A state-wide survey of medical emergency management in dental practices: incidence of emergencies and training experience

General dentists' awareness of how to cope with medical emergencies in paediatric dental patients

BACKGROUND

General dentists (GDs) should be aware of the symptoms, signs, diagnoses and treatment of medical emergencies in paediatric patients.

AIM

To evaluate the knowledge of GDs in coping with medical emergencies, and to identify whether they are confident to diagnose and treat medical emergencies in paediatric patients.

DESIGN

The questionnaire was conducted immediately before the beginning of national dental meetings and continuing education seminars in Croatia, attended by the GDs, in order to obtain a representative sample.

RESULTS

Of a total of 498 GDs who returned the questionnaire with valid data, 51.2% reported that a medical history was regularly taken. A high proportion (81.3%) of the GDs had never received any basic life support (BLS) training and education for paediatric patients during their undergraduate studies. After graduation, this value rose to 86.1% of GDs. However, more than two-thirds (68.7%) had experienced some emergency situation in their practice. The most frequent emergency was vasovagal syncope (83.6%) and the most rare was cardiac arrest (8.2%). One-fifth (20.5%) of GDs experienced some emergency but could not make a diagnosis. The more BLS training undergone by a GD, the more self-confident s/he felt in an emergency situation.

CONCLUSIONS

Most GDs have a lack of knowledge to cope with medical emergencies in paediatric patients, and do not feel confident to diagnose and treat emergency situations in children. It is suggested that adequate training and education should be provided for all GDs to address this shortcoming.

Radiographic diagnosis of proximal caries-influence of experience and gender of the dental staff

OBJECTIVES

The aim of this study was to examine the influence of experience and gender on the radiographic detection of proximal caries lesions and on therapeutic decisions.

MATERIALS AND METHODS

A survey of 220 examiners (students and employees at three universities and dentists in the field) was taken using a standardized written questionnaire concerning radiographic diagnosis and therapy planning. An expert opinion of four dentists was determined as radiographic reference. A mixed effect logistic regression model was used for statistical evaluation and the odds ratio and p values were calculated (α = 0.05).

RESULTS

Examiners with experience had an almost four times greater chance of a correct assessment, if proximal caries lesion was present or not, than examiners with low experience (OR 3.7 (95% CI 2.4-5.8)). No gender-specific differences were discovered (OR women vs. men 0.9 (95% CI 0.6-1.4)). There was a relationship between the severity of the burnout effect on the x-ray and false positive caries diagnosis. Overall, 43% of respondents would plan invasive treatment in the enamel on a patient at low risk of caries and 78% on a high-risk patient. The results showed that the more experienced practitioners would be more likely to postpone restorative therapy on proximal caries until the lesion reached a later stage.

CONCLUSIONS

The results of this study suggest that examiner's experience influences the radiographic diagnosis of proximal lesions. No gender-specific differences could be found.

CLINICAL RELEVANCE

Examiner's professional experience is an important factor when radiography is included for detection and treatment planning of proximal lesions.

The laryngeal tube - a helpful tool for cardiopulmonary resuscitation in the dental office?

BACKGROUND

Supraglottic airway adjuncts such as the laryngeal tube (LT) have been recommended to be used by cardiopulmonary resuscitation (CPR) first responders.Objective This study aims to evaluate the performance characteristics of dental students and dentists using the LT in comparison to a conventional bag valve mask device (BVM) within manikin CPR training.

METHOD

A group of eight dentists and 12 dental students performed randomised crossover CPR training using LT and BVM. Time intervals needed to perform five CPR cycles were recorded, as well as tidal and total gastric inflation volumes.

RESULTS

Median tidal volumes 0-1025 ml (median 462.5 ml) were observed using BVM and 100-500 ml (median 237.5 ml) with LT (p = 0.02). Total gastric inflation of 0-2900 ml was measured using BVM, no gastric inflation using LT (p = 0.0005). Time intervals needed to perform five CPR cycles did not differ between BVM (range 87.5-354.5 s, median 112 s) and LT (range 84.7-322.3 s, median 114 s) (p = 0.55). A median delay of 37.6 s (range 0-82.1 s) before starting CPR was observed using LT.

