|Year : 2020 | Volume
| Issue : 1 | Page : 6-10
Status of dentist handling medical emergencies in clinical set-up – A survey
M Halith Ahamed1, Vidhya2
1 Graduate, Sri Ramachandra Dental College and Hospital, Porur, Chennai, Tamil Nadu, India
2 Reader, Sri Ramachandra Dental College and Hospital, Porur, Chennai, Tamil Nadu, India
|Date of Submission
|Date of Acceptance
|Date of Web Publication
Dr. M Halith Ahamed
Graduate, Sri Ramachandra Dental College and Hospital, Porur, Chennai 600 116, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: An increasing number of elderly and medically compromised patients are being treated in the dental clinic. The management of medically compromised patients by the dental practitioner might require modifications in oral health care. The purpose of this study is to assess the status of dentist handling medical emergencies in clinical set-up. And about the awareness of basic life support (BLS), commonly occurring medical emergencies at dental office and availability of the emergency kit and drugs at dental office. Materials and Methods: A survey had been conducted among 100 dentists to assess the status of dentist handling medical emergencies in clinical set-up. The questionnaire survey includes 12 questions. The data were statistically analyzed and represented with bar graph diagram. Results: In our study, the survey has shown that 89% dentists were aware of BLS. Eighty-five percent of them were trained in cardio pulmonary resuscitation, 13% were trained in recognition of emergencies and 2% of them were trained in emergency drug usage. Forty-five of them were updating emergency training yearly. Ninety percent of them said syncope is the condition occurs most commonly in dental clinic, 6% of them said epilepsy, and 4% of them said bleeding episode. Eighty-two percentage dentists have the availability of the basic emergency kit at dental office. The availability of oxygen cylinders is higher than the automated external defibrillators in dental office. Sixty-two percent of them were able to give an intravenous injection. Conclusion: Medical emergencies occur in dental hospital practice more frequently but in similar proportions to that found in general dental practice. There is a perceived need for further training among dental hospital staff in the management of medical emergencies.
Keywords: Assessment, dentist, intravenous, medical emergency, oxygen cylinder, syncope
|How to cite this article:
Ahamed M H, Vidhya. Status of dentist handling medical emergencies in clinical set-up – A survey. Int J Soc Rehabil 2020;5:6-10
An increasing number of elderly and medically compromised patients are being treated in the dental clinic. The management of medically compromised patients by the dental practitioner might require modifications in oral health care., In general, a medical emergency can be prevented by taking a thorough medical history, examining the patient, and formulating a comprehensive treatment plan with appropriate alterations to dental treatment as required. Despite efforts to minimize any untoward incidence, emergency situations may arise on the dental chair. The more common medical emergencies encountered in the dental chair include syncope, angina pectoris, cardiac arrest, postural hypotension, swallowed foreign bodies, bronchospasm, anaphylaxis, hypoglycemia, and seizures. In general, these emergencies can be life-threatening, and there have been cases of patients dying resulting from medical emergencies in dental offices.,
Effective management of medical emergencies in the dental office is ultimately the dentist's responsibility. Lack of training and inability to cope with medical emergencies can lead to tragic consequences and sometimes legal action. Therefore, dental practitioners must be able to recognize and communicate adequately about relevant medical problems as well as have appropriate knowledge of oral health care and potential interactions with medical conditions. The purpose of this study was to assess the knowledge, attitude, and the perceived confidence of the dental practitioners having a varied range of experience and from different dental specialties in managing an emergency arising while treating a patient in the dental clinics.
Medical emergencies can be alarming to any clinician, but these situations are less alarming if proper preparations are made. Medical emergencies occur in dental practice more frequently. Fortunately, serious medical emergencies in dental practice are not common, but they are all the more alarming when they occur. A thorough patient history can draw the practitioner's attention to potential medical emergencies that could occur. Changing demographics in the population, leading to increased longevity, have led the people having medical conditions which predispose to a medical emergency or taking medication may influence their dental management and persons aged above 65 years or over are considered to be taking medication with a potential effect on dental care.
An increasing proportion of the population is medically at risk. According to the European resuscitation council, sudden cardiac arrest is a leading cause of death in Europe, affecting about 7, 00,000 individuals a year.
Thus, an effective management of an emergency situation in the dental office is ultimately the dentist's responsibility. Although a number of studies have been carried out which sought to ascertain the emergency drugs and equipment, the lack of training, and inability to cope with medical emergencies can lead to tragic consequences and sometimes legation action.. For this reason, as all the health professionals, dentists must be well prepared to attend to and collaborate with the medical emergencies. Providing basic life support (BLS) is the dentists' most important contribution until definitive treatment for a medical emergency can be provided.
