Medical emergencies in the dental surgery. Part 1: Preparation of the office and basic management

STATEMENT OF THE PROBLEM

Medical emergencies can and do happen in the dental surgery. In the 20- to 30-year practice lifetime of the typical dentist, he/she will encounter between five and seven emergency situations. Being prepared in advance of the emergency increases the likelihood of a successful outcome. PURPOSE OF THE PAPER: To prepare members of the dental office staff to be able to promptly recognize and efficiently manage those medical emergency situations that can occur in the dental office environment.

MATERIALS AND METHODS

Preparation of the dental office to promptly recognize and efficiently manage medical emergencies is predicated on successful implementation of the following four steps: basic life support for ALL members of the dental office staff; creation of a dental office emergency team; activation of emergency medial services (EMS) when indicated; and basic emergency drugs and equipment. The basic emergency algorithm (P->C->A->B->D) is designed for implementation in all emergency situations.

RESULTS AND CONCLUSIONS

Prompt implementation of the basic emergency management protocol can significantly increase the likelihood of a successful result when medical emergencies occur in the dental office environment.

Practical aspects to undertaking research in the primary care setting: experience from two studies

AIMS

To discuss the practical aspects of conducting research in a primary care setting, from the perspectives of the practitioner and the research team.

METHODS

Various issues are discussed, including the relevance of research questions being generated in this setting, the advantages to both parties and the processes involved in conducting a study in specialist practice. This paper describes two recent studies (a randomized clinical trial and a qualitative study) conducted within specialist practice, to illustrate some of the potential difficulties.

CONCLUSIONS

The success of conducting a study in primary care is determined by a variety of factors, including an interested specialist practitioner, motivated staff in a well-organized practice and the close support of an academic-based research team.

Training and the dental team--or how to get the best from your staff

This article explores the benefits and methods of training in dental practice based on current accepted educational theories.

CLINICAL RELEVANCE

Effective delivery of any service or clinical activity is dependent on having the right resources delivered at the right time, in the right place and in the right way. This can only happen if every person involved in the delivery knows what to do, when and how; this requires training.

The impact of a continuing education oral health program on providing services for young children by dentists, dental hygienists and dental assistants

PURPOSE

The purpose of this study was to determine the impact of a 4 hour continuing education (CE) program on the oral health knowledge and behaviors of dentists, dental hygienists and dental assistants in providing oral health services to young children in West Virginia general dental practices.

METHODS

A free CE program was provided for 92 general dentists, 123 dental hygienists and 37 dental assistants (n=252) at 4 sites across West Virginia. Participants completed a pre- and post-test on topics including the timing of the first dental exam, fluorides, xylitol, Alternative Restorative Technique (ART) and their practice pattern of caring for children under 3 years old. A 6 month follow-up questionnaire was mailed to participants to assess outcomes.

RESULTS

Participants showed a 22% increase in knowledge from the pre-test to the post-test (p<0.001) for all questions except for ART, which showed no change. The majority of dentists and hygienists (89%) increased their comfort in providing services for children under 3 years old. Participants (80%) stated they would increase the number of children under 3 years old they examine, yet 6 months after the program only 42% responded affirmatively (p<0.001). At the time of the program, 62% reported that they currently examine children at 1 year of age, and there was no significant change 6 months later. While 54% responded that they would contact their local physicians about early oral health care, only 27% followed through.

CONCLUSION

This program significantly increased the participants' knowledge and comfort level for providing infant and toddler oral health care. However, it did not motivate most to alter their practice behaviors to conform to national best practice guidelines.

Induction of staff and team training

Good training is vital for the safe and effective integration of a new team member. This training will be made easier if a deliberate, structured approach is taken, which takes due account of the need to safeguard their health, safety and welfare, from the moment they start.

Medical emergencies: are you prepared?

Billy Tyne sailed ill-equipped directly into a "perfect storm" at the cost of his boat, his crew, and his life. As a profession, we must not allow our own hubris to ignore the challenges that we are now facing: increasingly complex medical histories, more patients desiring sedation treatment, and more dentists expanding their scope of clinical services. Sadly, a nationally recognized set of guidelines has yet to be adopted. In the meantime, each member of the profession must be prepared to properly respond to any medical crisis that may occur in the dental office. The 6 links of survival provides a solid basis to meet that need.

