|Year : 2020 | Volume
| Issue : 1 | Page : 1-5
Evaluation of knowledge, experience, and perceptions about medical emergencies among dentists in Chennai, India
NM Pravina, R Ganesh
Department of Public Health Dentistry, Priyadarshini Dental College and Hospital, Thiruvallur, Chennai, Tamil Nadu, India
|Date of Submission||06-Oct-2021|
|Date of Acceptance||06-Oct-2021|
|Date of Web Publication||29-Nov-2021|
Dr. R Ganesh
Department of Public Health Dentistry, Priyadharshini Dental College and Hospital, Pandur, Thiruvallur, Chennai - 631 203, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: Dentists encounter medical emergencies in their clinics which can be life threatening. These emergencies should be treated immediately and cannot be avoided or referred, because they put the life and health of patients at risk. Therefore, the aim of this study was to evaluate how well dentists understand medical emergency during dental treatment. The aim of this research is to evaluate the knowledge, experience, and perceptions about medical emergencies among dentists in Chennai, India. Materials and Methods: Data were collected from 50 dentists of Chennai at self-convenience using a structured questionnaire consisting of a 10-item questionnaire. The sample was selected based on certain inclusion and exclusion criteria. Inclusion criteria include postgraduates and South Chennai dentists. Exclusion criteria include students and dental assistants. Results: The study reveals that 60% of the dentists in Chennai were confidently able to deal the life-threatening emergency situations whereas 100% of the dentists have knowledge of how to manage the life-threatening emergency situations. Conclusion: Based on the above study, it can be concluded that the level of training and the level of knowledge on medical emergencies of the dentist in Chennai are good but not up to the desirable standard.
Keywords: Basic life support, dental graduates, emergency drugs, medical emergencies
|How to cite this article:|
Pravina N M, Ganesh R. Evaluation of knowledge, experience, and perceptions about medical emergencies among dentists in Chennai, India. Int J Soc Rehabil 2020;5:1-5
|How to cite this URL:|
Pravina N M, Ganesh R. Evaluation of knowledge, experience, and perceptions about medical emergencies among dentists in Chennai, India. Int J Soc Rehabil [serial online] 2020 [cited 2023 Mar 21];5:1-5. Available from: https://www.ijsocialrehab.com/text.asp?2020/5/1/1/331465
| Introduction|| |
Every dental health professional should have the essential knowledge to identify, assess, and manage a potentially life-threatening situation. Dentists encounter medical emergencies in their clinics which can be life threatening. These emergencies should be treated immediately and cannot be avoided or referred, because they put the life and health of patients at risk. Professional bodies usually have its own code of conduct for their members. The code of ethics for dentists toward patients and the public was standardized by the Dental Council of India, “Treat the welfare of the patients as paramount to all other considerations and shall conserve it to the utmost of his ability.” In 1971–1972, health professions education worldwide was assessed by the World Health Organization commission, and the commission concluded that education and health service system are inextricably interwoven with each other and questions about the training of health-care providers follow soon after when questions arise about the delivery of service. Dental professionals are expected to provide safe and painless dental procedures when they complete their education from dental colleges. Undergraduate dental education's aim has been described as “to produce a caring, knowledgeable, competent, and skillful dentist who is able, on graduation to accept professional responsibility for the effective and safe care of patients who appreciates the need for continuing professional development, who is able to utilize advances in relevant knowledge and techniques and who understands the role of the patient in decision-making.” A medical condition demanding immediate treatment is an emergency.
Medical emergencies have many forms including syncope, asthmatic attacks, epileptic attacks, and cardiac arrest. In dental offices, medical emergencies do occur. A survey was conducted among 4000 dentists by Fast and others, and the results of the survey revealed that for 10 years, 7.5 emergencies per dentist were reported. A total of 13,836 emergencies were reported within a 10-year period in a survey conducted among 2704 dentists throughout North America. It is mandatory that every dental health professional should have basic knowledge to manage a potentially life-threatening situation. A study was conducted in Japan between 1980 and 1984 by the Japanese Dental Society, and it was reported in the study that anywhere from 19% to 44% of dentists had a patient with a medical emergency in any 1 year and about 70.2% of general dental practitioners in the United Kingdom have managed medical emergency even. One study conducted in Australia reported that approximately 15% of dental surgeons had done cardiopulmonary resuscitation (CPR) for the patients in their dental offices in 1 year.
Although a number of studies have been carried out which sought to ascertain the emergency drugs and equipment, the lack of training and inability to cope with medical emergencies can lead to tragic consequences and sometimes legation action. Changing socioeconomics in the populace and prompting expanded life span have driven the general population having therapeutic conditions which incline to a medicinal crisis or taking solution may impact their dental administration, and people matured over 65 years or over are thought to produce a drug with a potential result on dental care. An expanding extent of the populace is therapeutically in danger. According to the European Resuscitation Council, sudden cardiac arrest is a leading cause of death in Europe, affecting about 7,00,000 individuals a year. For this reason, as all the health professionals, dentists must be well prepared to attend to and collaborate with the medical emergencies. Providing basic life support (BLS) is the dentists' most important contribution until definitive treatment for a medical emergency can be provided. Few studies have assessed how competent dentists consider themselves in managing medical emergencies, and very few studies to our knowledge have reported studies involving fresh dental graduates. In a study conducted by Gupta et al., it was reported that less than half (42.1%) of the dentists received training during their undergraduate and postgraduate education. The lack of training and inability to cope with medical emergencies can cause tragic consequences and sometimes legation action. Hence, as all the health care professionals, dental care professionals must be well prepared to manage medical emergencies.