Few studies have assessed how competent dentists consider themselves in managing medical emergencies, and very few studies, to the best of our knowledge, have reported studies involving fresh dental graduates.
There are circumstances and procedures within a dental office having the potential of precipitating medical emergency. Fear and anxiety in patients seeking dental treatment may cause measurable metabolic changes, which make these patients prone to such emergencies. The chance of a medical emergency increases with the administration of anesthetics and medications, virtually all of which are known to have adverse reactions. Nearly one-third of these emergencies are potentially life-threatening.
Keeping in mind, the risk associated with dental treatment, it becomes imperative for the dentist to take appropriate steps for the prevention and management of such emergencies in the dental office. The prevention of medical emergencies should be the primary concern of a dentist. Successful prevention depends on the evaluation of a patient's history and physical condition as well as appropriate treatment modifications. Adequate preparation for the rapid and effective management of potentially life-threatening situations includes the following four specific actions:
- Ensuring the dentist's own education regarding medical emergency management is adequate and current
- Stocking the dental office with the supplies and equipment necessary for emergency care
- Education of the clinical staff in emergency recognition and management
- Providing for ready access to other healthcare providers capable of assisting during emergencies.
The aim of this study is to learn the experience of handling medical emergencies, their skills and competency, and how well they felt are prepared to manage such events with appropriate use of drugs and equipment in a dental setting.
| Materials and Methods
Study design and sample
To address the research purpose, a survey study is been implemented by conducting a questionnaire survey which contained 12 questions. All the questions were most relevant for the status of dentist handling medical emergencies in clinical set-up. The sample size for this study is 100 (convenience sampling).
To analyze the data, counts and tabulation were calculated. Results were obtained for survey responses, and were estimated according to the study. Bar charts were used to present the results.
The purpose of this study was to evaluate the dental graduates, knowledge, experience, and perceptions regarding medical emergencies in the dental practice. The questionnaire sought information on the frequency and type of medical emergencies encountered by the interns in the past 4 years.
89% of the participants reported that they were aware of basic life support and 98% answered that they enquire about medical history including medication and allergy and obtain filled health history proforma of the above from the patient. 68% of the participants reported that they can handle any emergency condition at your dental office and only 40% of the respondents had AED available in their dental office [Table 1].
Life-threatening emergencies can occur anytime, anywhere, and to anyone. Such situations are somewhat more likely to occur within the confines of the dental of office due to the increased level of stress which is so often present.
However, in our study, the survey has shown that 89% of dentists were aware of BLS. Eighty-five percent of them were trained in cardiopulmonary resuscitation, 13% were trained in recognition of emergencies and 2% of them were trained in emergency drug usage. Forty-five of them were updating emergency training yearly. Ninety percent of them said syncope is the condition occurs most commonly in dental clinic, 6% of them said epilepsy and 4% of them said bleeding episode. Eighty-two percent dentists have availability of the basic emergency kit at dental office. The availability of oxygen cylinders is higher than the automated external defibrillators in dental office. 62% of them were able to give an intravenous injection [Table 1].
The most important step in the preparation for medical emergencies is training of the dentist in recognition and management of emergency situations. According to the findings of this study, a majority (92.4%) of the participating dentists recalled having received training in the management of medical emergencies as undergraduates. However, less than half (42.1%) reported receiving practical training. In a study done by among general dental practitioners in Great Britain, 75.2% of respondents indicated they had received training in the management of medical emergencies as undergraduate students. However, the type of training received was not obtained in that study.
Amirchaghmaghi et al., in their study, observed that nearly 50% of dentists get training on Cardio-Pulmonary-Resuscitation (CPR), oxygen administration, and diagnosis of medical emergencies during their under and post graduate course. Gonzaga et al. also noted that nearly 55% of dentists can manage CPR, but training for the administration of the intravenous drugs is very low (10.8%) among dental interns. Chapman PJ did a survey among Australian dentists and found 96% of respondents believed that dentists should be competent in CPR; however, only just over half (55%) felt they were competent in CPR. These findings could be because of the low level of training and poor curriculum being followed by the dental institutes.
CPR and intravenous drug administration may be considered too complex for a dental student and hence not much relevance given for its training at undergraduate levels. The other possible reason could be the wrong thought process that dentist would rarely be expected to encounter a medical emergency requiring these interventions. These false notions must be changed since the incidences of medical emergencies in dental setup are always a possibility, and CPR provides the fundamental BLS that can be lifesaving in an emergency situation.