CONCLUSIONS

Lower tidal volumes but also lower or even no gastric inflation may be observed when dentists use a laryngeal tube during CPR. Respective training must focus on chest compressions. These must be started before inserting the LT or a different supraglottic airway adjunct and be delivered continuously during insertion. It is recommended to use a supraglottic airway such as an LT only after having been trained in its use.

A Review of the Available Guidance Regarding Management of Medical Emergencies in Primary Dental Care

This article provides an overview of the recent changes in guidance relating to the management of medical emergencies in primary dental care in the UK. The guidance relating to automated external defibrillators is also presented. The expectations of our regulatory bodies are discussed, as are the requirements for continued professional development. The potential shortcomings of the changes to the guidance are also discussed, as well as proposed solutions, such as the development of algorithms to use in a dental practice setting. Clinical relevance: All dental practitioners should be able to deal with medical emergencies in their practice.

The current state of emergency medical training in US schools of podiatric medicine

BACKGROUND

There is no information available in the medical literature regarding emergency medical training in the podiatric medicine predoctoral curriculum. This study was undertaken to describe the current state of emergency medical training in US schools of podiatric medicine.

METHODS

A Web-based descriptive survey was developed to assess course logistics, the curricular topics covered, and the teaching methods used. All of the US schools of podiatric medicine were surveyed.

RESULTS

Completed surveys were returned from all nine schools. All of the institutions incorporate training on the management of medical emergencies into their predoctoral curricula. Four schools (44.4%) reported initiating this training before 2000. All of the schools incorporate a didactic (lecture) component, and eight (88.9%) incorporate a clinical (hands-on) component into their training.

CONCLUSIONS

All of the schools of podiatric medicine in the United States incorporate emergency medical training into their predoctoral curriculum. However, despite some similarities across institutions, there seems to be variation regarding curricular topics, didactic teaching, and methods of teaching the material.

The preparedness of private dental offices and polyclinics for medical emergencies. A survey in Western Saudi Arabia

Objectives:

To assess preparedness for medical emergencies in private dental offices in Jeddah, Kingdom of Saudi Arabia (KSA).

Methods:

In this cross-sectional study, a survey was distributed to 70 dental offices and polyclinics in Jeddah, Saudi Arabia between October 2013 and January 2014. The questionnaire gathered information on the prevention of medical emergencies, the preparedness of the office personnel, and availability of emergency drugs and equipment.

Results:

For prevention, 92% (n=65) of the offices reported that they obtain a thorough medical history prior to treatment; however, only 11% (n=8) obtain vital signs for each visit. Using a preparedness percent score (0 to 100), the mean level of preparedness of the office personnel in all surveyed dental offices was 55.2±20. The availability of emergency drugs was 35±35, and equipment was 19±22.

Conclusion:

We found a deficiency in personnel training, availability of drugs, and emergency equipment in the surveyed dental clinics. More stringent rules and regulations for emergency preparedness must be reinforced to avoid disasters in these clinics.

Medical emergencies encountered in dental clinics: A study from the Eastern Province of Saudi Arabia

Objectives:

To report the prevalence of medical emergencies in dental clinics and self-perceived competence of dentists in the Eastern Province of Kingdom of Saudi Arabia (KSA).

Materials and Methods:

In this cross-sectional study, a self administered questionnaire was distributed to a random sample of 198 dentists working in private and government dental clinics in the Eastern Province of KSA. The respondents were approached twice to ensure good participation in the study.

Results:

One hundred and forty-five dentists returned the questionnaires yielding a response rate of 73.2%. Half were male (50.3%) and 56% worked in private dental clinics. About 67% of the respondents reported having encountered any episodes of medical emergencies. Vasovagal syncope was the most common medical emergency experienced by 53.1% of the dentists, followed by hypoglycemia (44.8%) and only 5.5% had faced foreign body aspiration. The responding dentists had encountered 599 episodes of medical emergencies in the last 3 years. Almost 45% of the participants felt competent to perform cardiopulmonary resuscitation (CPR). Most of the participants (74.3%) reported that they had emergency kits in their clinics; more than 70% of the dentists kept oxygen, adrenaline, and glucose. One-third of them were either not confident or did not know how to use the emergency drugs.

