Patient Information

• Your medical history, including any conditions being treated
• Previous dental records, if you have them
• Any recent dental X-rays
• A list of medicines you are currently taking
• Details of any allergies

Emergency situations may include

• Severe or sudden toothache
• Broken or fractured tooth
• Knocked-out tooth
• Dental injury or trauma
• Facial or gum swelling
• Dental infection
• Persistent bleeding
• Lost or damaged dental restoration

• Severe tooth pain

  Pain that disturbs sleep or does not settle with routine measures should be examined. Avoid placing anything directly on the gum unless advised.

• Dental injury

  If a tooth is knocked out or displaced after an accident, keep it moist and seek dental attention as soon as possible.

• Swelling

  Swelling of the face or gum may indicate infection. It should be assessed promptly rather than waiting for it to settle.

• Broken tooth

  Keep the area clean, avoid chewing on it and have the tooth examined so the remaining structure can be protected.

• Bleeding

  Bleeding after an extraction is usually controlled with firm pressure on a clean gauze pad. Contact the clinic if it continues.

Our clinic maintains a fully stocked emergency kit and the equipment required to respond promptly and effectively to a medical emergency during dental treatment. The following equipment and medications are kept on hand and checked regularly for readiness.

Emergency Equipment

• Oxygen cylinder and regulator suitable for delivering high-flow oxygen
• Syringes and needles for drawing and administering drugs
• Bag-valve-mask device with oxygen reservoir
• Basic airway adjuncts (oro-pharyngeal and naso-pharyngeal airways)
• Equipment for recording blood pressure
• Spacer device to deliver Salbutamol

Emergency Response Protocol — the P-C-A-B-D Sequence

Managing a medical emergency in the dental setting requires immediate cessation of treatment, rapid assessment using the P-C-A-B-D sequence, and activation of emergency medical services (EMS) when indicated.

1. P

   Position

   Unconscious or hypotensive: place supine with feet slightly elevated (Trendelenburg position). If the patient is in the third trimester of pregnancy, tilt onto the left side to avoid inferior vena cava compression. Conscious or in respiratory distress: keep upright or semi-reclining (Fowler's position) to make breathing easier.

2. C

   Circulation

   Check the carotid pulse, pulse rate, and blood pressure. If the patient is pulseless, begin CPR immediately using a 30:2 compression-to-ventilation ratio and attach an AED as soon as one is available.

3. A

   Airway

   Remove any foreign bodies and suction saliva or blood. Open the airway with a head-tilt/chin-lift manoeuvre, or a jaw thrust if a cervical spine injury is suspected.

4. B

   Breathing

   Assess chest rise. Administer supplemental oxygen via nasal cannula (2–6 L/min) or non-rebreather mask (10–15 L/min), except in cases of hyperventilation.

5. D

   Definitive Care

   Administer condition-specific emergency drugs, continue monitoring vital signs, and summon EMS if symptoms do not resolve rapidly.

Common Emergencies & Immediate Interventions

• Syncope (Vasovagal Fainting)

  Place in supine position with feet elevated. Loosen tight clothing. Apply a cool compress to the forehead. Administer oxygen. Ammonia inhalants may be used if recovery is delayed.

• Hypoglycemia — Conscious Patient

  Administer 15–20 g of rapid-acting oral glucose (fruit juice, glucose tablets, or soda). Recheck the patient's status after 15 minutes.

• Hypoglycemia — Unconscious Patient

  Never administer oral fluids. Call EMS. Administer 1 mg glucagon IM/subcutaneous, or IV 50% dextrose if trained and equipped to do so.

• Anaphylaxis / Severe Allergic Reaction

  Call EMS immediately. Administer epinephrine (1:1,000) IM into the anterolateral thigh — 0.3–0.5 mg for adults, 0.15 mg (or 0.01 mg/kg) for children. Repeat every 5–15 minutes if symptoms persist. Provide high-flow oxygen and albuterol for associated bronchospasm.

• Chest Pain — Angina vs. Myocardial Infarction

  Keep the patient upright. Administer nitroglycerin sublingually (0.4 mg spray or tablet) every 5 minutes, to a maximum of 3 doses, provided systolic blood pressure is above 90 mmHg and no erectile dysfunction medication has been taken within the past 24–48 hours. If pain persists beyond 5 minutes or myocardial infarction is suspected, call EMS immediately, give chewed non-enteric-coated aspirin (162–325 mg), and provide oxygen if SpO2 is below 94%.

• Asthmatic Attack / Bronchospasm

  Seat the patient upright. Administer an albuterol (salbutamol) inhaler — 2–4 puffs via spacer, repeated after 5 minutes if needed. Provide supplemental oxygen. If the attack is refractory to treatment, manage as severe anaphylaxis with IM epinephrine.

• Seizure

  Clear the immediate area of sharp instruments, dental handpieces, and trays. Do not place anything in the patient's mouth and do not forcibly restrain the limbs. Once active convulsing stops, turn the patient into the recovery position (lateral decubitus) to prevent aspiration. Call EMS if the seizure lasts longer than 5 minutes or repeats.

Essential Emergency Drug Kit Checklist

• Oxygen cylinder with regulator, non-rebreather mask, and bag-valve-mask (Ambu bag)
• Epinephrine 1:1,000 (auto-injectors or ampoules)
• Nitroglycerin spray or tablets (0.4 mg)
• Albuterol inhaler
• Aspirin, chewable (81 mg or 325 mg)
• Oral glucose source (gel or tablets)
• AED (Automated External Defibrillator)