Preparedness and attitudes towards medical emergencies in the dental office among Polish dentists

Background: Medical emergencies in dental offices are considered a problem in most countries owing to dentists’ concerns about emergency preparedness, practical skills, lifesaving equipment and staff availability. The prevalence of medical emergencies in dental offices and dentists’ preparedness have been analysed in several countries but have never been studied in Poland. Aim: To assess the prevalence of medical emergencies in dental offices in Poland, as well as dentists’ preparedness and attitudes towards medical emergencies. Methods: An 18-item questionnaire was completed by 419 dentists. It asked for information on their cardiopulmonary resuscitation training, availability of emergency medical equipment in the dental office, prevalence of medical emergencies and self-assessed competence in various dental office emergencies. Data were analysed using the Statistica 13.3 software package. Variability was measured with standard deviation. Pearson’s linear correlation coefficient was used to determine correlation strength. Results: The most common medical emergencies in Polish dental offices were vasovagal syncope (46.30% of study participants experienced at least one case in the preceding 12 months), orthostatic hypotension (18.85%), hyperventilation crisis (18.61%), mild allergic reactions (16.23%), hypoglycaemia (15.99%) and seizures (11.81%). The prevalence of medical emergency situations requiring an emergency medical service call or medical assistance within the preceding 12 months was 0 for 80.66% of dentists, one for 12.65%, two for 4.53%, three for 1.20%, four for 0.48%, 5–10 for 0.48% and more than 10 for 0%. As many as 41.29% of the participants did not feel competent in managing sudden cardiac arrest, 74.47% in managing hypertensive crisis, 55.61% in managing asthma, 55.13% in managing anaphylactic shock and 52.99% in managing seizures. Conclusion: The prevalence of medical emergencies in dental offices in Poland is comparable with that in other countries. A large number of dentists do not feel competent enough to manage medical emergencies. Better undergraduate and postgraduate training in medical emergencies is recommended, as well as broader availability of emergency medical equipment in the dental office.Key words: Dentist, medical emergency, cardiopulmonary resuscitation, dental education     

Simulation of medical emergencies in dental practice: development and evaluation of an undergraduate training programme

Background: The evidence available suggests that many dentists on graduation do not feel competent managing medical emergencies; a problem requiring improved undergraduate training. This study developed a comprehensive simulation based training programme for final year undergraduate dental students and assessed student attitudes towards training. Methods: Final year dental students (n = 52) from The University of Melbourne were required to complete simulation training incorporating an interactive tutorial and realistic, simulated emergency scenarios conducted in the students’ real clinical environment. A post‐participation questionnaire utilizing a 5‐point Likert scale (1 = strongly disagree, 5 = strongly agree) assessed student attitudes. Results: Student responses supported simulation training, evidenced by the following selected questionnaire responses: achieved greater confidence in managing emergencies 4.65 ± 0.48 (n = 52); prefer lecture to simulation 1.46 ± 0.74 (n = 52); simulation training is important in undergraduate teaching 4.86 ± 0.35 (n = 43). Conclusions: Realistic simulation training in management of medical emergencies for dental students is an effective adjunct to traditional lecture style teaching. Given the importance of this subject, this mode of training would benefit students if incorporated into undergraduate dental courses.     

Dentists can contribute expertise in a major public health disaster

BACKGROUND AND OVERVIEW: The time for dental professionals to educate themselves to respond to, and assist with, a catastrophic medical disaster is here. California dental healthcare workers must understand the various duties they may be asked to perform if a large-scale disaster were to occur. This article explores the various duties, which may need to be performed in the event of a medical disaster, and the duties a dentist, or dental auxiliary, may be able to complete, with minimal additional training. CONCLUSION: California dentists must be educated, at minimum, to recognize the symptoms of exposure to biological agents or naturally occurring diseases, such as avian flu and SARs, in their patients. Dentists must be further educated to correctly counsel their patients who exhibit such symptoms. Finally, dentists must alert the appropriate public health authorities of such exposure. California should consider amending the California Dental Practice Act to provide for the expansion of the definition of the practice of dentistry in the event of a declared healthcare emergency. The new definition should, at minimum, allow dentists to administer vaccines and dispense medications at a mass prophylactic distribution site. The definition could be further expanded to allow dentists to perform more complicated or invasive duties in the event of a disaster with large numbers of bodily injuries. In either event, California will also need to provide limited liability to dentists who do participate in emergency situations, similar to the Good Samaritan laws, which currently apply to physicians and surgeons. PRACTICE IMPLICATIONS: Dentists and their dental auxiliaries can augment the existing medical professionals, in responding to a declared medical emergency. In order to be ready to respond, dentists and their dental auxiliaries must receive additional training through continuing education courses developed specifically to train them in recognizing symptoms of exposure to biological agents.     