Conclusions:

The study findings revealed that dentists quite commonly encounter medical emergency situations during their practice in dental clinics, but a considerable proportion of dentists did not feel competent enough to handle medical emergency conditions.

Emergency response team activation in the outpatient clinic of a single dental teaching hospital in Korea: a retrospective study of 10 years' records

BACKGROUND

To prepare for possible emergency situations during dental treatment, it is helpful to know how often and what kinds of emergencies may arise. This study set out to evaluate the incidences, causes, treatments, and outcomes of emergency situations in the outpatient clinic of a dental teaching hospital in Korea.

METHODS

We retrospectively reviewed the records of patients who had experienced an emergency situation and emergency response team activated in a selected outpatient clinic between November 2004 and November 2013. Specific information about the emergency cases was collected, including the patient characteristics and the frequency, types, treatments, and outcomes of the emergency situations.

RESULTS

We identified 35 instances of emergency situations in 2,890,424 patients (incidence = 0.012 per 10,000 outpatients). The number of cases was as follows: 10 (28.6%) in the Department of Periodontics, 10 (28.6%) in the Department of Oral and Maxillofacial Surgery, 6 (17.1%) in the Department of Oral and Maxillofacial Radiology, 4 (11.4%) in the Department of Prosthodontics, 2 (5.7%) in the Department of Conservative Dentistry, 2 (5.7%) in the Department of Pediatric Dentistry, and 1 (2.9%) in the Department of Orthodontics. Three (8.6%) of the emergency situations arose before treatment, 22 (62.9%) during treatment, 7 (20.0%) after treatment, and 2 (5.7%) in a patient's guardian.

CONCLUSIONS

In accordance with the growing elderly population and more aggressive dental procedures, the number of emergency situations may increase in the future. We recommend that clinicians keep in mind airway management and the active control of emergency situations.

Competency in managing cardiac arrest: A scenario-based evaluation of dental students

OBJECTIVE

Advanced Cardiovascular Life Support (ACLS) in life-threatening situations is perceived as a basic skill for dental professionals. However, medical emergency training in dental schools is often not standardized. The dental students' knowledge transfer to an ACLS setting thus remains questionable. The aim of the study was to evaluate dental pre-doctorate students' practical competence in ACLS in a standardized manner to enable the curriculum to be adapted to meet their particular needs.

MATERIALS AND METHODS

Thirty dental students (age 25.47 ± 1.81; 16 male/14 female) in their last year of dental studies were randomly assigned to 15 teams. Students' ability to successfully manage ACLS was assessed by a scenario-based approach (training module: Laerdal® ALS Skillmaster). Competence was assessed by means of (a) an observation chart, (b) video analysis and (c) training module analysis (Laerdal HeartSim®4000; Version 1.4). The evaluation was conducted by a trained anesthesiologist with regard to the 2010 guidelines of the European Resuscitation Council (ERC).

RESULTS

Only five teams (33.3%) checked for all three vital functions (response, breathing and circulation). All teams initiated cardiopulmonary resuscitation (CPR). Only 54.12% of the compressions performed during CPR were sufficient. Four teams stopped the CPR after initiation. In total, 93% of the teams used the equipment for bag-valve-mask ventilation and 53.3% used the AED (Automated external defibrillator).

CONCLUSIONS

ACLS training on a regular basis is necessary and, consistent with a close link between dentistry and medicine, should be a standardized part of the medical emergency curriculum for dental students with a specific focus on the deficiencies revealed in this study.

Basic life support knowledge and skills of Iranian general dental practitioners to perform cardiopulmonary resuscitation

BACKGROUND

When cardiopulmonary arrest occurs, the dentist's ability to perform cardiopulmonary resuscitation (CPR) is the most important factor to minimize morbidity and mortality. This study assessed the basic life support (BLS) knowledge and performance of general dental practitioners in Hamadan, Iran.

