In the article, we will consider what emergency care in dentistry means. Not everyone knows what this concept means.
Every dentist has to deal with a patient emergency in their practice. Such cases include fainting along with anaphylactic shock, asthma attacks, epileptic seizures, and so on, up to a heart attack. In such situations, the main thing is to do everything right and quickly.
Also approved was the order on emergency care in dentistry No. 1496n dated 07.12.2011 “On approval of the Procedure for providing medical care to the adult population in case of dental diseases.”
Dental first aid kit
Given the emergency that can occur in dentistry, doctors use the following kit to help patients: an antihistamine syringe along with an oxygen canister for breathing, "Nitroglycerin" in the form of sublingualpills and spray, asthma inhaler, sugary foods, Aspirin and Benadryl.
Responsible for the regular (weekly) review of the above set should be appointed. It is extremely frustrating to find an inoperative oxygen cylinder at a time when the patient really needs it.
Emergency care in dentistry according to SanPiNu
Speed of reaction is the key to successful relief of any critical condition in patients. To do everything as quickly as possible, you need to distribute responsibilities. Every employee working in a dental clinic should know what to do when a patient needs emergency care.
The appropriate instruction for an emergency order in dentistry is created in advance and brought to the attention of absolutely all employees. Those who have a medical education are engaged in first aid. As for the administrators of dental clinics, they call an ambulance, contact the patient's doctor, and, if necessary, with his relatives.
Such a plan of action should be carried out in all directions, that is, it is impossible to entrust any specific task to only one person, because he can simply simply be absent from his workplace at the most critical moment. The main thing is to do everything in such a way that no one interferes with anyone and does what is required, making their own contribution to correcting and resolving the situation. In addition, it is not superfluous to train absolutely all employees of the dentalhospital basic basics of emergency care.
It is also required to appoint a person responsible for regularly checking the availability of the previously mentioned medical aid kit.
The algorithm for emergency care in dentistry will be discussed in more detail below.
Critical conditions in patients - what are they?
People requiring dental emergencies:
- Those caused by stress or anxiety.
- Conditions that are associated with anesthesia, and in addition, with difficulty in the work of the cardiac, respiratory or vascular system.
Anesthesia-related emergency is an airway obstruction. The patient may experience laryngospasm, hyperventilation, or bronchial spasm. Bronchospasm, according to dentists, is the most difficult case in terms of emergency care. The causes of this condition are allergic reactions or sensitivity to certain components, for example, sulfites and the like. Hyperventilation in patients can be triggered by stress and tends to be predominantly seen among more nervous individuals.
What is a dental emergency?
To quickly manage to cope with such conditions, it is necessary to have at hand everything that is required for the rapid relief of negative manifestations. For example, to avoid obstruction of the airways in the presence of complications in the functioning of the respiratory system,you need to quickly apply special sponges. For those patients in whom stress provokes hyperventilation, the use of an oxygen canister should be immediately offered. Next, consider how patients can experience anaphylactic shock in the dental office and how this condition can be normalized.
What is the emergency care algorithm for anaphylactic shock in dentistry?
Anaphylactic shock: how is it manifested and why is it dangerous?
This condition is an extremely severe allergic reaction that occurs in the form of acute heart and vascular insufficiency and adrenal insufficiency. As part of the clinical manifestations of anaphylactic shock, patients experience a state of severe discomfort with an indefinite painful sensation. First of all, there is a fear of death along with a state of inner unrest.
Nausea, sometimes vomiting and coughing may also occur. Patients may complain of severe weakness along with a tingling sensation and itching. In addition, when such a condition occurs, there is often a feeling of a rush of blood to the face, combined with a feeling of heaviness behind the sternum or compression of the chest. Very often there are pains in the region of the heart, along with difficulty breathing or the inability to take a breath, dizziness or a headache of a rather sharp intensity cannot be ruled out. The appearance of a disorder of consciousness can disrupt verbal contact with the patient. Complaints may occur immediately after taking the drug.
