Handbook for Dental Chair Side Assistants - Part 2

By Namita Kalra

Handbook for Dental Chair Side Assistants is a timely and comprehensive resource designed to educate the dental chair side assistant and dental nurses about dentistry. This unique practical handbook covers the basic sciences emergencies and clinical aspects of all dental specialties. The theoretical knowledge and background about dental anatomy, dental microbiology, oral pathology, dental materials, dental radiology, dental procedures, common drugs, problems and dental instruments in dental practice is explained in simple and clear terms. The contents have been designed to give an optimum balance between clinical skills and theoretical foundation of the subject.

The book is divided into 2 parts. Part 1 covers basic sciences and includes a guide to working in dental clinics. Part 2 includes a guide to medical emergencies, and information for different dental specialty settings.

Key Features

- Lucid yet simple explanations for learners

- Covers basic and practical tips for dental assistants and nurses

- Provides information for all dental specialties

- Includes notes on advanced technology in dentistry

- Illustrative and easy to retain information with colorful clinical pictures flowcharts and tabular data

- A comprehensive summary for every chapter

The book is useful reading material for undergraduate dental students and trainees.

• Language: English
• Publisher: Bentham Science Publishers
• Release date: Oct 4, 2023
• ISBN: 9789815136470

Book preview

Part 1: Emergency Care

Resuscitation Aids

Amit Khatri¹, *

¹ Department of Paedodontics and Preventive Dentistry, UCMS, Delhi, India

Abstract

The chapter deals with the various instruments and gadgets necessary to revive a patient in a dental clinic. The list is precise and practical. The chapter is not only of great value to the aspiring dental chairside assistant but also to all aspiring dental surgeons as a ready guide when they are about to start their dental practice. It also deals with the management of syncope and details the emergency drug tray and its contents. Some real-life photographs are included at the end of the chapter to give the student a very good orientation.

Keywords: Automatic external defibrillator, Flumazenil, Glucagon, Hypogly- caemia, Portable suction device, Oropharyngeal airway, Seizures.

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* Corresponding author Amit Khatri: Department of Paedodontics and Preventive Dentistry, UCMS, Delhi, India;

E-mail: [e-mail]

INTRODUCTION

The disciplines of dentistry are closely associated with medicine and its biological roots. An experienced dentist should be aware of the pathophysiology of certain disorders as well as the complex pathways and impacts of the body systems. Dental professionals have a duty of responsibility to ensure that their patients gain appropriate and healthy treatment.

The aim of this chapter is to provide an overview of the management of medical emergencies and resuscitation in dental practice.

All dental practitioners should follow the systemic ABCDE approach when assessing an acutely sick patient.

Resuscitation Equipment

The resuscitation equipment must be present in the dental practice every time.

Airway Equipment

A set of oropharyngeal airways, basic set (0, 1, 2, 3, 4) for adults and children.

(Fig. 1). Portable suction device (Fig. 2).

Fig. (1))

Airway tubes.

Fig. (2))

Portable suction device.

Breathing Equipment

Self-inflating resuscitation bag with oxygen reservoir and tubing (Figs. 4 & 5).

Pocket mask with oxygen port.

Oxygen cylinder (Fig. 3).

Oxygen face mask with tubing.

Fig. (3))

Oxygen cylinder.

Fig. (4))

Airway tubes.

Fig. (5))

Ambu bag (paediatric and adult) oxygen face mask with tubing

Circulation Equipment

Automatic External Defibrillators (AED) must be present in every dental clinic. The training must include a practical demonstration and the use of an Automatic External Defibrillator (AED).

Sterile syringes and needle.

Drugs (Fig. 6)

Fig. (6))

Emergency drug tray.

Salbutamol aerosol inhaler (100 g per activation).

Glyceryl trinitrate spray (400 µg/dose).

Oral glucose solution.

Glucagon injection 1mg.

Aspirin 300mg dispersible.

Midazolam 5mg/ml or 10mg/ml for topical buccal administration.

