First aid in dentistry

In the article, we will consider what implies emergency care in dentistry. Not everyone knows what this concept means.

Every dentist in his practice has to face an emergency in patients. Such cases include fainting along with anaphylactic shock, asthma attacks, epileptic seizures and so on, up to a heart attack. In such situations, the main thing is to do everything right and quickly.

The order on emergency care in dentistry No. 1496n dated 12/07/2011 “On approval of the Procedure for the provision of medical care to adults with dental diseases” was also approved.

First aid kit for dentist

Given the emergency situation that is possible in dentistry, doctors use the following kit to help patients: an antihistamine syringe along with an oxygen respiratory spray, Nitroglycerin in the form of sublingual pills and a spray, an asthma inhaler, and foods high in sugar, " Aspirin and Benadril.

A person responsible for the regular (weekly) verification of the above kit should be appointed. It is extremely unpleasant to detect a broken oxygen cylinder at a time when the patient really needs it.

Emergency Dentistry in SanPiNu

The speed of reaction is the key to successful relief of any critical condition in patients. To do everything as quickly as possible, it is necessary to distribute responsibilities. Every employee working in a dental clinic should know what he needs to do when a patient needs emergency care.

The corresponding instruction on the emergency care order in dentistry is created in advance and communicated to absolutely all employees. Those with a medical background are involved in 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 a plan of action should be carried out in all directions, that is, it is impossible to entrust any specific task to only one person, because he can simply be absent from his workplace at the most critical moment. The main thing is to do everything in such a way that no one bothers anyone and does what is required, making a certain contribution to the correction and resolution of the situation. In addition, it is not superfluous to teach absolutely all employees of the dental hospital the basic fundamentals of emergency care.

A responsible person is also required to regularly check for the availability of the previously mentioned medical kit for care.

The emergency care algorithm in dentistry is discussed in more detail below.

Critical conditions in patients - what are they?

Emergencies requiring help in dentistry in humans:

• Those caused by stress or excitement.
• Conditions that are associated with anesthesia, and in addition, with difficulty in the work of the cardiac, respiratory or vascular system.

A critical condition associated with anesthesia is a violation of airway patency. The patient may experience 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 mainly observed among more nervous people.

What implies emergency care in dentistry?

In order to quickly manage to cope with such conditions, you must have everything at hand that is required for the quick relief of negative manifestations. For example, to avoid obstruction of the respiratory canals in the presence of complications in the functioning of the respiratory system, it is necessary to quickly use special sponges. The same patients in whom stress provokes hyperventilation should immediately offer the use of an oxygen spray. Next, we will examine how anaphylactic shock can occur in patients 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 what is dangerous?

This condition is an extremely severe allergic reaction that proceeds as an acute cardiac and vascular insufficiency and adrenal insufficiency. Within the clinical manifestations of anaphylactic shock, patients experience a state of severe discomfort with an indefinite painful sensation. First of all, there is a fear of death along with a state of internal anxiety.

Nausea, sometimes vomiting and coughing may also occur. Patients may complain of severe weakness along with a tingling sensation and skin itching. In addition, when such a condition occurs, a feeling of a rush of blood to the face often occurs in combination with a feeling of heaviness behind the sternum or compression of the chest. Very often there are pains in the region of the heart along with difficulty breathing or inability to take a breath, dizziness or a headache of a rather sharp intensity are not excluded. The occurrence of a consciousness disorder may interfere with verbal contact with the patient. Complaints may occur immediately after taking the drug.

Hyperemia, pallor, cyanosis

As an additional symptom in anaphylactic shock, hyperemia of the skin occurs along with pallor and cyanosis, various exanthema, swelling of the eyelids or face and heavy sweating. Most patients often have cramps of the extremities in combination with developed convulsive seizures, motor anxiety, and involuntary excretion of urine, gases and feces. The pupils may dilate and not respond to light. The pulse is at the same time frequent, threadlike, tachycardia and arrhythmia are noted.

Emergency care for anaphylactic shock in dentistry should be provided competently. The life of the patient depends on this.

People’s pressure is rapidly dropping. In severe situations, diastolic pressure is difficult to determine. Subsequently, a clinical picture of pulmonary edema occurs. A typical form of anaphylactic shock is characterized by a violation of blood circulation, consciousness and respiratory functions.

The algorithm of emergency care for anaphylactic shock in dentistry

The principles for eliminating anaphylactic shock are as follows:

• Doctors are trying to stop the acute violation of the circulatory and respiratory functions.
• Achieving compensation for adrenococoid insufficiency that arose in a patient.
• Inhibition and neutralization in the blood of biologically active components.
• Blocking the flow of an allergen drug into the bloodstream.
• Support for vital functions of the patient’s body or resuscitation in the event of a serious condition or threat of clinical death.

Now we will consider what actions are taken by doctors in case of emergency emergency care in dentistry:

1. Stop administering the medication that caused the critical condition.
2. Lay the patient in a horizontal position with raised legs.
3. If a mild form of anaphylactic shock is observed, then the introduction of adrenaline (0.1%) is possible intramuscularly and also intravenously. 0.5-1 ml of the active substance is diluted in 5 ml of saline. Puncture the injection site of the allergen with 0.1% adrenaline solution, which is diluted in 5-10 ml of saline. If blood pressure continues to fall, administer adrenaline 0.5-1 ml intravenously every three to five minutes until the blood pressure stabilizes.
4. "Dexamethasone" 20-24 mg intravenously or intramuscularly, or "Prednisolone" 150-300 mg (3-5 mg / kg body weight).
5. "Diphenhydramine" 1% based on dosages: adults - 1.0 mg / kg, children - 0.5 mg / kg body weight, "Suprastin" or "Tavegil" 2 mg / kg body weight, if these drugs are not available, then use "Pipolfen" 2.5% 1-2 ml intravenously or intramuscularly.
6. If anaphylaxis proceeds according to the asphyxial and bronchial type, then aminophylline is administered 2.4% 10 ml intravenously.

