Dying in your chair

March 21, 2012

Photo: Tetra Images/Getty Images

Photo: Tetra Images/Getty Images

The possibility is small but real. Although it doesn’t occur often, a medical emergency that even leads to patient death in the dental office does happen. And when such situations happen, Dr. Stanley Malamed, professor of anesthesia and medicine at the University of Southern California in Los Angeles, says the dental staff must be ready to act. He cited four of the top medical emergencies that occur in the dental office, their symptoms, and the action the dental staff should take (click here for “Top medical emergencies in the dental office”).

Preparing your office

According to Dr. Malamed, the best office is a prepared office. This includes a staff well trained at least annually in basic life support, also known as cardiopulmonary resuscitation or CPR. Preferably, this training should be conducted in the dental office after-hours.

“That’s because it’s the venue where the problem is going to happen. Put the CPR mannequin or dummy in the dental chair, or place the mannequin in the waiting room, lying on the floor,” he said, adding that these options would prove more realistic than receiving the training in a gymnasium or a professional association meeting.

The office also should have an emergency team set up and ready to go (click here for “Teamwork counts”). But the preparation doesn’t stop with the staff. Dr. Malamed recommends that the doctor oversee all emergency operations. This means the doctor must first keep his or her own medical emergency certification current. Even more important, the doctor should know how to determine a medical emergency and when to dial 911, without hesitating to call when he or she believes the help is warranted.

Equipment

Dealing with emergencies does not just come down just to training and preparedness…proper equipment is needed in the office. This includes a basic medical first-aid kit (click here for “Basic medical emergency kit”) and an automatic external defibrillator (AED) (click here for “Why keep an AED?”).
This equipment should be kept in the office, without being stored in the operatory or kept in public view, for this could frighten some patients. Nonetheless, the equipment should be kept in an office location that is known and accessible to all staff members.

Dr. Malamed further pointed out not just the staff, but the doctor should know how and when to use/administer the equipment, including the drugs in the first aid kit. Also, these pharmaceuticals should have their expiration dates checked regularly, and the office should have a drug replacement system established for expired drugs

The worst does happen

Despite the best-laid precautions, patients do die in the dental chair.

According to Malamed, there are no reliable statistics on this. When it occurs, the only people who truly know are the dentist, the state dental board, and the dental insurance carrier, and none of these groups readily release such gruesome information.

“It’s a given that you’re not supposed to go to a dental office and die,” Dr. Malamed said. “In dental school, you were never told that a patient might die in your dental chair. It’s not in the book for dentists to think about. Does it happen? Absolutely. But there are no reliable numbers, and it’s very difficult to get good solid statistics” on frequency, he noted.

However, in addition to proper medical training, equipment and staff preparedness, there are other preventive steps a dental practice can take to avoid lethal consequences.

“Most dental emergencies are preventable…a survey I did showed that 75% of all emergencies are preventable. That’s because 75% of patient emergencies are induced by fear and pain. If we recognize the fear and treat it, and have good local anesthesia, we are actually preventing these medical emergencies from occurring,” he said.

Dr. Malamed suggested yet another major preventive measure: The medical history questionnaire, particularly for first-time patients.

The true goal of the questionnaire, Dr. Malamed explained, is for the doctor to determine what risk (if any) that the patient presents from a medical standpoint to receive dental care.

He pointed out that certain patients are so medically compromised that perhaps they shouldn’t be in the dental chair in the first place-the risk of having a medical emergency or death is too great.
It all comes down to knowing your patients, and when and when not to treat them.

“If it’s elective dental care, you can reschedule it. But if this is a dental emergency for a high-risk patient, you can treat some emergencies like infection or pain with drugs…that is, you can prescribe antibiotics or analgesics,” he said.

If treatment needs to be done on an acute basis, Dr. Malamed recommended referring such patients to hospital dental residencies in dental schools, where they are prepared to manage a high-risk dental patient.

“A typical dental office is not the ideal place to treat a high-risk patient,” he maintained.

Click here to check out the following information: Top medical emergencies in the dental office; teamwork counts; basic medical emergency kit; Why keep an AED in the dental office? 

Eileen White is an associate editor for Dental Products Report.