In the article we will look at what urgent care in dentistry implies. Not everyone knows what this concept means.
Every dentist in his practice has to deal with an emergency condition in patients. Similar cases include fainting along with anaphylactic shock, asthma attacks, seizures, and so on, up to a heart attack. In such situations, the main thing is to do everything correctly and quickly.
Also approved the order for emergency care in dentistry number 1496n from
Dentist’s set for first aid to the patient
Taking into account the emergency condition that is possible in dentistry, doctors use the following kit to assist patients: an antihistamine syringe along with an oxygen canister for breathing, “Nitroglycerin” in the form of sublingual pills and a spray, an asthma inhaler, products with high sugar content, “ Aspirin “and” Benadril “.
A person responsible for regular (weekly) checking of the above set should be appointed. It is extremely unpleasant to find a non-working oxygen cylinder at the moment when the patient really needs it.
Emergency care in dentistry according to SanPiN
The reaction rate 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 he needs to do when the patient needs emergency care.
The relevant instruction for the order of emergency care in dentistry is created in advance and communicated to absolutely all employees. Those who have a medical degree are engaged in rendering 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 an action plan should be carried out in all directions, that is, it is impossible to entrust any one specific task to only one person, because he simply may simply be absent from his workplace at the most critical moment. The main thing is to do this in such a way that no one interferes with anyone and does what is required, making his own specific contribution to correcting and resolving the situation. In addition, it is not superfluous to train absolutely all employees of the dental hospital in the basics of emergency care.
A responsible person is also required to be appointed to regularly check the availability of the previously mentioned medical kit for assistance.
The algorithm of emergency care in dentistry will be discussed in more detail below.
Critical conditions in patients – what are they?
Urgent conditions requiring help in dentistry in people:
- Those caused by stress or anxiety.
- Conditions that are associated with anesthesia, and in addition, with difficulty in the work of the heart, respiratory or vascular system.
The critical condition associated with anesthesia is a violation of the airway passage. The patient may have laryngospasm, hyperventilation, or bronchial spasm. Bronchospasms, according to dentists, are 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 caused by stress and, as a rule, is predominantly observed among more nervous people.
What does emergency care in dentistry involve?
To quickly have time to cope with such states, it is necessary to have on hand everything that is required for quick relief of negative manifestations. For example, in order to avoid obstruction of the respiratory channels in the presence of complications in the functioning of the respiratory system, it is necessary to quickly apply special sponges. The same patients whose stress provokes hyperventilation should immediately suggest using an oxygen canister. Next, we will consider how anaphylactic shock may appear 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 how dangerous?
This condition is an extremely severe allergic reaction, which proceeds according to the type of acute cardiac 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 feeling of pain. First of all, there is a fear of death along with a state of inner anxiety.
Nausea, sometimes vomiting and coughing may also occur. Patients may complain of severe weakness along with tingling and itching. In addition, when this condition occurs, there is often a feeling of flushing to the face in combination with a feeling of heaviness behind the sternum or compression of the chest. Very often, pain occurs in the region of the heart, along with difficulty breathing or the inability to inhale, dizziness or headache of a rather sharp intensity are not excluded. The appearance of a disorder of consciousness may interfere with speech contact with the patient. Complaints can occur immediately after consuming the drug.
Hyperemia, pallor, cyanosis
As an additional symptom of anaphylactic shock, hyperemia of the skin of the skin occurs, along with pallor and cyanosis, various exanthema, swelling of the eyelids or face, and profuse sweating. In the majority of patients, limb convulsions are often noted in combination with unfolded convulsive seizures, motor restlessness, and involuntary discharge of urine, gas, and feces. Pupils may expand and not respond to light. The pulse is at the same time frequent, filiform, marked tachycardia and arrhythmia.
Emergency care for anaphylactic shock in dentistry should be provided competently. The life of the patient depends on it.
The pressure in people is rapidly decreasing. 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 impaired blood circulation, consciousness, and respiratory functions.
Emergency algorithm for anaphylactic shock in dentistry
The principles for the elimination of anaphylactic shock are as follows:
- Doctors seek relief of acute disorders of blood circulation and respiration.
- Achievement of compensation arising from patient adrenococoid insufficiency.
- Inhibition and neutralization of biologically active components in blood.
- Blocking the receipt of the drug-allergen in the bloodstream.
- Support for the vital functions of the patient or reanimation in the event of a serious condition or the threat of clinical death.
Now let’s consider what actions are taken by physicians in case of emergency emergency care in dentistry:
- Stop taking the medicine that caused the critical condition.
- Lay the patient in a horizontal position with raised legs.
- If a mild form of anaphylactic shock is observed, then adrenaline (0.1%) may be administered intramuscularly as well as intravenously. 0.5-1 ml of the active substance is diluted in 5 ml of saline. Peel off the site of the introduction of the allergen with a 0.1% solution of adrenaline, which is diluted in 5-10 ml of saline. If blood pressure continues to fall, inject adrenaline in a dose of 0.5–1 ml intravenously, every three to five minutes, until blood pressure stabilizes.
- "Dexamethasone" 20-24 mg intravenously or intramuscularly, or "Prednisolone" 150-300 mg (3-5 mg / kg body weight).