Child protection training,experience, and personal views of dentists in the prefecture of Attica,Greece

International Journal of Paediatric Dentistry 2013; 23: 64–71 Background. The abuse and neglect of children constitutes a social phenomenon that unfortunately is widespread irrespective of geographic, ethnic, or social background. Dentists may be the first health professionals to recognize signs of child maltreatment (CM) and have an important role in dealing with such incidents. Aim. To describe the training, experience, and personal views of dentists practicing in the Prefecture of Attica regarding the recognition and referral of abused and neglected children. Design. A random sample was drawn from a target population of dentists registered with two of the largest dental associations in Greece. The dental practitioners were interviewed by two paediatric dentists using a specially designed questionnaire. Information was collected regarding their awareness on child maltreatment, the frequency of suspected incidents as well as the reasons for not reporting them. Results. With a response rate of 83%, findings are reported from 368 interviews (54% male, mean age 43 years). Only 21% of respondents had received training on child protection at undergraduate level. Suspected abuse was 13% and suspected neglect was 35%. Only six of the 368 respondents made an official report of a suspected case of child maltreatment. The most common reason that might prevent a dentist from reporting a case was doubt over the diagnosis (44%). Ninety‐seven per cent of dentists believed that recognition and referral of incidents should be part of undergraduate training. Conclusions. Dental practitioners did not feel adequately informed on recognizing and referring child abuse and neglect cases. The low percentage of reported incidents and the lack of legislation indicate a great need for continuously educating dentists on child maltreatment as well as for setting up an organized system in Greece for reporting such incidents to protect the dentist referring the case as well as the child being victimized.     

Differences in the Knowledge and Experience of Physicians and Dentists About Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients

Aim: Prevention of medication-related osteonecrosis of the jaw (MRONJ) in patients with osteoporosis requires the cooperation of physicians and dentists. We investigated the knowledge, experience, and behaviour related to medical and dental cooperation for MRONJ prevention in patients with osteoporosis between physicians and dentists practising in the Shiga prefecture. Materials and methods: We conducted a cross-sectional study to investigate the cooperation between practising physicians and dentists for preventing osteonecrosis of the jaw (ONJ) in patients with osteoporosis using 2 separate questionnaires from July 28, 2018, to February 3, 2019. Results: Of 461 dentists who were sent the questionnaires at their dental clinics, 307 (67%) responded via fax. Of 846 physicians who were sent the questionnaire at their clinics, 378 (45%) responded via fax. Of these, 268 (32%) were finally analysed because 110 (13%) physicians had never treated patients with osteoporosis; 50% dentists and 24% physicians were familiar with the MRONJ position paper in Japan, and 39% dentists and 9% physicians had encountered MRONJ in their clinical practice. A total of 30% physicians had requested oral health care by a dentist before administering bone-modifying agents (BMA) therapy. The knowledge and experience of MRONJ differed between physicians and dentists. Conclusion: The behaviour of physicians and dentists was insufficient to enable medical and dental cooperation for the prevention of MRONJ in patients with osteoporosis. The lack of cooperation between physicians and dentists during osteoporosis treatment in the Shiga prefecture in Japan is documented in this study.     

Dentist Empathic Accuracy Is Associated With Patient-Reported Reassurance

ObjectivesThe aim of this work was to determine dentists’ ability to accurately estimate patients’ anxiety level during dental treatment (ie, “empathic accuracy”) and to determine the strength of the association between empathic accuracy and patient-reported reassurance.MethodsA cross-sectional study was conducted amongst 177 adult patients who underwent different invasive dental procedures (ie, extractions or procedures requiring injections and drilling) performed by 10 different dentists from 3 dental offices in the Netherlands. Patients reported their anxiety level during treatment and the extent to which they felt reassured by the dentist using a visual analogue scale (VAS). Simultaneously, the dentists estimated patients’ anxiety level. Empathic accuracy was calculated as an absolute difference between patient-reported anxiety (100-point VAS) and dentist estimation of anxiety (100-point VAS).ResultsAgreement between dentists’ assessment of patients' anxiety and patient-reported anxiety proved good, intraclass correlation coefficient (177) = 0.63; 95% confidence interval [CI], 0.53-0.71. A small to medium-sized positive correlation, r (177) = 0.15; 95% CI, 0.00-0.29, was found between dentists’ empathic accuracy and patient-reported reassurance. A negative correlation was found between empathic accuracy and patients’ anxiety scores, r (177) = ?0.23; 95% CI, ?0.38 to ?0.09.ConclusionsGiven that greater empathic accuracy was associated with higher patient-reported reassurance during treatment, training young dental professionals in empathic accuracy might help patients feel reassured. Importantly, our results also suggest that with elevated levels of patient anxiety it is increasingly challenging for dentists to recognise this emotion, and thus support the patient in anoptimal manner.     

