Preparing Dental Office Staff Members for Emergencies: Developing a Basic Action Plan

Background and OverviewA medical emergency can occur in any dental office, and managing it successfully requires preparation. The dentist should develop a basic action plan that is understood by all staff members. The goal is to manage the patient's care until he or she recovers fully or until help arrives. The most important aspect of almost all medical emergencies in dentistry is to prevent or correct insufficient oxygenation of the brain or heart. The dentist or a staff member needs to position (P) the patient appropriately. He or she then needs to assess and, if needed, manage the airway (A), breathing (B) and circulation (C). The dentist and staff members then can consider “D,” which stands for definitive treatment, differential diagnosis, drugs or defibrillation. A team approach should be used, with each staff member trained in basic life support and understanding the role expected of him or her ahead of time. Clear and effective communication is essential during any emergency.ConclusionsAll staff members should understand the basic action plan so that they can put it into effect should any emergency arise in the dental office.Clinical ImplicationsPreparing staff members is integral to the successful management of a medical emergency in the dental office.     

Preparing the dental office for medical emergencies

Modern dental offices must be equipped to initiate prompt emergency care should the sudden need arise. With the elderly population in dental practices increasing, these emergencies will undoubtedly occur. This article discusses the basic emergency equipment the average dental office should possess to allow for an adequate initial response. It also discusses the policies and personnel needed for dealing with emergencies. Among the basic emergency equipment, an office should have syringes, an Ambu bag, a portable oxygen system, a sphygmomanometer (child and adult sizes), and an EKG/defibrillator. Emergency drugs that should be stocked include aromatic ammonia, aspirin, and nitroglycerine. The dentist should also develop a protocol and policy for his/her staff to follow when a medical emergency arise.     

Basic Management of Medical Emergencies: Recognizing a Patient's Distress

Background and OverviewMedical emergencies can happen in the dental office, possibly threatening a patient's life and hindering the delivery of dental care. Early recognition of medical emergencies begins at the first sign of symptoms. The basic algorithm for management of all medical emergencies is this: position (P), airway (A), breathing (B), circulation (C) and definitive treatment, differential diagnosis, drugs, defibrillation (D). The dentist places an unconscious patient in a supine position and comfortably positions a conscious patient. The dentist then assesses airway, breathing and circulation and, when necessary, supports the patient's vital functions. Drug therapy always is secondary to basic life support (that is, PABCD).Conclusions and Clinical ImplicationsPrompt recognition and efficient management of medical emergencies by a well-prepared dental team can increase the likelihood of a satisfactory outcome. The basic algorithm for managing medical emergencies is designed to ensure that the patient's brain receives a constant supply of blood containing oxygen.     

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     

Emergency protocol in the dental clinic: Assessing medical emergency training requirements and guidelines for dentists

BackgroundMedical emergencies are an unavoidable reality affecting dental practices. This review synthesizes and examines the guidelines offered by governmental and professional organizations.Types of Studies ReviewedLicensing agencies and professional associations were chosen as organizations of focus based on legal authority, high professional regard, or both. International and interprofessional organizational counterparts were chosen as points of comparison. In total, 11 organizations were examined. Guidelines reported were compiled by examination of documents published on official agency websites and in associated peer-reviewed journals.ResultsGuidelines for the handling of medical emergencies in the dental clinic vary in level of detail and scope among sources. Licensing agencies provide basic requirements for training, encouraging oral health care providers to develop and integrate their own emergency response plans. Professional associations provide extensive detail on instruction in medical emergency management. Both licensing agencies and professional associations provide lists of emergency medications and equipment, with varying levels of instruction on drug maintenance and organization. Professional associations emphasize regular review of training and office emergency drills.ConclusionOral health care professionals are provided with basic and required elements of medical emergency training by licensing agencies. They may seek out recommended, but not required, instruction from professional associations. Although guidance is provided, literature on protocol instituted in dental practices is limited. Further research is necessary to determine the oral health care community’s approach to emergency management.Practical ImplicationsProviders must be prepared to handle medical emergencies that they encounter. Accessible and understandable guidelines are crucial to safe dental practice.     

