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Medical and Dental Care Emergencies

The primary purpose of a patient visit to the dental office is to allow their doctor and/or dental auxiliary to perform a dental treatment that will aid in the improvement of their overall oral health. The primary goal of the doctor is to perform this treatment as effectively and as safely as possible. Patients give little thought to the possibility that some unforeseen medical emergency might arise in the period of time during which they are in the dental office.

Many of the things done by the doctor and staff prior to, and during, the dental treatment are done to minimize the risk of a medical emergency. For example, the medical history questionnaire, recording of blood pressure, and discussion of a patient's health history help to determine what potential risks might be present and enables the doctor to modify the planned dental treatment to minimize the potential risks. In many instances, the use of conscious sedation will be indicated as a means of decreasing stress associated with dental care. This is especially important in persons with cardiovascular diseases (such as high blood pressure or angina) who might be somewhat fearful of visiting the dentist. The use of effective drugs for pain control (such as local anesthetics) is yet another means of minimizing the risk of medical emergencies developing during treatment.

In the unlikely event that a medical emergency does occur while a patient is in the dental office, one should know that (it is highly likely) the doctor has received training in the management of medical emergencies that develop frequently.

Amongst the more commonly observed medical emergencies in dental offices are fainting, seizures, acute asthmatic attacks, allergy, and chest pain (angina).

Virtually all of these emergencies occur as a result of fear and anxiety. Therefore, it becomes very important for the patient to advise their doctor if they are apprehensive about their dental treatment. Steps usually can be taken which will prevent these situations from occurring.

Additionally, in many states it is mandatory for all dentists to be certified in basic life support (CPR) on a regular basis. In many dental offices, additional staff personnel are also trained in this very important technique.

Dental offices maintain an emergency supply of oxygen, as well as commonly used emergency equipment and drugs.

And finally, most dental offices are located in close proximity to their community's Emergency Medical Services (EMS) system (9-1-1). A telephone call activating this system will provide well-trained life-saving medical assistance within a few minutes.

By Stanley F. Malamed, DDS

Why Some People Take Antibiotics Before Visiting The Dentist

Dentists prescribe prophylactic (to prevent the spread of disease) antibiotics before dental treatment for people with certain medical conditions. The American Heart Association, the American Dental Association, and the American Academy of Orthopedic Surgeons have recommended the guidelines for preventive antibiotics for these medical conditions. The current guidelines were developed for patient well-being, as well as in consideration of the current concern regarding the overuse of antibiotics. The guidelines outline specific medical conditions and provide examples of which dental procedures indicate the need for prophylactic antibiotics.

The risk of infective endocarditis (infection and inflammation of the lining of the heart and its valves) is increased with dental procedures that cause bleeding and the potential release of oral bacteria into the bloodstream of people with certain medical conditions. Individuals who have certain congenital or acquired heart defects, as well as some conditions or abnormalities of the heart, have an increased chance of a bacterial infection.

The link between dental procedures and infective endocarditis is controversial. Not all dental procedures require the use of antibiotic prophylaxis. Dental procedures that have minimal potential to cause bleeding are considered low risk for infective endocarditis. Antibiotic prophylaxis may be indicated for invasive dental procedures that are likely to cause bleeding and release of oral bacteria in the bloodstream.

Also, the release of oral bacteria into the bloodstream appears to increase the risk of developing an infection around a prosthetic joint in people with a depressed immune system. Use of prophylaxis antibiotics is recommended for individuals with total joint replacements who have certain other health conditions.

Antibiotic prophylaxis also can be prescribed for circumstances other than prevention of infective endocarditis and prosthetic joint infections. Some other conditions or situations that may indicate antibiotic prophylaxis include in-dwelling catheters, hemodialysis patients with arteriovenous shunts, shunts for hydrocephalus, oral surgical or operative procedures (depending on the patient's immune system), insulin-dependent diabetes, or diabetics whose disease is poorly controlled.

By Denise J. Fedele, DMD, MS