Biomedical subjects
Publications and source records attributed to S F Malamed.
Medical emergencies can arise in the dental office. Preparedness for these emergencies is predicated on an ability to rapidly recognize a problem and to effectively institute prompt and proper management. In all emergency situations, management is based on implementation of basic life support, as needed. The author describes the appropriate management of two common emergency situations: allergy and chest pain.
One hundred and fifty years ago, Horace Wells opened the door to local anesthetics. Since then, many advances have been made in pain control. The development of dentistry's most important drugs is highlighted here.
The management of pain and anxiety form the backbone of contemporary dental practice. The past decades have seen the introduction of a significant number of promising new techniques, drugs and equipment designed to aid the dental professional in the quest for a more pain-free and fear-free dental practice. This paper presents a brief look at these drugs and techniques.
It was assumed that dentists employ a complete system of physical evaluation for all new patients in their dental practices. Results of a survey of 1,588 dentists demonstrated that the use of a written medical history questionnaire was commonplace; however, recording of blood pressure and heart rate and rhythm on all new patients was quite limited. A greater percentage of dentists monitored blood pressure when there was a history of cardiovascular disease or high blood pressure. Monitoring of the heart rate and rhythm, even in patients with cardiovascular disease or high blood pressure, was severely limited in scope. A significant number of dentists still employ racemic epinephrine impregnated gingival retraction cord, and of these, 40% had observed "epinephrine-reactions."
A simple dental procedure can quickly escalate into a medical emergency. Management of six common emergencies is described.
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Local anesthetics are the most widely administered drugs in dentistry. Significant advances have been made in past decades that have greatly increased both the safety and the efficacy of these important drugs. This paper reviews the history of local anesthesia, pharmacokinetics and clinical implications, techniques, complications, and future directions in the quest for more effective pain control in dentistry.
Every dental office needs an adequate emergency treatment structure. While theoretical and practical pregraduate education in emergency medicine is included (in differing degrees) in the curricula of dental schools throughout the world, postgraduate training is generally undertaken on a voluntary basis. Repeated training in emergency techniques is encouraged for the dentist and dental office staff, as the trained and coordinated action of the whole team in the dental office is necessary when an emergency occurs. Whenever possible, a recognized risk factor should be eliminated or its possible influence minimized prior to dental treatment. Patients requiring immediate dental therapy will need appropriate monitoring, adequate application of systemically acting drugs, or even treatment under standby conditions. Diagnostic equipment as well as equipment for monitoring the respiratory and cardiovascular systems should be available. Several monitors (blood pressure, ECG, and pulsoximetry) have been introduced to dentistry and have their indications in special patient groups. Clear therapeutic concepts are the endpoint of proper emergency management. The restoration of an undisturbed vital function has to be achieved, followed by detailed therapy. Dentists should refresh their knowledge of emergency treatment techniques and prepare themselves with therapeutic guidelines.
The physical evaluation of the patient before and during anesthesia and sedation is assuming an ever greater importance with the advent of sophisticated and reliable monitoring devices. This paper reviews the possible methods of evaluation and describes the types of mechanical monitors most suited to the dental office.
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A 56-year-old patient with alleged allergy to local anesthetics required restorative dental treatment. Electronic dental anesthesia was used successfully, in lieu of injectable local anesthetics, to manage intraoperative pain associated with the restoration of vital mandibular teeth.
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Postanesthetic complications can occur even in the best of circumstances. Proper preparation of the staff, aggressive monitoring of the recovering patient, and early recognition and management of the complications are essential if the outcome is to be successful. In reviewing postanesthetic complications, two factors are present in the overwhelming majority of situations--hypoxia and hypercarbia--often the direct result of inadequate monitoring during the postanesthetic period. The anesthetic procedure is not over once the anesthetic agents are discontinued. The skillful anesthetist is aware of the possibilities of postoperative complications and prevents problems by employing enhanced monitoring techniques during the recovery phase.
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Explore the source record for details and available documents.