1. DENTAL EMERGENCIES
Assoc. Prof. (Dr) Rashidi Ahmad
Dept. of Emergency Medicine

2. Objectives
Common dental emergencies – What? When?
How? Where? Who?.
Basic approach to dental emergencies

7. Factors increasing risk during dental
treatment
Increased number of older patients
Medical advances – drug therapy, surgical
techniques
Longer appointments
Increased drug use – LA, sedatives,
analgesics, antibiotics

8. Death
Most emergency situations: potentially life threatening BUT death
is rare.
8 deaths a/w GA in a 20-year period
(1 death in every 673,000 GA administration)
Lytle JJ, Stamper EP: The 1988 anesthesia survey of the Southern
California Society of Oral Surgeons, J Oral Surg 32:739. 1974
“10% of all non-accidental deaths are classified as sudden,
unexpected death & unpreventable.”
McCarthy EM. J Am Dent Assoc. 1971 83:1091

9. STILL OK????

10. “When you prepare for an
emergency, the emergency ceases
to exist”
“To be forewarned is to be forearmed”
“Prevention is better than cure”

11. Important Rules
Find and correct life threats
If life-threat is present, CORRECT IT!
If it can’t be corrected
Support oxygenation, ventilation, perfusion
GET HELP & TRANSPORT!!

13. Life threatening events
Airway obstruction
Ventilation-perfusion mismatch
Circulatory compromised
Dysfunction of CNS

14. APPROACH
S: Stop Procedure & Observe
R: Response
P: Position
A: Airway
B: Breathing
C: Circulation/Cardiac Monitor/Cardioversion
D: Dysfunction Of CNS & Definitive Management

15. Stop procedure
Avoid injuries
Proper assessment and
management
Proper position

16. Response
Ability to speak
Appropriate orientation
If unconscious -Loud voice & gentle
tap/shake
Call for HELP!!

17. Airway
Anticipate airway problems with
Decreased level of consciousness
Oral bleeding
Foreign body
Return head to neutral position
Head tilt, chin lift, jaw thrust

18. Triple Maneuver

21. Breathing
Is oxygen getting to the
blood?
- Is air moving?
- Is it moving adequately?
- Is it moving at an adequate
rate?

22. Breathing
Oxygenate immediately if:
Decreased level of consciousness
Shock
Severe hemorrhage
Chest pain
Dyspnea
Respiratory distress
If you think about giving oxygen,
GIVE IT!!

23. Resuscitation trolley

24. Assisted ventilation
Respirations <12
Respirations >24
Tidal volume decreased
Respiratory effort increased

25. Circulation
Is the heart beating?
Is there serious external bleeding?
Does patient have radial pulse?
Absent radial = systolic BP < 80
Does patient have carotid pulse?
Absent carotid = systolic BP < 60

26. Circulation
Serious oral bleeding?
Clear the airway/suction
Treat the cause/stop the bleeding – bone wax, stitches
? Intubation
GXM – blood transfusion
Surgical intervention
Is patient perfusing?
Cool, pale, moist skin = shock UPO
Capillary refill > 2 sec = shock UPO
Restlessness, anxiety, combativeness = shock

27. Cardiac monitoring/defibrillator
Heart rate
Dysrythmias
Ischemic changes
Defibrillation

29. Disability (CNS dysfunction)
Decreased LOC =
Hypoxia
Hypoglycemia
Shock
Acute stroke
Think about drugs, alcohol, or
personality

30. Definitive management
Confirm the problem
Treat the cause
Treat the complication
Disposition

31. Conclusion
Be prepared – staffs, equipments, training
Proper assessment – past medical history,
history of allergy, & PE
Intervene possible complication
Emergency approach

32. APPROACH
S: Stop Procedure & Observe
R: Response
P: Position
A: Airway
B: Breathing
C: Circulation/Cardiac Monitor/Cardioversion
D: Dysfunction Of CNS & Definitive
Management

33. Important message
Survival depends on assessment skills
Good assessment results from
An organized approach
Clearly defined priorities
Understanding available resources