Introduction

The primary obligation and ultimate responsibility of oral healthcare personnel (OHCP) is the timely delivery of quality preventive, diagnostic, and therapeutic services within the bounds of the clinical circumstances presented by patients. Because an ever-increasing number of patients with medical problems seek dental treatment, OHCP can expect to face situations that may threaten the physical well-being of at-risk patients.

It follows that OHCP must possess the knowledge and skills essential to determine their patients’ physical and emotional ability to undergo and respond to dental care.1 Diagnostic activities should be effective to establish a database that will serve as reference points for significant medical problems and, importantly, the database must identify those patients at-risk who may experience a medical emergency during the perioperative period.

The best available data on the types and incidence of medical emergencies in oral healthcare settings is based on two independent prospective surveys.2 Over a 10-year period, 4,309 dentists documented 30,602 medical emergencies (Box A) that fell into six major categories: (1) cardiovascular, (2) respiratory, (3) endocrine, (4) allergic, (5) neurogenic, and (6) toxic events. The data also indicate that the rate of medical emergencies per dentist per year is low (0.5/year).

Box A. Medical emergencies in oral healthcare settings.2

DiagnosesPercent of Total in 10 YearsTotal Number per Dentist per Year
Syncope30.10.15
Mild allergic reaction18.70.09
Postural hypotension17.90.08
Hyperventilation9.60.04
Hypoglycemia5.10.02
Angina pectoris4.60.02
Seizures4.60.02
Asthma2.80.01
Local anesthetic overdose1.50.007
Myocardial infarction1.40.007
Anaphylaxis1.20.006
Cardiac arrest1.10.005
All others1.40.007

Being ill prepared to respond to emerging perioperative medical events is inexcusable; being subjected to public censure or accused of negligence is an agony best prevented. Consequently, OHCP must P-R-A-Y, i.e., (1) “P”repare for the role of “first responders;” (2) “R”ecognize predisposing factors and signs and symptoms of medical emergencies; (3) “A”ct to stabilize the patient; and (4) “Y”ell for help, i.e., activate emergency medical services (EMS).2-10

OHCP must provide emergency care appropriate for the emergent setting (i.e., oral healthcare facility). At the very minimum, in the event of a life-threatening medical emergency, OHCP must feel comfortable to perform basic life support (BLS) techniques to stabilize the patient until EMS arrives. It must be emphatically stated that advanced life support (ALS) activities should not be attempted without sufficient training and maintenance of skills.