Dental Emergencies Preparation Quiz

Medical Emergencies in Dental Practice

• Respiratory Distress (Asthma):
  • Airways narrow and swell, producing extra mucus, making breathing difficult.
  • Manifestations: Shortness of breath, wheezing, cough, chest tightness, anxiety, cyanosis.
  • Management:
    • Position patient upright.
    • Administer beta-2 agonist inhaler (e.g., albuterol), one puff at a time, every 60 seconds (max 10 puffs).
    • Provide oxygen (O2).
    • Contact emergency services (997).

Chest Pain

• Acute Myocardial Infarction (MI):
  • Occlusion of a coronary artery, causing cessation of blood flow and heart muscle damage.
  • Manifestations: Sudden onset severe pain, radiating to jaw and/or left arm, crushing chest pain, shortness of breath, sweating, weakness, restlessness.
  • Management:
    • Call emergency services (997).
    • Chew one regular aspirin (325 mg), or four baby aspirins (4 x 81 mg).
    • Monitor vital signs.
    • Relieve pain (e.g., morphine, nitrous oxide).
    • Administer oxygen (as needed, for SpO2 > 92%).
    • Perform basic life support (BLS), if needed.
  • Angina:
    • Chest pain or tightness, caused by reduced blood flow to the heart.
    • Manifestations: Warning signs can vary between individuals (especially in women and diabetics). Typical signs may include crushing chest pain, radiating to the jaw and/or left arm, shortness of breath, sweating, weakness, restlessness. Some silent MI's can occur. Typical symptoms may be less easily observed such as chest discomfort radiating to the throat and back, shortness of breath, heart palpitations and lightheadedness for women.

Syncope

• Definition: A transient loss of consciousness, with rapid recovery. Thought to be caused by reduced cerebral blood flow.
• Causes: Cardiac, neurological, vasovagal, seizures, among others.
• Manifestations: Dizziness, nausea, turning pale, feeling faint, sweaty, blurred vision, ringing in ears.
• Management:
  • Stop the procedure.
  • Place patient in Trendelenburg position (head lower than the feet).
  • Apply a cold compress to the forehead.
  • For complete loss of consciousness, use ammonia ampule.
  • Monitor vital signs.
  • Contact emergency services (997).

Seizures

• Definition: Excessive and hypersynchronous activity of cortical neurons, resulting in transient neurological symptoms.
• Triggers: Physical exertion, alcohol consumption, fever, sleep deprivation, flashing/strobe lights, certain medications, hormonal changes, among many others.
• Manifestations: Uncontrollable jerking movements, loss or changes in consciousness.
• Management:
  • Calm patient.
  • Move dangerous items away.
  • Note time the seizure starts.
  • Place patient on their side if they've fallen.
  • Do not restrain or put anything in their mouth.
  • Prevent others from crowding around.
  • Place in recovery position after seizure ends.
  • Contact emergency services (997).

Stroke

• Manifestations: Muscle weakness/paralysis. Difficulty speaking or seeing. Loss of balance. Confusion, headache, loss of consciousness.
• Management: Call emergency services (997). Reassure patient.

Allergy-Related Emergencies

• Mild allergic reaction: Managed by oral antihistamine.
• Anaphylaxis:
  • Inject epinephrine (EpiPen), if available.
  • Administer intramuscular epinephrine as soon as possible.
  • Call emergency services (997).
  • Perform CPR if needed.

Hypoglycemia

• Manifestations: Hunger, nausea, sweating, tachycardia, anxiety, diaphoresis, decreased ventilation, loss of consciousness, seizures, coma.
• Management (conscious patient): Assess vitals and blood glucose. Provide oral carbohydrates (e.g., orange juice, candy, dextrose gel).
• Management (unconscious patient): Assess vitals and blood glucose. Provide CPR as necessary. Administer 25-50 mL of 50% dextrose IV if possible. If no IV access, administer 1 mg glucagon IM. Call emergency services (997).

Neurological Diseases

• Seizure Disorders:
• Epidemiology & Etiology: Neurodegenerative conditions like seizures, cerebrovascular disorders, Parkinson's disease, myasthenia gravis, multiple sclerosis, and Alzheimer's have a significant impact on patient cases and management.
• Clinical Features: Varying symptoms depending upon the specific condition, from seizures, tremors, and muscle weakness to impaired cognition and memory.
• Oral Health Considerations: Dental management requires careful consideration of the specific type of neural disorder and requires that providers understand the disorder's impact on oral health and dental management procedures. Considerations include patient history (seizure triggers, frequency, level of control). Updates to medication protocols should be thoroughly reviewed and discussed with patients.