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提要：口腔门诊治疗中常会出现一些意外，因此要求口腔科医生必需掌握一定的急救知识和技术。本文结合国外口腔医生急救培训项目和我们临床工作中常见的一些门诊意外，介绍门诊意外的基本处理方法和急救技术，为临床口腔医生提供一定的指导。     

Emergency medicine in pediatric dentistry: preparation and management

Medical emergencies can and do occur in the practice of dentistry. Although most emergencies take place in adults, serious problems can also develop in younger patients. The contemporary dentist must be prepared to manage expeditiously and effectively those few problems that do arise. Basic life support (as necessary) is all that is required to manage many emergency situations, with the addition of specific drug therapy in some others. Preparation of the office and staff includes basic life support (annually), pediatric advanced life support, development of an emergency team, consideration for emergency medical services, and the availability of emergency drugs and equipment with the ability to use these items effectively. As with the adult patient, effective management of pain (local anesthesia) and anxiety (behavioral management, conscious sedation) will minimize the development of medical emergencies.     

Office emergencies and emergency kits

Preparedness to recognize and appropriately manage medical emergencies in the dental environment includes the following: current BLS certification for all office staff; didactic and clinical courses in emergency medicine; periodic office emergency drills; telephone numbers of EMS or other appropriately trained health care providers; emergency drug kit and equipment, and the knowledge to properly use all items. This update on office emergencies and emergency kits replaces the previous Association report, prepared in 1980 by the Council on Dental Therapeutics.     

Recommendations for Managing Endodontic Emergencies during Coronavirus Disease 2019 Outbreak

IntroductionThe management of endodontic emergencies has been particularly challenging during the coronavirus disease 2019 (COVID-19) outbreak because of the possible generation of airborne particles and aerosols. The aim of this report was to contribute to the practice of endodontics by proposing a general protocol for the management of emergencies showing the rationale for remote diagnosis, clinical procedures, and the use of personal protective equipment and barriers at the dental office during the COVID-19 outbreak.MethodsA review of the literature was conducted up to May 2020 on relevant institutional sites, aiming to retrieve the best updated evidence. The reporting considered the Reporting Tool for Practice Guidelines in Health Care statement.ResultsRecommendations from Cochrane Oral Health, the American Dental Association, and the Centers for Disease Control and Prevention were included along with the American Association of Endodontists resources and scientific articles that addressed the issue.ConclusionsThe proposed protocol could contribute to the management of endodontic emergencies at the dental office during the COVID-19 outbreak.     

Clinical Response to COVID-19 and Utilization of an Emergency Dental Clinic in an Academic Institution

IntroductionThe spread of coronavirus disease 2019 (COVID-19) in the spring of 2020 resulted in the temporary suspension of elective dental procedures and clinical dental education in academic institutions. This study describes the use of the Tufts University School of Dental Medicine emergency dental clinic during the peak surge in COVID-19 cases in Massachusetts, highlighting the number of endodontic emergencies.MethodsAggregate data from clinical encounters and call records to an emergency triage phone line from March 30 through May 8, 2020, were used to describe the characteristics of dental emergencies, clinical encounters, and procedures performed.ResultsA total of 466 patient interactions occurred during this period, resulting in 199 patients advised by phone and 267 clinical encounters. The most common dental emergencies were severe dental pain from pulpal inflammation (27.7% of clinical encounters) followed by a surgical postoperative visit (13.1%). The most frequent procedures were extractions (13.9% of clinical encounters) and surgical follow-up (13.5%); 50.2% of the clinical encounters were categorized as aerosol generating, and 86.1% of encounters would have required treatment in a hospital emergency department if dental care was not available. There were no known transmissions of severe acute respiratory syndrome coronavirus-2 among clinic providers, patients, or staff during this period.ConclusionsThese results highlight the importance of endodontic diagnosis and treatment in the provision of emergency dental care during a pandemic and demonstrate that dental treatment can be provided in a manner that minimizes the risk of viral transmission, maintaining continuity of care for a large patient population.     

