Medical emergencies in the dental office (Case study): Dental assisting

Annabelle is a dental assistant working in a general dental practice with Dentist Gwen, and is caring for Weston, a 62-year-old patient who arrives for a tooth extraction. As part of the dental team, Annabelle promotes patient safety and quality care by observing and identifying information, preparing for and recognizing the needs of the patient, safely assisting the dentist, monitoring and responding to the patient, and documenting care.

Annabelle knows that while medical emergencies are not common, they can occur during routine dental procedures. Patients often experience apprehension when going to the dentist, or they may have had a negative experience in a dental setting. This can cause stress and anxiety, which are common triggers for medical emergencies.

These emergencies can include syncope, or fainting; rapid or deep breathing, called hyperventilation; and postural hypotension - also known as orthostatic hypotension - which is a drop in blood pressure and decreased blood flow to the brain that can occur when a patient stands up too quickly after being in a sitting or lying position, causing dizziness, syncope, or even a loss of consciousness.

Other common emergencies include allergic reactions to certain dental materials, like latex gloves or topical anesthetics, that can cause a rash or even a life-threatening reaction called anaphylaxis; asthma attacks that cause breathing difficulties; hyperglycemia and hypoglycemia, or high and low blood sugar; myocardial infarction, or heart attack; angina or severe chest pain that’s a warning sign for a heart attack; cerebrovascular accident, or stroke, when blood flow to the brain is interrupted; and seizure, or convulsion.

As she reviews Weston’s health history, Annabelle begins to observe and identify key information. She notes that he has no known allergies and is on a statin medication daily for high cholesterol.

Next, Annabelle calls Weston from the waiting room. As they walk to the operatory, she sees that Weston appears to be walking slowly; he’s breathing heavily; and is pale and sweating. She recognizes these as possible signs of stress and anxiety, but that they also could be a sign of a serious medical condition.

Annabelle: Weston, how are you feeling today?

Weston: I’m a little tired and short of breath, but I just finished a walk outside, so I probably need to rest. The pain in my teeth is getting worse, though, so I hope Dr. Gwen can do something.

Annabelle: Okay, let’s get you seated in the chair and get your vital signs.

Annabelle takes Weston’s vital signs, which are pulse 112 beats per minute, respirations 26 breaths per minute, blood pressure 154/94 mmHg, and oxygen saturation of 93% on room air. His pain rating is 6 on a 0 to 10 scale, which he says he feels in his teeth and left shoulder.

Annabelle documents this information in the dental record.