Hyperemia, pallor, cyanosis
As an additional symptom in anaphylactic shock, hyperemia of the skin occurs along with pallor and cyanosis, various exanthemas, swelling of the eyelids or face and profuse sweating. In most patients, cramps of the limbs are often noted in combination with extended convulsive seizures, motor restlessness, involuntary excretion of urine, gases and feces. Pupils may dilate and not respond to light. At the same time, the pulse is frequent, thready, tachycardia and arrhythmia are noted.
Emergency care for anaphylactic shock in dentistry must be provided competently. The patient's life depends on it.
People's blood pressure is dropping fast. In severe situations, diastolic pressure is difficult to determine. Subsequently, there is a clinical picture of pulmonary edema. A typical form of anaphylactic shock is characterized by a violation of blood circulation, consciousness and respiratory functions.
Algorithm for emergency care for anaphylactic shock in dentistry
The principles of elimination of anaphylactic shock are as follows:
- Doctors seek relief of acute circulatory and respiratory dysfunction.
- Achieving compensation for the patient's adrenococoid insufficiency.
- Inhibition and neutralization of biologically active components in the blood.
- Blocking the entry of the allergen drug into the bloodstream.
- Support of the vital functions of the patient's body or resuscitation in the event of a severecondition or threat of clinical death.
Now consider what actions are taken by doctors in case of emergency dental care:
- Stop injecting the drug that caused the critical condition.
- The patient is placed in a horizontal position with legs raised.
- If there is a mild form of anaphylactic shock, it is possible to introduce adrenaline (0.1%) intramuscularly, as well as intravenously. 0.5-1 ml of the active substance is diluted in 5 ml of saline. The injection site of the allergen is cut off with a 0.1% solution of adrenaline, which is diluted in 5-10 ml of saline. If blood pressure continues to fall, inject epinephrine 0.5-1 ml intravenously every three to five minutes until blood pressure stabilizes.
- Dexamethasone 20-24mg IV or IM, or Prednisolone 150-300mg (3-5mg/kg body weight).
- "Dimedrol" 1% based on dosages: adults - 1.0 mg / kg, children - 0.5 mg / kg of body weight, "Suprastin" or "Tavegil" 2 mg / kg of body weight, if absent these drugs, then you can use "Pipolfen" 2.5%, 1-2 ml intravenously or intramuscularly.
- If anaphylaxis proceeds according to the asphyxial and bronchial type, then eufillin 2, 4% 10 ml is administered intravenously.
Emergency care is also provided in pediatric dentistry.
Reasons for emergency dental care for children
The object of pediatric dentistry isespecially children under the age of fifteen. This period is directly related to the peculiarities of the design of the physiology of the teeth, jaws, oral mucosa, periodontal, and in addition, with immune reactions. The difference in children's temperament, combined with their weak resistance to pain, brings its own characteristics to the specifics of emergency care. Pathological processes that in children are reasons for emergency care in dentistry are classified into three groups:
- Traumatic injury: fracture of the jaw, trauma to the lips, cheeks and other injuries of the teeth.
- Obtaining carious lesions in the form of pulpitis or periodontitis.
- The occurrence of acute processes in the oral mucosa in the form of inflammation of the gums against the background of the eruption of temporary incisors, aphthous herpetic stomatitis or ulcerative gingivitis.
Emergency dental care for children
In the presence of any trauma to the tooth, it is necessary to clarify the condition of the paradental bones and the affected incisor by X-ray method. After that, you need to make a decision about the preservation or extraction of teeth. Teeth that have broken roots are removed, since today there are no methods for their restoration yet. Removal, especially in children, should be postponed until the severity of traumatic processes subsides, except for those situations where their fragments interfere with the process of restoration of jaw fractures.