Emergency care in pediatric dentistry is also provided.

Reasons for emergency dental care for children

The object of pediatric dentistry is primarily children under the age of fifteen. This period is directly related to the design features of the physiology of teeth, jaws, oral mucosa, periodontal, and in addition, with immune reactions. The difference in temperament of children, combined with their poor resistance to pain, brings its own characteristics to the specifics of emergency care. Pathological processes that in children are the reasons for providing emergency care in dentistry are systematized in three groups:

• Traumatic injury: fracture of the jaw, trauma to the lips, cheeks and other injuries to the teeth.
• Getting carious damage in the form of pulpitis or periodontitis.
• The occurrence of acute processes in the oral mucosa in the form of gum inflammation on the background of eruption of temporary incisors, aphthous herpetic stomatitis or ulcerative gingivitis.

Emergency dental care for children

In the presence of any tooth injury, the condition of the parietal bones and the injured incisor itself should be determined by an X-ray method. After this, a decision must be made regarding the preservation or extraction of the teeth. Teeth whose roots are broken are removed, since today there are still no methods for their restoration. Removal, especially in children, must be postponed until the severity of the traumatic processes, except in situations where their fragments interfere with the restoration of jaw fractures.

Permanent incisors with broken crowns are left to children in any case. If the pulp has not been affected, then you should wait only a few weeks for the subsequent determination of its viability. In the event that it was damaged, the dentist decides whether to cure the teeth, followed by preservation of the living pulp or devitalize it.

You should know that the pulp of permanent incisors in childhood has great reparative capabilities. When the dentist decides to leave her, treatment begins immediately. Best of all, when this is carried out in one session with the closure of the damaged surfaces with Kalksil or paste, which is prepared from a solution of novocaine and calcium oxide. The paste must necessarily cover the pulp with a thin layer. Then, without pressing, phosphate cement is applied and the broken part of the crown of the incisor is restored. This method gives a very good cosmetic effect, along with a fairly stable repair of the tooth crown.

In the event that the dentist does not have the appropriate recovery options in the next hour, then you can provide first aid in dentistry by temporarily covering the pulp with sulfidine powder, the aforementioned biological pastes or, in extreme cases, with a cotton swab, which must first be soaked in chlorophenolcamphore. This material will be better coated with phosphate cement, which, in turn, must necessarily capture the healthy walls of the incisor crown.

In case of a fracture of a temporary tooth crown and considering a decision regarding extraction or devitalization, 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. In case of tooth dislocation after an injury, it must be immobilized. In the event that the tooth was slightly dislocated, and there is no evidence of a fracture of the alveolar bone directly on the radiograph, the patient is advised to avoid stress on the affected teeth.

First aid in dentistry for coma

Comatose conditions are allocated in a separate group, since their manifestation is observed mainly in patients with certain concomitant pathologies, which they always need to warn their dentist about. Coma is a state of sharp inhibition of nervous activity, which is accompanied by loss of consciousness and the failure of all analyzers. To whom doctors should be able to distinguish from stupor when certain elements in the mind are preserved and reactions to strong light and sound stimuli are noted.

What implies emergency care in dentistry in this case?

Significant information for evaluating coma is primarily due to the appearance of the patient as part of the examination and determination of his condition. The presence of cyanosis and a pronounced pattern of the venous system on the abdomen indicates cirrhosis of the liver, that is, the development of hepatic coma. Dry hot skin in people happens with sepsis, and in addition, against the background of severe infections and dehydration. Seizures combined with stiff neck confirm coma amid increased intracranial pressure due to trauma, thrombosis, swelling, and more.

In diagnosing this condition, it is very important to evaluate breath odor. For example, in diabetic acidosis, the smell of acetone from the mouth is usually observed. The appearance of a putrefactive aroma indicates the presence of a hepatic coma in the patient, and the smell of urine indicates renal pathology. In case of alcohol intoxication, the smell will be typical. If there is a coma of unclear etiology, it is necessary to examine the sugar content.

Emergency medical care in dentistry in the event of a coma consists in the mandatory and urgent call of the resuscitation team. You need to start with oxygenation and stopping a functional disorder (you need to normalize breathing, blood circulation and heart function). In particular, in the presence of a hypoglycemic coma, it is required to immediately administer to the patient intravenously 60 milliliters of a 40% glucose solution, since 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.

Conclusion

Thus, as part of the therapy, each doctor must be prepared for the fact that his patient may have any emergency conditions in dentistry and he may need timely first aid. Immediately before the start of surgical or conservative treatment, the patient should inform his dentist about what acute or chronic pathologies he has, an allergy to certain medications, and the like.

In addition, patients should also notify dentists about the current intake of certain medications and their dosage. In the event that the patient is at risk, his treatment should be carried out under strict supervision and with care to avoid the appearance of serious complications. Untimely provision of medical care often entails extremely serious consequences in the form of destructive pathological processes in the body.

We examined emergency conditions in dentistry and first aid.