MATERIALS AND METHODS

The participants in the study were 80 Iranian general dental practitioners who were chosen randomly. Their CPR knowledge was evaluated by verbal questions and their CPR skills were determined by CPR execution on a special manikin. Nearly 39% (n = 31) of dentists answered none of the questions and only 2.50% (n = 2) answered all of the questions correctly. Thirty six dentists had been participated CPR course after graduation.

RESULT

There was a significant difference between dentists who participated in CPR training course and those that did not participate (P value = 0.000). Only 3.75% (n = 3) were able to perform CPR properly.

CONCLUSION

The results showed that the amount of CPR knowledge and skills were low in participated Iranian general dental practitioners. However, CPR training courses after graduation increased the amount of knowledge significantly, thus, retraining CPR courses is necessary for dentists.

Evaluation of preparedness for medical emergencies at dental offices: A survey

BACKGROUND

The best way to handle an emergency is to be prepared in advance. The purpose of this study was to assess the availability of medical emergency drugs at dental offices and to determine the level of knowledge and preparedness of dentists to manage medical emergencies at their dental offices.

MATERIALS AND METHODS

A descriptive cross-sectional study was conducted from January to June 2014 with 250 dental graduates to determine their knowledge and ability in the management of medical emergencies and assess availability of emergency drugs and equipments in dental offices in the Ahmedabad and Udaipur areas of India. The questionnaire consisted of mainly objective questions, requiring a simple yes or no reply. Mann-Whitney test was used for the analysis. A 95% confidence level was used and a P value of less than or equal to 0.05 was considered statistically significant.

RESULTS

The results of our study showed that almost all the surveyed dentists (98%) enquired about medical history, but only 12% obtained filled health history proforma from patients regarding the above. Only 38.4% participants recorded the vital signs of patients before commencing any treatment. Also, 7.6% reported about having attended any workshops on emergency training or management programs. Emergency kits were available with only 24% participants and the available kits were assessed for the availability of emergency drugs. Also, 34% were confident about giving intramuscular injection and only 6.6% were sure about giving intravenous injections. The P value was found to be highly statistically significant.

CONCLUSION

The results of our study reflect an alarming situation about the capability of dentists to deal with such conditions.

Compliance with and attitudes towards the management of medical emergencies in general dental practice

Patient safety and risk management are increasing priorities in dental practice today. Ensuring that members of the dental team are prepared and equipped to adequately manage the common medical emergencies that might occur is an expectation of the public and increasingly demanded by the inspecting and regulatory bodies in healthcare.

Medical emergency management among Iranian dentists

AIMS

More than 18,000 patients need medical emergencies management in dental offices in Iran annually. The present study investigates medical emergencies management among Iranian dentists.

MATERIALS AND METHODS

From the list of the cell phone numbers of the dentists practicing in the city of Tehran, 210 dentists were selected randomly. A self-administered questionnaire was used as the data collection instrument. The questionnaire requested information on personal and professional characteristics of the dentists, as well as their knowledge and self-reported practice in the field of medical emergency management, and availability of required drugs and equipments to manage medical emergencies in their offices.

RESULTS

Totally, 177 dentists (84%) completed the questionnaire. Less than 60% of the participants were knowledgeable about characteristics of hypoglycemic patient, chest pain with cardiac origin, and true cardiopulmonary resuscitation (CPR) practice. Regarding practice, less than one quarter of the respondents acquired acceptable scores. In regression models, higher practice scores were significantly associated with higher knowledge scores (p < 0.001).

CONCLUSION

The results call for a need to further education on the subject for dentists. Continuing education and changing dental curriculum in the various forms seems to be useful in enhancement of the self-reported knowledge and practice of dentists.

CLINICAL SIGNIFICANCE

To successful control of medical emergencies in the dental office, dentists must be prepared to recognize and manage a variety of such conditions. In addition to dentist's knowledge and skill, availability of necessary equipments and trained staff is also of critical importance.