Permanent incisors with broken crowns are left to children anyway. If the pulp has not been affected, then you should wait allseveral weeks for the subsequent determination of its viability. In the event that it is damaged, the dentist decides whether to cure the teeth with the subsequent preservation of the living pulp or still devitalize it.
You should know that the pulp of permanent incisors in childhood has great reparative capabilities. When the dentist decides to leave her, treatment begins immediately. It is best when this is done in one session with the closure of damaged surfaces with Calxil or a paste prepared from a solution of novocaine and calcium oxide. The paste must necessarily cover the pulp with a thin layer. Further, without pressing, phosphate cement is applied and the fractured part of the incisor crown is restored. This method gives a very good cosmetic effect along with a fairly stable repair of the tooth crown.
In the event that the dentist does not have adequate recovery options within the next hour, first aid in dentistry can be provided by temporary pulp capping with sulfidine powder, the aforementioned biological pastes, or, in extreme cases, a cotton swab, which must first be soaked in chlorophenol camphor. It would be better to cover this material with phosphate cement, which, in turn, must necessarily capture the he althy walls of the incisor crown.
When the crown of a temporary tooth is fractured and contemplating a decision about extraction or devitalization, the dentist needs to considerthe physiological value of incisors along with the possibility of their long-term treatment and the nature of the injury. With a tooth dislocation after an injury, it must be immobilized. In the event that the tooth was slightly dislocated, and there is no evidence of the presence of a fracture of the alveolar bone directly on the radiograph, the patient is advised to avoid stress on diseased teeth.
First aid in dentistry for comatose conditions
Coma states are separated into a separate group, since their manifestation is observed mainly in patients with certain concomitant pathologies, which they always need to warn their dentist about. Coma is a state of sharp inhibition of nervous activity, which is accompanied by loss of consciousness and failure of all analyzers. To whom doctors should be able to distinguish from stupor, when individual elements in the mind are preserved and reactions to strong light and sound stimuli are noted.
What is emergency dental care in this case?
Significant information for assessing coma is primarily the appearance of the patient as part of the examination and determination of his condition. The presence of cyanosis and a pronounced pattern of the venous system on the abdomen indicates cirrhosis of the liver, that is, the development of hepatic coma. Dry hot skin in people occurs with sepsis, and in addition, against the background of severe infections and dehydration. Convulsions in combination with stiff neck confirm coma due to increased intracranial pressure due to trauma, thrombosis,tumors and more.
Evaluation of breath odor is very important in diagnosing this condition. For example, in diabetic acidosis, the smell of acetone from the mouth is usually noted. The appearance of a putrid odor indicates the presence of a hepatic coma in the patient, and the smell of urine indicates renal pathology. In case of alcohol intoxication, the smell will be typical. When a coma of unclear etiology occurs, it is required to examine the sugar content.
Emergency medical care in dentistry in the event of a coma consists in the mandatory and urgent call of the resuscitation team. It is necessary to start with oxygenation and the implementation of relief of a functional disorder (it is required to normalize breathing, blood circulation and heart function). In particular, in the presence of a hypoglycemic coma, it is required to immediately inject the patient intravenously with 60 milliliters of a forty percent glucose solution, since this condition develops almost immediately in comparison with other manifestations and is more dangerous in its consequences. The scheme of therapeutic measures in the presence of a coma is similar to the principles of ABC resuscitation.
Conclusion
Thus, as part of therapy, every doctor must be prepared for the fact that his patient may experience any emergency conditions in dentistry and he may need timely first aid. Immediately before the start of surgical or conservative treatment, the patient should notify his dentist thatwhat acute or chronic pathologies he has, allergies to certain medications, and the like.
In addition, patients should also inform dentists about the current intake of certain medications and their dosage. In the event that the patient belongs to the risk group, his treatment should be carried out under strict supervision and with caution in order to avoid the occurrence of serious complications. Untimely provision of medical care often entails extremely serious consequences in the form of destructive pathological processes in the body.
We covered dental emergencies and first aid.