Tobacco cessation activities of UK dentists in primary care: signs of improvement

OBJECTIVE: To investigate attitudes and opinions of the members of the British Dental Association towards implementing tobacco cessation strategies in dental practices. DESIGN AND METHOD: Questions about tobacco and tobacco cessation were asked on the September 2002 BDA Omnibus survey. The survey was sent out to a random sample of 1,500 BDA members, excluding retired members, overseas members and students. After two reminder circulations, 870 completed questionnaires were received, giving a response rate of 58%. RESULTS: The survey results revealed good awareness amongst respondents of the health risks of tobacco. One fifth of respondents said that patients had asked them for advice on tobacco cessation. The majority (64%) of respondents stated that they gave advice on tobacco cessation 'fairly regularly' or 'always' (whether asked or not) and 37% of respondents recommended over-the-counter nicotine replacement therapy. Overall, 68% of respondents agreed that offering patients advice about tobacco cessation was the duty of every dentist. The most common barriers to a successful tobacco cessation campaign were perceived to be the amount of time required, lack of reimbursement, lack of training, lack of patient education materials and lack of knowledge of available referral resources. Nearly all respondents (92%) said that their practice was a completely smoke-free environment, and 66% of respondents had never used tobacco. The majority of respondents displayed patient education materials in their practice waiting/reception areas less than 60% of the time, and nearly a quarter (23%) never had them available. The survey revealed that most respondents did not feel particularly well prepared to assist patients in quitting tobacco, but 70% of respondents said they would be willing to cooperate with a campaign to inform all tobacco using patients about the advantages of tobacco cessation. Respondents felt that leaflets for patients, staff training and posters in the practice would contribute to the success of the campaign. CONCLUSION: Members of the dental team are very willing to implement tobacco cessation strategies in the dental practice. Most dentists feel that promotion of tobacco cessation is an important part of the duty of a dentist, but they feel inadequately prepared to deliver such advice. The major barriers to delivering successful tobacco cessation campaigns are the amount of time required, lack of reimbursement, lack of training, lack of patient education materials and lack of knowledge of available referral resources. The majority of dentists have received no training in tobacco cessation strategies. They feel that staff training and free availability of more patient education materials (leaflets, posters, etc) would help promote the success of such a campaign.     

Education of dentists in Thailand

Thailand is geographically located in southeast Asia and its population is 63 million. Little has been published on dental education in Thailand. This paper provides information about Thailand regarding its dental history, dental school system including curriculum and dental licensure. There are eight public and one private dental school in Thailand. A six-year dental education leads to the DDS degree. On graduation from the public dental schools, dentists are required to work in the public system for three years. Currently, there are approximately 8000 active dentists, with a dentist: population ratio of approximately 1:7000.     

Medical doctors’ knowledge of dental trauma management: A review

Education in dental trauma is extremely important to promote knowledge on the assessment and management of a traumatized tooth. Medical doctors are normally only required to manage the emergency phase of traumatic dental injury (TDI) treatment before referring to a dentist, endodontist or oral and maxillofacial surgeon for continuing care. Medical doctors who possess sufficient theoretical knowledge and are competent enough clinically to handle TDI can provide a higher standard of treatment care and ultimately achieve a better patient outcome. The aim of this literature review was to assess the extent of medical doctors’ knowledge of dental trauma management for injuries in the following four areas: (a) tooth structure; (b) to the supporting bone; (c) to the periodontal tissues; and (d) to the soft tissues. Based on the findings from this literature review, an overall deficiency in knowledge and confidence in managing dental trauma has been identified. Knowledge and understanding to categorize TDI using the same classification of dental injuries commonly used amongst dentists would allow medical doctors to better manage and communicate with dental colleagues concerning referral for further care. If the medical education curriculum provided medical doctors with more information and skills for the management of dental trauma and an understanding of the importance of early management, then more favourable outcomes may prevail for dental trauma patients.     

The readiness of New Zealand general dental practitioners for medical emergencies.

