Introduction

"ER" and "Chicago Hope" have introduced many to the adrenaline filled world of emergency medicine where almost any medical dilemma can be solved in an hour, and viewers' most critical decision is which television program to watch next. Most people are fascinated with such stories, but if an emergency situation occurs in the dental office it can be frightening and there are no commercial breaks. Oral health care providers should know what to do so automatically that their actions are as precise and controlled as those of the medical personnel on television or in the movies.

In reality, while emergency situations do arise in dental hygiene practice and almost all are life threatening to a degree, only rarely does a patient die while in the dental office. Totally reliable national or even regional data describing patient deaths in the dental office or within 24 hours posttreatment are not available. However, according to Frank McCarthy, a physician-dentist it would not be too far-fetched to speculate that the average dentist would experience one or two deaths during a practice lifetime.1 If one extrapolates this to dental hygiene practice, a dental hygienist might also experience a patient death as well. Statistics cannot predict exactly an individual practitioner's future experience. One can only hope to experience no emergencies or deaths. However, it is best to be prepared to prevent the preventable and deal with the unavoidable emergencies as quickly, effectively, and calmly as possible.

Today's dental patient is far different from those in the past. In the past, older dental patients were generally edentulous, but today a person over the age of 60 years is much more likely to have all or most of his or her natural teeth. An older dental patient may now require the full gamut of dental care.

Life expectancy also has risen significantly during this century. In the early 1900s, a white male could expect to live to the ripe old age of 47 years, and a white female to 48 years. Today, that same white couple could expect about 30 more years of life. The most rapidly growing segment of the United States population is those above 60 years of age even before the baby boomer generation reaches late middle age. As people age physiologically, they are usually less able to tolerate stress, a condition often inherent in dental treatment, making them more susceptible to medical emergencies. Additionally, while many older Americans appear to be in good health, they may have significant subclinical diseases, or diseases controlled by medication.

Diseases that previously killed many people at an early age, can now be successfully treated. Advances in health care have contributed not only to an increased life span, but also to greater numbers of medically compromised people of all ages.

The increasing use of drugs for a wide variety of medical conditions is another risk factor for medical emergencies. Kim Tolson, who holds a PhD in pharmacology/toxicology, stated in a recent course that more drugs are available and being prescribed than ever before. Requa-Clark, lists over 125 drugs that are classified as the latest drugs available.2 With media advertising of prescription drugs, consumers are more aware of specific drugs and may be more likely to request them from their physicians. Additionally more drugs formerly available only by prescription are now available over the counter and are being purchased and used by many. Use of every drug carries inherent risk and many can contribute to risk of a medical emergency. Tolson also stated that a high percentage of the top 100 drugs prescribed and dispensed in U.S. community pharmacies are cardiovascular drugs, any of which can potentially cause significant untoward effects.

According to Malamed**, many patients often take more than one drug.3 Use of multiple drugs can give even greater rise to emergency situations that are related either to the pharmacological action of the drugs or to complex interactions between commonly used dental drugs and other medications taken by the patient.

The good news is that 90% of life-threatening situations are preventable.3 If the practitioner assesses a patient's medical status and takes the precautions necessary, life-threatening emergencies may never occur. For the 10% of life-threatening situations that may occur despite the best preventive effort, oral health care practitioners should be prepared to carry out the procedures most likely to preserve the life of the affected individual.