Exploring Leadership and Team Communication Within the Organizational Environment of a Dental Practice

BackgroundA lack of training in leadership and communication skills can place dentists at a disadvantage, leading to high degrees of staff-related stress and turnover. A dentist's leadership style directly affects an office's communication practices, and specific leadership behaviors affect the degree of team identity, interdependence and social distance (a measure of the influential power of team members).MethodsThe author recruited 10 dental offices to take part in a study. Qualitative methods included in-depth interviews of one dentist, one senior staff member and one newer staff member from each office.ConclusionsThe interview findings show that clear and definable relationships exist between leadership behaviors—hierarchical or team-oriented organizational perspectives, proactive or laissez-faire leadership styles, and autocratic or participative decision-making processes—and the team's communication practices. Decision-making processes directly affect the degree of team identification experienced by staff members, and conflict-management tactics affect team members' sense of interdependence and social distance.Clinical ImplicationsThe findings of this study indicate that dentists should engage in participative decision-making processes that include staff members, thereby communicating their value to the practice and empowering employees. They also must become proactive in facilitating an environment that encourages collaboration and confrontation as healthy forms of conflict management. These leadership and communication behaviors are the most significant in creating a real rather than nominal team culture, which, in turn, leads to increased overall productivity, an enhanced level of services provided to patients and improved team member satisfaction.     

Office emergencies: an outline of causes, symptoms, and treatment.

Conscientious dental practitioners are aware of the increasing chances for medical emergencies to arise in the dental office. New treatment modalities and drugs have increased potential life spans, but have also presented greater responsibilities to the dentist for properly managing these patients. Additionally, widely diversified sources are available to the dentist for acquiring and assembling all necessary information to train his personnel and organize equipment and drugs so he is constantly ready to handle any emergency. We have attempted to give a simple, thorough outline that provides basic information on causes, symptoms, and treatment of major medical emergencies, but that in no way reflects the only means of treating the specific emergency. We feel the manner presented allows one to regiment his diagnosis and treatment rapidly and make modifications to the list as needed.     

Practical skills training influences knowledge and attitude of dental students towards emergency medical care

Background: Medical emergencies in dental practice are generally perceived as being rare. Nonetheless, recent studies have shown that incidents occur on a regular basis. Therefore, patients have the right to expect necessary skills to manage life‐threatening situations from every dentist. Objective: To observe students’ attitude and self‐assessment towards emergency medical care (EMC) and its practical appliance. Material and methods: Students of dentistry took part in small group sessions for adult and paediatric basic life support. Participants filled out pre–post questionnaires regarding knowledge and attitude towards EMC (6, respectively, 10‐point Likert scale). Additionally, feedback was asked for the quality of course and tutors. Results: Forty dental students in their last 2 years of study registered for the EMC courses. The majority had never attended any first‐aid course; the mean age was 25% and 75% were women. A comparison between pre‐ and post‐evaluation showed that the participation in practical training easily enhances the students’ awareness of EMC importance as well as self‐confidence in managing emergencies. After the course, 71% shared the opinion that retraining should be obligatory for all medical personnel. At the same time, students’ self‐assessment of confidence for specific tasks got significant upgrades in every aspect. Conclusion: The evaluation data clearly show the participants’ needs to deal with topics of EMC within the curriculum of dentistry. The proposed course is able to change participants’ attitudes towards EMC and its importance for their daily practice. The considerable enhancement of self‐confidence in performing EMC‐techniques might also lead to more willingness to manage emergency situations.     

Dental students' ability to locate emergency equipment‐lessons learned from aviation

Purpose

The purpose of this study was to evaluate the dental student's ability to locate medical emergency equipment/items at the University of Michigan School of Dentistry clinic.

Methods

A total of 138 second‐year dental students (traditional group) participated in this study as part of a simulation‐based medical emergencies rotation course held during the winter term of 2014 and 2015. Without prior training, students were tested on their ability to locate nine predetermined items on the clinic floor using a self‐reported checklist. Six months later, a convenience sample of 18 students (novel group) from the same cohort were later trained on their location and retested individually.

Results

Of the 138 students tested, only 10.14% students could locate seven of the nine items when compared to 100% in the novel group. Only 5.07% of students in the traditional group could locate all items initially, compared with 72.22% students in the novel group.

Conclusion

Whilst our students have lecture‐based knowledge about medical emergencies, the results of our study identified a gap of knowledge of emergency equipment/item location amongst students. Therefore, an intervention performed with a similar group of second‐year dental students supported that proper training may be used to achieve retention of knowledge. Based on our “novel group” results, we have incorporated targeted training in the dental curriculum that leads to students being better prepared in locating emergency equipment/items. This study suggests that other populations, such as faculty or staff, may also benefit from hands‐on training.     