A risk of medical emergency accompanies every dental procedure, but little is known of general dental practitioners' readiness for such events. The few previous studies have shown that nearly all dentists have received training in medical emergencies at some time, most of this training being postgraduate. Up to 20 percent of dentists have reported feeling inadequately prepared for medical emergencies, and most are receptive to the idea of receiving further medical emergency-related training. We conducted a postal survey of 314 dentists concerning their readiness for, and experience of, medical emergencies within general dental practice; 199 dentists (63.4 percent) responded. Medical emergencies had occurred in 129 practices (65.2 percent) within the previous 10 years, at a mean rate of 2.0 events per 10,000 patients treated under local analgesia, other forms of pain control, or sedation. Vaso-vagal events had occurred in 121 (61.1 percent) practices within the previous year, the mean rate being 6.9 events per 10,000 patients treated using the same modes. More than half the respondents were dissatisfied with the training they had received for medical emergencies as undergraduate students, and 28 (14.1 percent) currently felt inadequately prepared for an emergency in practice. When asked how their preparedness could be improved, 165 (83.3 percent) opted for hands-on courses, 15 (7.5 percent) opted for lectures alone, and 5 (2.5 percent) opted for other courses alone. One in 20 felt no need for further training. Further training in the management of medical emergencies should be made available to New Zealand's dentists.     

Medical emergencies in general dental practice in Great Britain. Part 3: Perceptions of training and competence of GDPs in their management

OBJECTIVES: To ascertain the training received in management of medical emergencies recalled by general dental practitioners (GDPs), as undergraduates and since graduation, to examine how well prepared they felt to manage such events and how their readiness might be improved. DESIGN: Postal questionnaire survey of a random sample of GDPs in Great Britain. SUBJECTS: 1500 GDPs, 1000 in England & Wales and 500 in Scotland. RESULTS: There was a 74% response. Among respondents, 75% had received training as undergraduates in the management of medical emergencies, 95% had subsequently received training. The proportion considering themselves 'well' or 'fairly well' prepared to manage emergencies rose from 30% at graduation to 80% currently. The 20% who felt themselves 'not very well' or 'not at all' prepared were less likely to possess the drugs and equipment to manage an emergency. Nevertheless, a need for further training was expressed by 96%: only 3% felt no need. CONCLUSIONS: Virtually all GDPs (99.2%), had received training in the management of medical emergencies at some time, principally since graduation. The 20% who feel inadequately prepared are less likely to possess the necessary drugs and equipment. There is a perceived need for further training among the majority of respondents.     

Preparedness of dental clinics for medical emergencies in Riyadh,Saudi Arabia

Aim

To assess knowledge, training of dental staff and the availability of emergency drugs and equipment in dental clinics, Riyadh, Saudi Arabia.

Brazilian dental students' perceptions about medical emergencies: a qualitative exploratory study

Dental students have little understanding about medical emergencies, and there is very little in-depth data about the importance they place on this important area that is fundamental to their professional training. This study aimed to identify the perceptions of a group of undergraduate dental students about the dentistry-medical emergency interface. Twenty undergraduate dental students at the Federal University of Goias, Brazil, took part in this study. The data were collected through in-depth interviews with these students and were interpreted using qualitative content analysis. Two themes emerged from this data analysis: dentistry as a comprehensive health science, and students' knowledge, feelings, and attitudes about medical emergencies in the dental office. Based on the students' perceptions, an interface between dentistry and medical emergencies in the dental office was proposed that is comprised of the following intertwined concepts: 1) dentistry is a health science profession that should focus on the whole patient instead of being limited to the oral cavity; 2) medical emergencies do occur in the dental office, but students' minimal knowledge about these incidents and their etiology causes feelings of insecurity, dissatisfaction, and a limited appreciation of the dentists' responsibility; and 3) the inability to perform proper basic life support (BLS) technique in the dental office is the ultimate consequence. Undergraduate health courses need to develop strategies to teach professionals and students appropriate behavior and attitudes when facing life-threatening emergencies.     

