Following these units of instruction, the dental practitioner will
be able to do the following:
1. Describe ten practices that prepare dental teams for the
most common medical emergencies.
2. Define the potential roles of team members in a basic
emergency action plan
3. Discuss how the American Society of Anesthesiologists
physical status classification system can be used to identify
“at risk” patients.
While life-threatening medical emergencies are uncommon
in the dental practice environment, most professionals will be
responsible for managing multiple emergency events throughout their careers. By planning for the unexpected, dental teams
hone their skills and build the necessary confidence to cope with
these high pressure situations. Although some emergencies are
unavoidable, participants in this course will be provided with
information and tools to prepare for, prevent and definitively
manage the most common medical emergencies that occur in
general dental practice.
The Effects of Optimism Bias
“For myself I am an optimist - it does not seem to be
much use to be anything else.”
— Winston S. Churchill
Human brains naturally generate pervasive optimism.
For most, the day does not begin with opening one’s eyes and
being consumed with a feeling of impending doom. Instead,
our emotional well-being combined with our past experiences
promotes a positive outlook in healthy individuals. In the
work environment, “optimism bias” is generally viewed in a
positive light. When it comes to the management of medical
emergencies, however, solely relying on blind optimism over
sober reality will typically result in emergency situations ending badly.
Developing a Comprehensive Preparedness
Medical emergencies can be confusing and frightening; consequently, it is not uncommon for people to panic or become
paralyzed with fear or indecision when faced with a crisis. Being
ill-prepared often results in a delay in response time for the dental team, and an increase in the likelihood of mortality or serious
morbidity for the victim. Thus, it is the obligation of the responsible dental practitioner to develop a clear medical emergency
preparedness program to decrease the likelihood of unfavorable
outcomes. Ten actions that will assist dental teams in becoming
better prepared for emergency events are listed below.
Action #1: Accept That It Really Can Happen to
You: Prevalence of Emergency Events
The first step in preparing for a medical emergency is to accept
that the possibility is real: An acute medical emergency can
happen in any dental office at any given moment in time. While
some emergencies take place by chance, others are directly
linked to dental treatment. A survey of 4,039 private dentists in
the United States and seven Canadian provinces revealed that
more than 30,000 medical emergencies had occurred in their
offices over a period of 10 years.
While these statistics may seem high to some, advances in
medicine and technology have resulted in a much older patient
population in many practices. In the past, people were by and
large edentulous by the time they reached old age. Today, seniors are much more likely to seek dental care as many continue
to have all or most of their dentition. Advances in health care
have contributed to increased life spans and an increase in the
number of medically compromised patients. This factor further
escalates the likelihood of an emergency event occurring.
Complications verses Life-Threatening Events
The majority of emergency events are not life-threatening
and are better classified as systemic “complications”. Signs
and symptoms of complications can occur instantaneously or
may be delayed.
3 It is therefore essential that dental personnel
are well-versed in recognizing the clinical presentations of the
most common complications and/or emergencies that occur in
the practice of dentistry. The emergency event that is reported
most frequently is syncope, accounting for roughly 50% of
all medical emergencies. Other frequently cited emergencies
include suspected cardiovascular events, complications related
to local anesthesia, allergic reactions, hypoglycemia4, seizures,
bronchospasm, postural hypotension, diabetic emergencies,
and swallowing of foreign bodies.
5 Box I outlines some emergencies that might be encountered in the dental practice along
with basic principles on how to safely and effectively manage
Action #2: Detail Your Basic Action Plan in Writing
Creating a basic action plan with a team approach should be
one of the first steps in planning for an emergency event. Each
team member should be trained to perform specific tasks and
their assigned roles should be outlined in a written plan. The
Occupational Health and Safety Administration (OSHA)
requires all employers with eleven or more staff members to
have a written emergency action plan detailing the steps to be
taken in the event of an emergency.
6 Ultimately, the goal of the
basic action plan is to preserve life3 by managing the patient’s
condition until he/ she fully recovers or until emergency
medical services (EMS) arrive. More specifically, the most
principal role for the dental professional during an emergency
situation is to prevent, or correct, inadequate oxygenation of
the brain and heart.