Evaluation of the dentists' knowledge on medical urgency and emergency

This study aimed at evaluating how well dentists understand medical emergency/urgency procedures and issues during dental treatment at a hospital specialized in cleft lip and palate. It comprised a hundred dentists from the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Brazil, from different dental specialties. A questionnaire was applied to evaluate their knowledge of medical emergencies/urgencies from June through September 2011. The questionnaire was anonymous, confidential and constructed with closed questions and either yes-no or multiple-choice responses. Results showed that most professionals (87%) were trained in basic life support (BLS), but only 43% considered themselves capable of providing first aid and performing the necessary maneuvers. Most participants (94%) claimed that they knew the difference between medical urgencies and emergencies, and 69% had BLS training in their undergraduate courses, as opposed to 37%, during their specialization. Some participants (23%) mentioned that they had received knowledge of the subject during extracurricular courses and/or graduate courses (12%). Only 9% had not been educated on the subject; however, all participants showed interest in attending a course in BLS. In regard to assessing training that dentists who attended BLS courses received, 49% were satisfied and 42% were dissatisfied. Results of the present study emphasize that dentists from HRAC/USP have little knowledge about BLS procedures to perform them. Dentists must gain adequate education and training to minimize possible technical, ethical and legal problems associated with dental practice. It is necessary to improve both knowledge and practice in order to become well-qualified practitioners.

Assessment of a group of nigerian dental students' education on medical emergencies

BACKGROUND

The training of dental students in the management of medical emergencies is of utmost importance as they may encounter some of these emergencies at some point in their career.

AIM

The aim of this study was to evaluate the medical emergency education in a Nigerian Dental School.

SUBJECTS AND METHODS

This descriptive cross-sectional study was carried out among 124 final year dental students of the University of Benin, Benin City. Data was collected using a self-administered questionnaire. The questionnaire elicited information on demography, knowledge of inclusion of a medical emergency in the dental curriculum, knowledge of guidelines on medical emergency formulated by any dental authority, opinion on the comprehensiveness of the present training on medical emergency, type of medical emergency training received, previous encounter with a medical emergency, previous participation in emergency drills and knowledge of the content of an emergency kit. Descriptive statistics was carried out on the collected data.

RESULTS

Only 58.1% (72/124) respondents were aware of the inclusion of a medical emergency in the dental curriculum and fewer, 17.7% (22/124), were aware of guidelines on medical emergency formulated by any dental authority. Fifty-two out of all the respondents (41.9%) claimed not to have received any form of training on medical emergency. Only 22.6% (28/123) had previously participated in an emergency drills and just 34.7% (43/124) had ever seen an emergency kit.

CONCLUSIONS

It can be concluded from this study that the level of training and level of knowledge on medical emergencies of the studied dental students is below desirable standard. It is therefore necessary to put proper strategies in place to strengthen their identified areas of weakness.

Patient safety incidents reported by Finnish dentists; results from an internet-based survey

BACKGROUND

Few data are available on dental patient safety (PS), as most PS studies have focused on other activities in health care.

OBJECTIVE

To detect types and causes of dental PS incidents (PSIs), including adverse events (AEs) and near misses (NMs), in Finnish dental care.

MATERIAL AND METHODS

Altogether 1041 privately or publicly employed dentists in southern Finland completed a structured questionnaire using an internet-based system (Webropol) in 2010.

RESULTS

Nearly one third of the dentists reported some PSI in the previous 12 months. Of the 872 reported events, 53% were classified as AEs, 45% as NMs and 2% remained unclassified. Nearly half of the PSIs had occurred during some form of dental treatment. One third of the AEs were related to dental equipment, devices and supplies. Most of the reported AEs resulted in little or no permanent harm to patients. However, 13% of AEs were considered as serious enough to potentially cause severe harm or did in fact cause permanent harm.

CONCLUSIONS

Reported dental PSIs in Finland are in many respects similar to those reported in other countries. Compared to all annual dental visits in Finland, severe dental AEs seem to be relatively rare. Less severe AEs and NMs are not uncommon, especially in dental surgery, endodontic and restorative treatment. The results of this retrospective study, however, reveal more about incident types than their true prevalence and that further studies on dental PS are needed.