Adrenaline injection (1:1,000,1mg/ml).

Flumazenil (0.5 mg/ 5 ml): only required for those dental settings where conscious sedation is undertaken using benzodiazepines.

Oxygen cylinder: The oxygen cylinder should provide a flow of at least 15 litres per minute.

ADDITIONAL EMERGENCY DEVICES FOR SEDATION DENTAL PROCEDURES

Dental procedures are those in which active sedation, using intravenous, oral or transmucosal methods, is done and can be a valuable addition in the handling of medical emergencies.

1. Pulse oximeter with audible alarm: for constant tracking.

2. Blood pressure monitor: access to the hospital review and pre-and post-treatment tests.

Medical Emergencies

All dental healthcare professionals may face medical emergencies. Fortunately, these occur less but can be life-threatening if they happen.

These include:

1. Airway obstruction (choking and aspiration)

2. Angina

3. Hypoglycaemia

4. Asthma

5. Anaphylaxis

6. Seizures

7. Myocardial infarction

8. Vasovagal syncope (faint)

Training of Staff

Standards

Accurate recording of any patient's medical history would make it easier for certain patients at risk of such medical problems and potential cardiorespiratory arrest to be detected prior to any planned procedure.

Dental health care professionals must be trained in cardiopulmonary resuscitation (CPR) so that during the occurrence of a cardiorespiratory arrest episode, they can:

Recognize episode;

Call help immediately;

Begin CPR, using compressions on chest and giving ventilation using a pocket mask or bag-mask and adjunct oxygen (evidence is present that CPR can be done effectively on a fully reclined dental chair);

Attempt defibrillation (if required) under 3 minutes of the episode using an AED;

Give other advanced life support skills if trained.

Dental health care professionals who deal with children must learn the differences in CPR procedures for use in children and should practice these on a paediatric mannequin.

1. All primary dental health caregivers should know the need and make provision for the dental community to have sufficient time to provide training in resuscitation skills as part of the job.

2. All training must be added to the database.

3. Training and retraining would be a compulsory prerequisite for continued career learning and management of medical health records. It might be necessary to undergo any retraining using 'e-learning.'

4. Mock drills should be practiced to ensure preparation.

Syncope and its Management in a Dental Clinic

Syncope is defined as a brief loss of consciousness caused by a fall in blood pressure. It is most commonly seen in dental practices (50% to 60% of all).

Pre-disposing Factors

1. Hunger from dieting or missed meal

2. Seating for long in an upright position

3. Hot humid environment

4. Exhaustion of patient

5. Poor physical condition

6. Anxiety, stress, sudden pain

The most frequent cause of syncope is a vasovagal attack. Vasovagal refers to a transient decrease in pressure due to pallor, fainting, sweating, and nausea induced by increased activity of the vagus nerve, particularly as a result of stress. Other common causes of syncope include extreme panic, extended pacing, perception of blood, and eye of the needle. Typical manifestation of vasovagal syncope is dizziness followed by sweating, feeling light-headed, sluggish heart rate, nausea and vomiting, blurry vision, yawning, and abrupt collapsing.

Management of vasovagal syncope includes:

1. Stopping treatment immediately.

2. Assessing the level of consciousness.

3. Activating clinic emergency system (call for oxygen).

4. Positioning the person into a supine position and raising both the legs.

5. Assessing airway and circulation, readjusting the jaw head position, and measuring the pulse and blood pressure.

6. Definitive treatment: administrating oxygen and keeping an eye on the vital signs.

7. Post Syncopal:

a. Postponing any further treatment, if recovery is in less than 15 minutes.

b. If recovery takes more than 15 minutes, then transferring the patient to hospital emergency services.

8. Determining the precipitating factors in order to find the etiology of syncope.

9. Once the patient is in conscious form, keeping him in the seating position; making sure that heart rate and blood pressure are normal; offering glucose in water.