Perceptions of dentists, dentistry undergraduate students, and the lay public about dental sedation

Sedation is an option for controlling fear and anxiety related to a visit to the dentist. The goal of this study was to capture, by means of a questionnaire, the perceptions of twenty dentists, twenty dental students and twenty lay people concerning the use of sedatives in a dental environment. The responses were evaluated using the quantitative-interpretative method. Dentists: 75% had knowledge of sedatives in a dental setting, but their actual use was mentioned by only three. As far as the use of sedatives by dentists is concerned, one considered it "risky" and 19 were favorable. Two affirmed that sedation does not present risks. Eighteen said they would be able to react to a medical emergency. Dental students: 60% said they were aware of the topic, in theory. Nineteen expressed interest in the topic. Fifteen claimed there were risks associated with the technique. Twelve (60%) have the theoretical knowledge to deal with a medical emergency in the dental office. Lay public: Seven (35%) responded that they felt some discomfort during dental treatment, because of fear (n=6) and equipment noise (n=2). Five said they would go to the dentist more often if there was a way to reduce the discomfort. Half of those interviewed indicated that they knew what sedation was. Sixteen favored using it for dental treatment. Seven thought that there were no risks when sedation is carried out. It was concluded that few participants in any of the three categories felt confident about the topic, though they demonstrated interest. The population in general felt optimistic, while practicing dentists and dental students complained of a lack of exposure to the subject at dental school.     

Medical emergencies in dental practice and choice of emergency drugs and equipment: A survey of Australian dentists

This is a report of a postal questionnaire survey of 1250 general dental practitioners regarding occurrence of medical emergencies and their choice of emergency drugs and equipment. The response rate was 65 per cent and the results showed that about one in seven practitioners had had to resuscitate a patient. The most common medical emergencies were adverse reactions to local anaesthetics, grand mal seizures, angina pectoris and hypoglycaemia (insulin shock). Nearly all respondents (96 per cent) believed that dentists need to be competent in cardiopulmonary resuscitation, just over a half (55 per cent) felt they were competent in CPR on graduation and a similar, figure (57 per cent) felt they could perform effective single person CPR for five minutes. Almost twothirds (64 per cent) had undertaken CPR courses since graduation. Additionally, the most commonly kept emergency drugs were oxygen (63 per cent) and adrenaline (22 per cent), while the most commonly kept emergency equipment was a manual resuscitator (recoil bag-valve-mask type) which was kept by 27 per cent of the practitioners.     

Challenges and dilemmas in behaviour guidance of the pediatric dental patient

In addition to the pressures of providing a high quality of dental care for children, dentists practising pediatric dentistry are faced with some legal and ethical concerns regarding the use of behaviour management techniques. The following article will discuss some of the pressures and ethical dilemmas facing dentists treating children. Strategies for making the dental appointment more humane for child, parent and dentist are suggested. The most perplexing issues in pediatric dentistry today are related to the management of patients. In addition to questions regarding clinical management, dentists treating children have to make careful judgements concerning management of patient's behaviour. The following scenarios are a few examples of the situations that often arise during the dental treatment of child and adolescent patients: "I really had to raise my voice to Jamie today and use a lot of physical restraint to administer the local anesthetic. I was not happy about being so aggressive, but it was important to get that filling done. I wonder, though, how he is going to feel about going to the dentist now?" "I feel frustrated that I did not get any work done on that four-year-old today, but I did not want to use undue force. Maybe I should have been more forceful; hand-over-mouth-exercise might have worked, but I always feel uncertain about using that technique and I wonder what the parents will think if I use it."     

Nigerian dentists' knowledge and attitudes towards mouthguard protection

Abstract –  The objective of this study was to assess the knowledge and attitudes of Nigerian dentists towards mouthguard protection. A pre-tested 15-item, one-page questionnaire was distributed to 185 dentists practising in different parts of the country with government hospitals or private establishments, by 'hand-delivery' system. Filled and returned forms were 170 (response rate of 92%). The period of the survey was between April and August 2003. Dental graduates from the different dental schools in the country responded to this survey. About 49% of the respondents indicated having only classroom lectures on mouthguards during their undergraduate trainings, 11% said they had some laboratory sessions in addition while no form of education on mouthguards was received by 40%. About 82% had never recommended mouthguard protection for athletic patients, and the major reason was no formal training in the subject. Only 58.5% were familiar with the different types of mouthguards, 75.9% would not be able to supervise or fabricate mouthguards and 50.6% would prefer custom-made mouthguard for their athletic patients. About 84% felt the current training on mouthguards in Nigerian dental schools is inadequate. Over 98% agreed that mouthguard usage in contact sports should be encouraged with the involvement of the dentists. The knowledge and attitudes of the respondents towards mouthguard protection did not vary significantly across years of postqualification from dental schools as well as the professional status of the dentists ( P  > 0.05). Although Nigerian dentists support mouthguard protection in contact sports and want to be involved in the provision of mouthguards for athletes, their knowledge of the protective device is inadequate. There is need for attention to be given to this subject in the undergraduate curricula of our dental schools.