- "Diphenhydramine" 1% based on the dosage: for adults – 1.0 mg / kg, for children – 0.5 mg / kg of body weight, "Suprastin" or "Tavegil" on 2 mg / kg of weight, if these drugs are absent, then it is possible to use "Pipolfen" 2.5% to 1-2 ml intravenously or intramuscularly.
- If anaphylaxis occurs in the asphyxial and bronchial type, then aminophylline is administered 2.4% 10 ml intravenously.
It also provides emergency care in children’s dentistry.
Reasons for emergency dental care for children
The object of children’s dentistry are primarily children under the age of fifteen years. 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. Difference of children in temperament, combined with their weak resistance to pain, brings its own characteristics to the specifics of emergency care. Pathological processes, which in children are causes for emergency care in dentistry, are systematized into three groups:
- Traumatic injury: fracture of the jaw, injury to the lips, cheeks and other teeth injuries.
- Getting carious lesions in the form of pulpitis or periodontitis.
- The emergence of acute processes in the oral mucosa in the form of inflammation of the gums on 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 of the tooth should be X-ray method to clarify the condition of the bones and the affected incisor. After that, you need to make a decision about the preservation or extraction of teeth. Teeth that have broken roots are removed, because to date there are still no methods for their restoration. Removal, especially in children, should be postponed until the severity of the traumatic processes, except for those situations where their fragments interfere with the process of repairing jaw fractures.
Permanent incisors with broken crowns are left to children anyway. If the pulp was not affected, you should wait only a few weeks for the subsequent determination of its viability. In the event that it is damaged, the dentist decides whether to cure the teeth and then preserve the live pulp or still devitalize it.
You should know that the pulp of the permanent incisors in childhood has great reparative potential. When the decision is made by the dentist to leave her, treatment begins immediately. Best of all, when such is carried out in one session with the closure of damaged surfaces “Calxyl” or paste, which is prepared from a solution of novocaine and calcium oxide. The paste must cover the pulp with a thin layer. Then, 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 reparation of the tooth crown.
In the event that the dentist does not have adequate recovery opportunities within the next hour, the first emergency dental care can be provided by temporarily coating the pulp with sulphidine powder, the above mentioned biological pastes or, in extreme cases, with a cotton swab, which must be soaked in chlorophenol camphor. This material will be better coated with phosphate-cement, which, in turn, must necessarily capture the healthy walls of the cutter crown.
When a temporary tooth crown is fractured and the decision about extraction or devitalization is considered, the dentist must take into account the physiological value of the incisors along with the possibility of their long-term treatment and the nature of the injury. When a dental dislocation after injury, it must be immobilized. In the event that the tooth was dislocated slightly, and there are no data on the presence of a fracture of the alveolar bone directly on the radiograph, the patient is advised to avoid straining the aching teeth.
First aid in dentistry with coma
The comatose states are distinguished as a separate group, since their manifestation is observed mainly in patients with certain accompanying pathologies, about which they always need to warn their dentist. Coma is a state of sudden inhibition of nervous activity, which is accompanied by loss of consciousness and failure of all analyzers. To whom doctors must 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 does emergency care in dentistry mean in this case?
Significant information for assessing coma is primarily the patient’s appearance as part of the examination and determination of his condition. The presence of cyanosis and a pronounced pattern of the venous system on the stomach indicates cirrhosis of the liver, that is, the development of hepatic coma. Dry, hot skin in humans occurs in sepsis, and in addition, due to severe infections and dehydration. Convulsions in combination with stiff neck confirm who against the background of increased intracranial pressure due to injury, thrombosis, tumors and other things.
In the diagnosis of this condition, it is very important to evaluate the smell when breathing. For example, in diabetic acidosis, the smell of acetone from the mouth is usually noted. The appearance of putrid odor indicates the presence of a patient with hepatic coma, and the smell of urine indicates renal pathology. In case of alcohol intoxication, the smell will be typical. If a coma of unknown etiology occurs, it is necessary to investigate the sugar content.
Emergency medical care in dentistry in the event of a coma is a compulsory and urgent call to the intensive care brigade. It is necessary to begin with oxygenation and the implementation of the relief of functional disorder (it is required to normalize breathing, blood circulation and the work of the heart). In particular, in the presence of a hypoglycemic coma, it is required to immediately inject 60 milliliters of a 40% glucose solution into the patient intravenously, as this condition develops almost instantly in comparison with other manifestations and is more dangerous in its consequences. The scheme of therapeutic measures in the presence of coma is similar to the principles of ABC-resuscitation.
Thus, as part of the treatment, each doctor must be prepared for the fact that his patient may experience any emergency conditions in dentistry and may need timely first aid. Immediately before the start of surgical or conservative treatment, the patient must notify his dentist about what acute or chronic pathologies he has, are allergic to certain medicines, and the like.
In addition, patients should also inform dentists about the current intake of certain medications and their dosage. In the event that a patient is at risk, his treatment should be carried out under strict supervision and with caution in order to avoid the occurrence of severe complications. Late provision of medical care often entails extremely serious consequences in the form of destructive pathological processes in the body.
We considered emergency conditions in dentistry and first aid.