Competency in managing cardiac arrest: A scenario-based evaluation of dental students

Objective. Advanced Cardiovascular Life Support (ACLS) in life-threatening situations is perceived as a basic skill for dental professionals. However, medical emergency training in dental schools is often not standardized. The dental students’ knowledge transfer to an ACLS setting thus remains questionable. The aim of the study was to evaluate dental pre-doctorate students’ practical competence in ACLS in a standardized manner to enable the curriculum to be adapted to meet their particular needs. Materials and methods. Thirty dental students (age 25.47 ± 1.81; 16 male/14 female) in their last year of dental studies were randomly assigned to 15 teams. Students’ ability to successfully manage ACLS was assessed by a scenario-based approach (training module: Laerdal® ALS Skillmaster). Competence was assessed by means of (a) an observation chart, (b) video analysis and (c) training module analysis (Laerdal HeartSim®4000; Version 1.4). The evaluation was conducted by a trained anesthesiologist with regard to the 2010 guidelines of the European Resuscitation Council (ERC). Results. Only five teams (33.3%) checked for all three vital functions (response, breathing and circulation). All teams initiated cardiopulmonary resuscitation (CPR). Only 54.12% of the compressions performed during CPR were sufficient. Four teams stopped the CPR after initiation. In total, 93% of the teams used the equipment for bag-valve-mask ventilation and 53.3% used the AED (Automated external defibrillator). Conclusions. ACLS training on a regular basis is necessary and, consistent with a close link between dentistry and medicine, should be a standardized part of the medical emergency curriculum for dental students with a specific focus on the deficiencies revealed in this study.     

Opening a new office: the dentist's personal frontier

BackgroundThe purpose of this article is to assist the dental practitioner by providing insight into commercial real estate and a framework for identifying and securing new office space, as well as by addressing concerns about the physical space of a dental practice.ConclusionsIn the process of identifying and securing new office space, the dental practitioner can maximize efficiency and minimize risk by assembling a team of professionals to assist him or her. This team should be composed of an accountant and an attorney, as well as a dental equipment/design specialist and a commercial real estate professional.Practice ImplicationsThe professional team will provide invaluable assistance to the dentist, enabling him or her to avoid major financial, legal, logistic and real estate–related pitfalls inherent in establishing or moving a dental practice.     

Awareness of dental practitioners to cope with a medical emergency: a survey in Belgium

Objective: The aim of the study is to determine whether in Belgium dentists feel confident to diagnose a medical emergency situation in their dental practice. Methods: A questionnaire was completed by 7.0% of the active Belgian general dental practitioners (n = 548) including questions on the frequency and knowledge of medical emergency situations in the dental office, history of dental training to treat emergency situations and confidence level in treating emergency situations. Results: A medical history of each patient was taken by 55.3% of the dentists. A link was found between years since graduation and the systematic decline of a medical history in a new patient (P = 0.001): the older the dentist, the less consistent was the updating of medical history. Almost 50% of the dentists (49.4%) never participated in any basic life support (BLS) training during their undergraduate education. Moreover, 78.3% never had any paediatric BLS training during undergraduate education and BLS training after graduation was lacking by 37.2% of the dentists. Conclusion: Knowledge of BLS should be fundamental to medical professionals. The more BLS training a practitioner has experienced, the more self-secure they feel coping with an emergency situation.Key words: Basic life support (BLS) training, dentist and medical emergency situations, dentists and medical history     

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.

Focused care of pediatric patients in the dental office.

No dental text can adequately prepare the practitioner with the necessary expertise to treat all presentations or office complications that may arise in the therapy of children. There are times when consultation with the child's parent and pediatrician may answer necessary treatment-related questions. Most chronic conditions do not prevent needed treatment interventions. Any acute illness or exacerbation of a chronic disease should be cleared by the primary care physician before commencing dental treatment. The mainstay of safe practice requires that the dentist to maintain a basic level of understanding of what constitutes an emergency and that office staff receive basic training and are adequately supplied with emergency equipment. Dentists are cautioned to consult their state board or dental society as well as their insurance carrier as to what constitutes necessary emergency equipment in the office and to what level they are responsible for providing emergency care to their patients. There is a great difference within the dental field just as there is with medical specialties. All practitioners, however, are liable for any acts of consignment, and although the intention is not to dissuade anyone from providing assistance in an emergency, supportive care and an immediate call of 911 to activate the local EMS are important. In addition, maintaining a familiarity with the local hospital and emergency department capabilities as well as travel time and distance is also important. Routine reviews and updates on life-saving interventions and resuscitations are good general practice and will save lives.     

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.