Attitudes and behaviour regarding deep dentin caries removal: a survey among German dentists

Incomplete removal of deep caries has been shown to reduce the risks of pulp exposure and postoperative pulpal complications. It is therefore of interest whether dentists perform one- or two-step incomplete excavation, and which criteria and methods they use to assess and provide removal of deep caries. This study investigated the attitudes and behaviour of dentists in northern Germany using a new, validated questionnaire. The survey included 2,346 practitioners, 821 (35%) of whom responded. Demographic and sensitivity analysis did not indicate selection bias. 50% of dentists considered only complete excavation, even if pulp exposure was likely. If caries was to be removed incompletely, 77% considered two-step excavation. Hardness was the most important criterion to assess excavation. To treat an exposed pulp, 75% of dentists considered direct capping, 70% refused incomplete excavation fearing caries progression or pulp damage, and 59% reported to prefer more invasive treatment to facilitate restoration longevity. Over 50% recognised an influence of professional regulations on their treatment decisions. There was a moderate correlation between attitudes and behaviour of dentists, with dentists who suspected residual caries to be harmful rejecting incomplete excavation and vice versa. Cluster analysis identified two groups of dentists with opposite attitudes and behaviour, independently from dentist's age or gender. In conclusion, the majority of surveyed dentists was sceptical about leaving caries during excavation and does not practice incomplete caries removal. Therefore, benefits of partial excavation should be highlighted in under- and postgraduate education and regulatory incentives modified to promote minimally invasive techniques.

Practical skills training influences knowledge and attitude of dental students towards emergency medical care

BACKGROUND

Medical emergencies in dental practice are generally perceived as being rare. Nonetheless, recent studies have shown that incidents occur on a regular basis. Therefore, patients have the right to expect necessary skills to manage life-threatening situations from every dentist.

OBJECTIVE

To observe students' attitude and self-assessment towards emergency medical care (EMC) and its practical appliance.

MATERIAL AND METHODS

Students of dentistry took part in small group sessions for adult and paediatric basic life support. Participants filled out pre-post questionnaires regarding knowledge and attitude towards EMC (6, respectively, 10-point Likert scale). Additionally, feedback was asked for the quality of course and tutors.

RESULTS

Forty dental students in their last 2 years of study registered for the EMC courses. The majority had never attended any first-aid course; the mean age was 25% and 75% were women. A comparison between pre- and post-evaluation showed that the participation in practical training easily enhances the students' awareness of EMC importance as well as self-confidence in managing emergencies. After the course, 71% shared the opinion that retraining should be obligatory for all medical personnel. At the same time, students' self-assessment of confidence for specific tasks got significant upgrades in every aspect.

CONCLUSION

The evaluation data clearly show the participants' needs to deal with topics of EMC within the curriculum of dentistry. The proposed course is able to change participants' attitudes towards EMC and its importance for their daily practice. The considerable enhancement of self-confidence in performing EMC-techniques might also lead to more willingness to manage emergency situations.

Buccolam(®) (buccal midazolam): a review of its use for the treatment of prolonged acute convulsive seizures in the dental practice

This article is published in response to a query from reader Sarah Clements, based at Golding House Dental Practice Ltd in Kent, regarding the BDJ paper entitled 'Updated guidance on medical emergencies and resuscitation in the dental practice' (BDJ 2012; 212: 41-43). Sarah wished to be provided with further clarification on the ordering, prescribing and administration of midazolam.

Updated guidance on medical emergencies and resuscitation in the dental practice

This article outlines the updated guidance relating to the management of medical emergencies in the dental practice. The incidence of medical emergencies in the dental practice is discussed. The key recommendations from the Resuscitation Council UK on the treatment of medical emergencies in the dental practice are listed, with specific reference to oxygen therapy, medications and automated external defibrillators. An overview to the professional responsibilities of dental practitioners and dental care professionals is provided.

The influence of systemic diseases on the diagnosis of oral diseases: a problem-based approach

Although all dentists are taught about the importance of oral health to general health and that systemic disease can manifest in the oral cavity, the 4-year dental school curriculum does not allow time to gain competency in these relationships. Nevertheless, all dentists must have skills in taking a medical history and an appreciation of oral findings that might have a systemic origin. This article focuses on the identification of abnormal signs and symptoms in the oral cavity and the determination of those that have a systemic origin. It is imperative that clinicians are mindful of the possible oral-systemic associations, because these could potentially have a huge impact on patient care.