EMERGENCY DRUGS IN DENTAL PRACTICE

INTRODUCTION
Collapse of a patient in the dental surgery is an infrequent occurrence whose incidence is
largely unknown. Dentists must be aware of the potential medical complications that may
arise through the delivery of dental care to medically compromised patients.
This article reviews the more common emergency drugs that the dental team may have to
administer in general dental practice. Practitioners administrating general anesthetics and
using i.v sedation techniques should undergo recognized training in advance cardiac life
support.
The drugs commonly used are
1. oxygen
2. adrenaline
3. glyceryl trinitrate
4. nitrous oxide
5. glucagon
6. glucose
7. salbutamol
8. hydrocortisone
9. diazepam
10. flumazenil ; and
11. chlorpheniramine
In all cases, the best method of managing medical emergencies is by preventing them
from occurring in the first place. With this in mind, it is essential to take a comprehensive
medial history from any patient about to receive dental care. This will:
• help to warn the clinician about any potential complications that may arise during
dental treatment;
• indicate necessary preventive measures that can be taken to help prevent a crisis;
and
• aid in the rapid diagnosis of the cause of collapse.
Drug Indications Administratio Dose
n
Adults children
Oxygen All emergencies Face mask 4-6l/min
except Bag valve 10 l/min
hyperventilation mask
Adrenaline Anaphylaxis intramuscular 0.5-1mg 10µg/kg

Glyceryl trinitrate Acute chest pain Sublingual 0.3-1mg Not appropriate

Nitrous oxide Myocardial Inhalation 50% oxygen
infarction +50% nitrous
oxide
Glucagon Hypoglycaemia Intramuscular 1mg 0.5mg(under 12
years)
Glucose Hypoglycaemia Intravenous 50ml of 1-2ml/kg of
50% 50%
Acute asthma Inhalation 2 puffs 1 puff upto 20
Salbutamol upto times
20times
Hydrocortisone Prophylaxis and Intramuscular 200mg 25mg(<1yr);
treatment of acute 50mg(1-5yrs);
adrenal crisis; 100mg(6-12yrs)
anaphylaxis;
asthma
Diazepam Status epilepticus Intravenous 10 mg 200-300µg/kg
Rectal 10mg 5mg(1-3yrs);
solution 100mg(6-12yrs)
Flumazenil Benzodiazepine- Intravenous 200µg Inadequate data
induced over 15s,
respiratory then
depression 100µg
every
60s.max
1mg
Chlorpheniramine Anaphylaxis Intramuscular 10-20mg 200µg/kg
Urticaria Oral 4mg tds (<12yrs);
1mg/12h(1-
2yrs);
1mg/8h(2-5yrs)
2mg/8h(6-
12yrs)
LOOKIN AFTER EMERGENCY DRUGS
It is best to store drugs in a cool place (between 4˚C and 25˚C) to ensure that all
members of the dental team are aware of their location. The expiry dates should be
checked every 6 months and recorded, and expiry items replaced immediately.

CONCLUSION
Management of medical emergencies should involve the whole dental team. All
members must be familiar with the practice protocol in the event of collapse. Each
team member should be allocated and rehearse a role so that all emergencies are
managed efficiently. Dentists are advised to attend courses regularly on the
management of medical emergencies and to keep up to date with new protocols,
equipment and drugs. Resuscitation routines should be practiced regularly within the
dental surgery under simulated conditions; this has been shown to be essential to help
retain the skills involved.