’s emergency kit to facilitate handling of common dental office emergencies. This critical list (Table 3) of medications remains the standard for all dental clinics.

Table 3. Emergency Kit Basics for Dental Practices.50

  • Epinephrine 1:1,000 (injectable)
  • Histamine-blocker (injectable)
  • Oxygen with positive-pressure administration capability
  • Nitroglycerin (sublingual tablet or aerosol spray; be aware of contraindications)
  • Bronchodilator (asthma inhaler)
  • Sugar (a quick source of glucose such as orange juice)
  • Aspirin

Emergency kits can also include many more products such as airbags, blood pressure apparatus, blood sugar monitors, ammonia gas, etc. to handle other complicated situations.