Asthmatic attack can be induced/ provoked when an asthmatic patient is exposed to allergens and drugs used in dental practice and when they undergoing certain amount of anxiety and stress. A patient who is undergoing asthmatic attack will normally complain of a tight chest and shortness of breath. You may also hear a wheezing sound (a high pitched whistling sound) when the patient exhales. Rapid pulse can be detected during the attack and this situation can be fatal if the patient is unable to talk to you. Thus, remember to bring along your asthmatic drugs or salbutamol inhalers (if you are an asthmatic patient) or postpone your dental treatment if you had an asthmatic attack recently.
Management of an acute asthmatic attack (What will the dentist do?)
- Stay calm and reassure the patient. Keep the area ventilated.
- Keep the patient upright.
- Administer patient’s asthmatic drugs or use a salbutamol inhaler.
- Give oxygen and steroids. (They should be available in dental emergency kit) This will normally resolve an asthmatic attack.
- 5. Call an ambulance, send them to the nearest hospital and defer the dental treatment.
(iv) Anaphylactic shock and other drug reactions
Anaphylactic shock is a severe, life threatening allergic reaction. Causative agents of anaphylatic shock include: penicillin which is the most common offender (It is important for you to inform the dental practitioner that you are allergic to penicillin), latex, several drugs such as cephalosporins and NSAIDS.
Signs and symptoms observed during an anaphylactic shock : facial swelling and flushing(redness), itching, cold clammy skin, wheezing (high pitched whistling sound), abdominal pain, pallor (patient is turning blue ) with a rapid and weak pulse.
Emergency management of an anaphylactic shock (What will the dentist do?)
- Lay the patient flat and raise his/her legs (this will improve the patient’s blood circulation)
- Give oxygen and administer 0.5ml adrenaline intramuscularly. The duration of action for adrenaline is relatively brief and repeat the injection if symptoms recur.
- Give antihistamine such as 10 -20 mg of chlorpheniramine slowly and send the patient to a nearby hospital.
- Defer the dental treatment until the next day.
(v) Epileptic seizures (Epileptic fits)
Epileptic seizures are caused by abnormal electrical discharges in the brain. There are various factors that may induce a seizure which include starvation, menstruation, exposure to certain drugs and alcohol. Epileptic seizures can also occur in patients with no history of epilepsy, especially after a deep faint/loss of consciousness.
Symptoms of a seizure attack: Sudden loss of consciousness with a rigid body, loss of bladder control,muscles twitching/jerking movements. Epileptic attacks usually last for few seconds to minutes and it can be an emergency situation if seizure continues.
Management of an epileptic attack: (What will the dentist do?)
1) Put patient in recovery position.(lying on the side to clear the airway)
2) Protect the patient from hurting himself. Move all equipments and sharp instruments away from the patient.
3) Maintain the patient’s airway and administer oxygen.
4) Stay with the patient until they regain consciousness. Epileptic seizures usually recover spontaneously.
5) If fits continue for more than 10 minutes, call an ambulance and summon for medical assistance. Give patient 10-20 mg diazepam intravenously. There is a chance of permanent brain damage if fits continue for more than 20 minutes.
6) Repeat diazepam if no recovery within 5 minutes.
7) Defer the dental treatment.
Aggressive or disturbed behavior
Aggressive behavior is defined as excessive verbal abuse or violent physical acts. Underlying causes of aggressive behavior include psychiatric disorder, drugs such as barbiturates and alcohol, severe pain, brain injury.
Management of a patient with aggressive behavior
- Calm the patient down.
- Summon psychiatric assistance or call an ambulance if patient continues to show aggressive behavior.
- If the patient is violent, call the police and seek for help.
- Defer dental treatment.