MANAGING DENTAL EMERGENCIES

Objectives

•Basic dental anatomy

•Diagnosis and treatment planning

•Pulpitis

•Dental abscess and cellulitis

•Trauma

•Anesthesia for dental procedures

•Extraction

•Drugs in dentistry

•Emergency dental kit

Introduction

• Dental disease is evident in all patient populations regardless of medical conditions.
• Most commonly occurs because of dental neglect, however, certain populations have unique oral health issues.
• Dental care consistently ranks in the top 5 of unmet needs in Statewide Statement of HIV/AIDS needs Survey.

Lymphatic Drainage

•Lymphatic drainage is to the submental, submandibular and deep cervical nodes.

DIAGNOSIS &TREATMENT PLANNING

Emergency vs Urgency

•Emergencies interrupt normal eating, working and sleeping.

•Emergencies occur within 2 days.

•Pain medications for emergencies are usually ineffective.

What is a true dental emergency?

•The presence of pain does not necessarily constitute a dental emergency.

•An acute dental emergency requires the presence of :

–Swelling

–Fever

–Pus

–Bleeding

Ludwig’s Angina

Cellulitis involving bilateral sublingual, submandibular and submental spaces
Tongue is elevated toward palate
Rapid spread of infection into lateral and retropharyngeal spaces leading to airway obstruction

When to Admit?

Deep fascial space threatening the airway
Patient is dehydrated and requires IV fluids
General anesthesia needed for surgical procedure

Aims &Objectives

At the end of the session the students will be able to:

identify medical emergencies 

Understand resuscitation procedures

provide immediate management of anaphylactic reaction, hypoglycaemia, upper respiratory

obstruction, cardiac arrest, fits, vasovagalattack, inhalation or ingestion of foreign bodies

apply the principles of first aid

Asthma

Clinical features of acute severe asthma include:

• Inability to complete sentences in one breath.

• Raised respiratory rate 

• Increased heart rate

Management of Acute asthma

• Most attacks will respond to a few ‘activations’ of the patient’s own inhaler such as salbutamol

• Repeat doses may be necessary.

• Reassure and calm patient Reassure and calm patient Severe / life threatening 

• Call emergency service 

• Call for help and when available give oxygen

• 4–6 activations from the salbutamolinhaler should be given using a large-volume spacer device and repeated every 10 minutes if necessary until an ambulance arrives.

Common medical emergencies in dental practice Signs and symptoms 

Anaphylaxis

• Urticaria, erythema, rhinitis, conjunctivitis.

• Abdominal pain, vomiting, diarrhoea.

• Difficulty in breathing

• Vasodilation leading to low blood pressure and collapse. vomiting, diarrhoea.

• Flushing  and swelling of the face, especially of the eyelids and lips.

collapse. 

• Respiratory arrest 

• Cardiac arrest.

Common medical emergencies in dental practice Management Anaphylaxis

• Call for emergency service

• Lay the patient flat & raise the feet (restoration of blood pressure)

• administer oxygen (10 litres per minute). Severe reactions

• adrenaline should be given