Carvalho et al., in their study, found that Brazilian dental students considered continuing training in BLS to be necessary over their entire professional lives to control a medical emergency situation in the dental office. Newby et al. conducted and evaluated undergraduate training program on simulation of medical emergencies in dental practice and concluded that training should be incorporated into undergraduate teaching. Similarly, Balmer and Longman found simulation training tailored for dentist's needs highly effective. Furthermore, printing and distributing leaflets can be costly, and there is no opportunity for the health worker to ask questions, interact with a trainer or raise issues relevant to their practice.
In a primary health care setting, it may not be possible to eliminate some hazardous procedures and so training (an administrative control) is important in the prevention and management of medical emergencies. The handling of a medical emergency in a dental office is a skill that cannot be acquired just by attending lectures. One must have hands-on experience to gain the level of confidence necessary to manage life-threatening situations. This can be done by regularly attending hands-on workshop which will subsequently assess the skills acquired.
Gill and Scully evaluated the attitude and awareness of final-year predoctoral dental and medical students to medical emergencies in dentistry and reported that knowledge and training of dental students were moderate. They suggested that the training of the dentists is inadequate, and the curriculum should be revised to include the training so that medical emergencies can be handled in a more efficient manner.
Medical emergencies have been reported to occur frequently in dental practice. A study suggested that up to 44% of dentists may have a patient with a medical emergency in a year. The result of this study also reacts that medical emergencies occur quite frequently because more than half of the studied dental students claimed to have previously encountered medical emergency during their training.
Another study suggests that a deficiency in this dental students' curriculum on medical emergencies. A curriculum refers to the overall content of what is to be taught about a subject matter. With progressive points of view, the curriculum can be defined as experiences in the classroom, which are planned and enacted by the teacher and also learned by the students.
It is important that a student-centered approach is used in the development and implementation of the curriculum for better results, and this is why curriculum mapping was advocated. This refers to a situation where students can identify what, when, where, and how they can learn, i.e. the scope and sequence of students' learning are made transparent. Barely, over half of the students studied were aware of the inclusion of a medical emergency in their dental curriculum. This result raises a few questions, especially since the students were subjected to the same condition. Could this result be because some students do not pay attention to the curriculum or because they are not adequately informed by those to implement the curriculum, fortunately, however, only very few out of the students who claimed not to be aware felt the inclusion of a medical emergency in the dental curriculum is unnecessary.
Guidelines are in place for the management of medical emergencies in a dental setting,, and the purpose of these guidelines is to set out agreed philosophy and responsibilities of all dental staff in relation to resuscitation and management of medical emergencies in the dental surgery. Only 17.7% of the dental students studied were aware of such guidelines. The students' role, as part of the dental team, in the management of a medical emergency can therefore not be said to be optimal. There is also a possibility that the students are not in possession of the right guidelines as only 31.8% of them felt the guidelines are sufficient and comprehensive.
The Nigerian dental students are expected to be exposed to both the theoretical and practical aspect of medical emergencies management in the course of their training., An earlier study done on the final year dental students toward the development and evaluation of their undergraduate training program reported that realistic simulation training in the management of medical emergencies for dental students is an effective adjunct to traditional lecture-style teaching. Simulation training was reported to improve the ability to manage medical emergencies.
Another study also reported that the more advanced the simulation is the better management of medical emergencies. Full-mission simulation, using physical patient simulators, appeared to be the most useful training method. Only 28.2% of the studied dental students claimed to have received the desired forms of training on medical emergencies, while an alarming 41.9% claimed not to have received any form of training. This feedback will be useful in the curriculum evaluation process.
Other important points revealed by this study are that only the theoretical training in medical emergencies seems to be effective. Many of the dental students were able to volunteer the information that they received lectures on the topic. The use of visual teaching aids like videotapes and PowerPoint projections; however, did not get so much mention. Fewer than half of the students had any form of simulation, which would have help them to put their theoretical knowledge into practice.
Every effort must be made to prevent such emergencies. However, in the advent of such an emergency occurring, the dental team must be prepared to manage it competently and timely. Dental regulatory boards across the USA require mandatory completion of board-approved courses in Infection Control and certification in BLS courses for license renewal. Similarly, the UK and Canadian boards require that all members of staff who might be involved in dealing with a medical emergency are trained together regularly in a simulated emergency so they know exactly what to do.
These trainings are redirected through the continuing education programs that the dentists must attend to collect the credit points required to renew their license to practice. Thus successful management of medical emergencies would require preparedness in the form of a well-trained and skilled dental team as well as the immediate availability of the emergency drugs and equipment.
The results of the study emphasize the need for improvement of the training of practicing dentists in the recognition of medical emergencies, emergency drug usage, and awareness of BLS among dentist. Dentist needs improvement while obtaining vital signs before commencing any treatment. There is a need for the availability of basic emergency kit and automated external defibrillators in dental office.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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