Cerebrovascular Disease

• Definition: Disorders affecting the cerebral blood vessels, resulting in impaired cerebral circulation.
• Causes: Sudden impairment affecting cerebral circulation and/or vascular conditions of an area.
• Manifestations: Sensory and motor deficits, weakness, visual defects, headache, altered mental status, dizziness, nausea, seizures, speech impairment or hearing problems.
• Management: Brain imaging (CT, MRI), risk factor stratification (diabetes, hyperlipidemia), acute treatment (thrombolysis with t-PA), chronic treatment (aspirin, antiplatelet medications).
• Oral Health Considerations: Timing and type of the incident must be considered in dental care. Warfarin or other anticoagulants affect treatment protocols. Pain control and appropriate anesthesia should be implemented. Consider the potential implications of oral self-care and preventive measures (recall appointments, fluoride use) for patients.

Parkinson's Disease

• Definition: A chronic, progressive neurodegenerative disorder.
• Causes: Degeneration of dopaminergic cells in the substantia nigra.
• Manifestations: Resting tremor, rigidity, bradykinesia, postural instability.
• Management: Clinical diagnosis, genetic testing, dopamine replacement therapy (levodopa/carbidopa), medication for various symptoms.
• Oral Health Considerations: Patient position, dysphagia risks (aspiration), and orthostatic/severe hypertension need to be addressed. Careful monitoring of patient vitals is necessary during procedures.

Myasthenia Gravis

• Definition: Chronic neuromuscular disease.
• Causes: Autoimmune destruction of the skeletal neuromuscular junction.
• Manifestations: Muscle weakness that worsens with activity and improves with rest. Oropharyngeal, facial, muscle weakness; diplopia and/or ptosis (drooping eyelids). Various other symptoms exist
• Management: Clinical examination, history, Tensilon (edrophonium) challenge, testing for anti-AChR antibodies, plasma exchange, and high-dose IV immunoglobulin.
• Oral Health Considerations: Risks of aspiration during procedures. Maintaining oral hygiene in patients with reduced muscle weakness and control measures should be prioritized.

Multiple Sclerosis

• Definition: Chronic inflammatory disease of the central nervous system (CNS). .- Causes: Unknown, but likely autoimmune in nature.
• Manifestations: Varying depending on the affected area in the CNS. Symptoms frequently include visual disturbances, limb weakness, spasticity, ataxia, bladder and bowel dysfunction, and sensory disturbances; and potential additional symptoms, like depression.
• Management: No cure; treatment focuses on treating acute exacerbations, modifying disease progression, and managing symptoms. Treatment typically involves medication or therapy.
• Oral Health Considerations: Avoid dental treatment during acute exacerbations.

Alzheimer's Disease

• Definition: Progressive neurodegenerative disorder that usually begins with mild memory loss and gradually progresses.
• Causes: Amyloid plaques and neurofibrillary tangles in the brain, causing massive apoptosis.
• Manifestations: Memory loss, trouble handling daily tasks, decreased judgment, misplacing things, changes in mood, personality, and/or behavior.
• Management: No cure, therapy aimed at slowing progression. Medications to address impairments.
• Oral Health Considerations: Considerations of patient frustration, irritability, and/or combative behavior when confronted with unfamiliar circumstances, information not understood, questions, instructions, and/or information. Caregiver involvement, verifying patient info, and interpreting behavior can help alleviate anxiety.

Renal Diseases

• Renal Failure: Loss of kidney function.
• Causes: Chronic kidney disease from diabetes, infections, prolonged obstruction, toxins, hypertension, and/or nephrosclerosis.
• Manifestations: Anemia, reduced appetite, dry skin, vomiting, bone pain, and metallic taste in the mouth.
• Oral Manifestations (Uremic Stomatitis): Painful, ulcerative lesions in the mouth (buccal mucosa, dorsum of the tongue).
• Management: Dietary changes, careful management of fluids, and electrolytes.

Infectious Diseases

• Definition: Diseases caused by pathogens such as viruses, bacteria, fungi, or parasites.
• Classification: Bacterial (strep, staph), viral (influenza, herpes), fungal infections of the oral cavity, and others.
• Symptoms: Fever, cough, sore throat, headaches, etc.
• Investigations: Tests for the specific pathogen.
• Treatment: Medication specific to the pathogen.

Other conditions mentioned

• Dengue Fever:
• Pulmonary Tuberculosis (TB):
• Allergy-Related Emergencies & Hypoglycemia