Using evaluation to enhance educational support for dental teams in the UK

Each United Kingdom regional postgraduate deanery offers courses and educational support for the NHS (National Health Service) primary care dental team, primarily through networks of tutors (dental educators). After reporting literature on effective continuing education and the role of evaluation, this article provides an analysis of five educational evaluations (2005-08), identifying key messages and distilling ways to enhance educational support for the UK dental team. These evaluations adopted case study design and principally employed interviews (n=51) and questionnaires (n=221). The studies' key messages and recommendations are as follows: clarify dental educator roles; provide strategic management and educational support for educators; ensure continuing education is matched to the learning needs of dental teams and specific groups; and use practice (office) visits to support practice (team) development plans. Evaluation enables initiatives to be evidence-informed, focus effort where most needed, argue for continued funding, and give voice to stakeholders. However, there is added value in a collective consideration of evaluation findings from related studies. Doing this has identified ways to enhance the strategic development of educational support for the UK dental team and is applicable in a wider context both nationally and internationally.

Educational systems and the continuum of care for the older adult

This article outlines educational developments for adaptive and adapted work roles, current educational systems and practice, and aspects of educational research to illuminate issues for the future of geriatric oral health and well-being. The concept of work roles is used as a proxy to point up continuity of care issues, albeit limited, for patients/clients/consumers. Interdisciplinary learning for the initial education of dental providers/team members requires review with specific reference to geriatric care. Experienced dental and other health and social care professionals should review their roles in meeting the oral health needs of the aging cohorts. The relationship of dental schools/faculties in higher education institutions to those organizations that deliver education to various health and social care sectors-the personnel being at key points in the delivery of care-is also worthy of review.

Will your clinic be in compliance with the safe patient handling law by July 1, 2010?

Clinical settings have been added to the Minnesota Safe Patient Handling law. Even though previously dentists may not have considered manual assisting of patients to be a safety hazard, studies have clearly shown the risk for injury to staff and patients. By being the first state to address patient handling in clinics, Minnesota is acknowledging that patient movement can occur in all clinical settings and is demonstrating its desire to ensure staff safety at those previously overlooked facilities. SPH and the SPH law requirements may seem a bit foreign and confusing at first, but hopefully, by reading this article dentists and their staffs have gained the understanding and knowledge they will need to make sure each individual clinic meets the compliance deadline.

Medical emergencies in dental practice

Serious medical emergencies are fortunately a rare occurrence in the dental practice environment; however, if an emergency situation is encountered a delay in treatment may result in potentially avoidable consequences. The risk of mortality or serious morbidity can be reduced by ensuring that basic emergency equipment and medications are in place, and that the dental team is appropriately trained in basic life support measures. This article aims to provide an overview of the basic emergency medications and equipment that should be present in dental practices, and to discuss specific responses to some of the more common adverse medical events that can present while providing dental treatment.

Education for the dental team: make your practice a centre of learning excellence

This paper discusses the future educational needs of the changing dental team, the potential for new institutions and teachers to deliver and assess that education, including outreach-based teaching and learning, and interchangeability of educational credits between institutions. The author's opinion is that primary care practices can become 'centres of learning' where all members of the dental team can interact to teach and learn together at the same time. The development of a career pathway for dental care professionals (DCPs), a more unified pan-Europe approach to integrated dental education and the development of further roles for senior dental students are proposed. The importance of dentistry acting upon sound, innovative concepts, and of not resisting educational change, is stressed.

Preparedness for management of medical emergencies among dentists in Udupi and Mangalore, India

AIM

The aim of this study was to assess the preparedness for management of medical emergencies among dentists in the cities of Udupi and Mangalore in India.

METHODS AND MATERIALS

A self-administered questionnaire was completed by the dental teaching hospital faculty members and private dental practitioners in Udupi and Mangalore, India.