SUMMARY

Medical emergencies might arise in the dental setup, and therefore, dental professionals as well as the nursing staff should be well versed with their pathophysiology and ways to manage them. Most commonly, these include syncope, angina attack, airway obstruction, anaphylaxis, asthma, seizures, and myocardial infarction on the dental chair before starting the procedure or during the procedure. ABCDE rule should be followed while dealing with such kinds of emergencies. The resuscitation aids, which include airway, breathing, circulation equipment, and certain emergency drugs, should be kept handy in the dental clinic to deal with such emergencies. Proper education and training should be given to the staff, and they also should be updated with advanced techniques and drugs to manage such situations.

SUGGESTED READINGS

Basic Life Support

Ashok Saxena¹, *, Geetanjali T. Chilkoti¹

¹ Department of Anasesthesiology and Critical Care, UCMS, Delhi, India

Abstract

The chapter is essential for the dental chairside assistant. It details the first step that needs to be provided to the victim of a life-threatening injury, cardiopulmonary arrest, or sudden cessation of breathing. It deals with basic medical skills, and if implemented, these can enable saving a life. The basic life support provider needs practical training, which needs to be further updated at regular intervals. The details of various algorithms, chances of survival, sequence of action, airway obstruction in children, method of defibrillator use and cardiopulmonary resuscitation are also explained in detail.

Keywords: Compression, Defibrillation, Heimlich’s maneuver, Resuscitation, Rescue breathing, Unresponsive, Unconscious.

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* Corresponding author Ashok Saxena: Department of Anasesthesiology and Critical Care, UCMS, Delhi, India;

E-mail: [e-mail]

INTRODUCTION

Basic life support (BLS) is the first level of medical care provided to the victims of cardiopulmonary arrest, obstructed airway or life-threatening injuries by either the first responder or the healthcare professional till they receive advanced medical care. Cardiopulmonary arrest (CPA) is a sudden cessation of effective respiration, circulation, or both. Basic life support is provided by any bystander who is trained in BLS or trained medical personnel, including emergency paramedics. A lot of emphasis has been laid upon providing the training of BLS skills to everyone, including laypersons. However, it is paramount that all medical doctors, including dental practitioners, and medical and paramedical staff, should be trained in high-quality cardiopulmonary resuscitation (CPR); needless to say, it is a basic medical skill, which can save many lives when implemented properly on time. BLS training has been highly recommended for all healthcare profes- sionals. In our country, though it is increasingly becoming a part of the teaching curriculum of medical students, awareness about the correct technique among dental practitioners is still deficient.

Cardiac arrest can occur in dental practice. Therefore, BLS education is highly recommended for dentists and has become universal among various dental schools worldwide; however, there has been variation in its reinforcement. The CPCR guidelines are consistent with the 2015 American Heart Association (AHA) guidelines update for Cardio-Pulmonary Resuscitation (CPR) and Emer- gency Cardiovascular Care (ECC). BLS healthcare provider courses are designed by AHA and are standardized worldwide, even in India. However, its further reinforcement in dental education is deemed essential.

AHA CHAIN OF SURVIVAL

The early recognition of CPA, followed by CPR, is crucial for improved patient outcome. Hence, learning the skills of high-quality CPR can save many lives. The American Heart Association advocates a chain of survival for both in-hospital and out-hospital cardiac arrest (IHCA, OHCA) for all victims needing CPR. It includes early recognition of a victim, activation of emergency medical services, early CPR, rapid defibrillation, effective advanced life support, and integrated post-cardiac arrest care (Fig. 1). Amongst these, the initial steps constitute what is known as basic life support (BLS). Early and effective BLS can greatly improve the chances of survival as the central nervous system can undergo irreversible damage within 3-4 min of hypoxia or anoxia. The cause of cardiac arrest in adults is cardiac; however, in children, the cause is respiratory failure and shock. This has led to the introduction of a prevention link in the paediatric chain of survival while the rest is the same as of adult chain of survival (Fig.