RESULTS

Less than half (42.1%) of the dentists reported having received practical training in management of medical emergencies during their undergraduate and postgraduate education. Only about one-third of the respondents felt competent in performing mouth-to-mouth breathing (39.3%), cardiac compression (35.2%), foreign body obstruction relief (32.8%), and in administering IV drugs (34.5%) or supplemental oxygen (27.4%). The most commonly available emergency drugs in treatment areas were oral glucose (82.2%) and adrenaline (65.8%). However, less than one-fourth of the respondents had the following on hand in their treatment facility: oxygen (24.0%), an AMBU bag (17.1%), pocket mask (13.0%), bronchodilator spray (24.7%), diazepam (20.5%), aspirin (20.5%), and glyceryl trinitrate (17.8%). Less than half (39%) of the respondents reported having clinical staff members trained to assist in emergency recognition and management and only 5.8% carried out emergency drills in their workplace.

CONCLUSION

Preparedness for management of medical emergencies was found to be inadequate among the surveyed dentists.

CLINICAL SIGNIFICANCE

The results of the study emphasize the need for improvement of the training of practicing dentists in the management of medical emergencies at the undergraduate, postgraduate, and continuing education levels as well as the need for organization of the dental workplace to handle such emergencies.

Preparing the dental office for medical emergencies

Modern dental offices must be equipped to initiate prompt emergency care should the sudden need arise. With the elderly population in dental practices increasing, these emergencies will undoubtedly occur. This article discusses the basic emergency equipment the average dental office should possess to allow for an adequate initial response. It also discusses the policies and personnel needed for dealing with emergencies. Among the basic emergency equipment, an office should have syringes, an Ambu bag, a portable oxygen system, a sphygmomanometer (child and adult sizes), and an EKG/defibrillator. Emergency drugs that should be stocked include aromatic ammonia, aspirin, and nitroglycerine. The dentist should also develop a protocol and policy for his/her staff to follow when a medical emergency arise.

Infection control in the dental office

The risk of infectious disease transmission is an inherent part of dental practice. Fortunately, such risks can be greatly reduced through modern infection control practices. Such practices include the use of various measures, including administrative, engineering, and work practice controls. Such measures should be codified in an office infection control plan, which should form the basis for the daily infection control activities of the staff. This article discusses some of the measures that should be taken to safeguard the health of dental healthcare workers and patients.

Risky business: influencing people to change

The evolution of prevention methods represents a positive development of significant value. Managing the behavioral components of prevention is crucial to create buy-in by staff and patients. Numerous recommendations for successful implementation of CAMBRA are cited. It is important for dentists to establish which option works best with each employee, and for the dental care team to do the same with each patient in the practice.

Changes in the levels of knowledge and attitudes of dental hospital staff about domestic violence following attendance at an awareness raising seminar

OBJECTIVES

To assess changes in dental team knowledge and awareness about domestic violence following attendance at a brief training intervention.

MATERIALS AND METHODS

Seventy-five dental hospital staff at the University of Manchester Dental Hospital attended a two-hour session delivered by Manchester's City Wide NHS Domestic Violence Project manager. Participants completed identical questionnaires immediately before and after the session. Paired t-tests were conducted to determine changes in responses to individual questions before and after training. Independent sample t-tests were also conducted to compare mean responses by sex.

RESULTS

Statistically significant improvements were seen in 50% of attitude questions and 100% of knowledge questions. After training, there was improved recognition that interpersonal violence was a health issue and that the dental profession should be more involved in identification of abuse. There was also improved comfort asking about abuse and respondents were less afraid of offending the patient and less likely to blame the victims for being abused. Statistically significant sex differences at baseline were also seen for several items: females obtaining more correct answers at baseline than males.

CONCLUSIONS

Brief domestic violence training interventions can be effective in improving knowledge and attitudes amongst a dental team but could lead to false confidence in staff and should be followed by in-depth practical training and the development of appropriate processes for dealing with abuse victims.

Adult and paediatric basic life support: an update for the dental team

The aim of this paper is to review the current Resuscitation Council (UK) basic life support guidelines. The main changes made to the guidelines published in 2000 are that for adult basic life support no initial rescue breaths should be delivered before commencing chest compressions and that the compression to ventilation ratio should be 30:2 irrespective of the number of rescuers. For children over the age of one year, two rescuers should provide life support with a compression to ventilation ratio of 15:2. There is still a need to deliver rescue breaths before starting compressions in the child patient.