Therefore, the aim of this study is to learn the experience of handling medical emergencies, their skills and competency and how well they are prepared to manage such events with appropriate use of drugs and equipment in a dental setting.
| Materials and Methods|| |
Data were collected from 50 dentists in Chennai using a structured questionnaire consisting of a 7-item questionnaire (6 – closed and 1 – open ended).
The sample was selected based on certain inclusion and exclusion criteria.
- South Chennai dentists.
- Dental assistants.
| Results|| |
The percentage of dentists about the knowledge of identifying the recommended drugs in their emergency kit is explained in [Figure 1]. 94% of the dentists reported Chlorpheniramine is considered to be the essential drug in dental treatment. [Figure 2] denotes the percentage of dentists' confidence of using the recommended drugs in their emergency kit. 76% of the dentist were confident of using the recommended drugs in the emergency kit. Majority of the participants reported all the equipment's in the emergency Kit are considered to be essential [Figure 3]. 60% of the dentist were unsure of using the essential equipment's in emergency kit [Figure 4]. 96% of the dentist mentioned Intramuscular region to be the commonest site for drug administration [Figure 5].
|Figure 1: The percentage of dentists about the knowledge of identifying the recommended drugs in their emergency kit|
Click here to view
|Figure 2: The percentage of dentists' confidence of using the recommended drugs in their emergency kit|
Click here to view
|Figure 3: The percentage of dentists about the knowledge of essential pieces of equipment in the emergency kit|
Click here to view
|Figure 4: The percentage of dentists' confidence of using essential pieces of equipment in the emergency kit|
Click here to view
|Figure 5: The competency in the areas of drug administration/other procedures|
Click here to view
| Discussion|| |
Medical emergencies have been reported to occur frequently in dental practice. Fortunately, serious medical emergencies in dental practice are not common, but they are all the more alarming when they occur. A thorough patient history can draw the practitioner's attention to potential medical emergencies that could occur. Dental professionals' most important contribution is to provide BLS to the patients until absolute treatment for medical emergency situations. Data obtained from dentists in independent studies by Fast et al. and Malamed et al. report that the dental office environment is not immune to the occurrence of potentially life threatening. In a 10-year period, more than 30,000 emergencies were reported by more than 4000 dentists, Junaid Ahmed et al. surveyed the nature of the emergencies varied significantly, from syncope to cardiac arrest and anaphylaxis. It is believed that the overwhelming majority of emergencies encountered were precipitated by the increased stress that is so often present in the patient in the dental environment. Increased stress can result from fear and anxiety or inadequate pain control., Stress is associated with an increased occurrence of emergency situations was also reported by Matsuura et al. who reported that 77.8% of life-threatening systemic complications in the dental office developed either during local anesthetic administration or during dental treatment.
The above data dictate the need for the dental surgeon to be trained to promptly recognize and efficiently manage emergency situations. Our study showed knowledge about medical emergencies among the dental graduates. They hand the best knowledge was about handling syncope, diabetic emergencies, and asthma, and the knowledge about cardiac arrest was very minimal. Birang et al. in their study showed that the knowledge score of Esfahan dentists was 5.42/10. Gupta et al. stated that the knowledge of dental surgeons from Udupi and Mangalore, Karnataka, was from moderate to poor. Regina et al., in their study, stated that dental students have little understanding about medical emergencies. The knowledge of Mashhad dentists was also poor as stated in their study conducted in the province of Iran. These results indicate a need for a revision in the curriculum of dental graduate studies. The dental graduates in our study showed a good level of confidence in checking carotid pulse, performing Heimlich maneuver, cardiopulmonary resuscitation, and artificial respiration. We believe that though the knowledge level is adequate, what the graduate lack is in the skills. In the present study, a large number of graduates stated that they did not know how to react in those situations even though they received training in the management of medical emergencies at some time in their curriculum.
From the responses regarding the number of hours of medical emergency training earmarked in the undergraduate curriculum, it is evident that there is a definite need to increase the number of hours spent on emergency management. Only 54.7% of respondents had undergone training in medical emergency and BLS training. Providing BLS is dental surgeons' most important contribution until definitive treatment for a medical emergency can be given. The purpose of BLS is to prevent inadequate circulation or respiration through prompt recognition of the problem and intervention to support a victim's circulation and respiration through CPR. However, a number of studies have found that about half of the dentists from all over the world are not able to perform CPR properly.,, The result may be due to the lack of definitive guidelines from the regulatory bodies about the training with medical emergencies in the dental curriculum. In the dental curriculum, management of medical emergencies in dental practice comes under the syllabi of general medicine and oral surgery. The exact duration and the methodology have not been specified, which need to be updated to enable students to develop a confident approach toward handling medical emergencies.
The dental graduates expressed the need for further medical emergency training and were prepared to be lifelong learners about the topic at hand, and expressed their willingness to attend continuing professional development programs by which they can update their knowledge about medical emergencies. Our result was in accordance with other studies done in the same field.,,,,, The confidence in the use of drugs and equipment mentioned was at a very lower level than the knowledge for all. This suggests that although training is received in the theoretical aspect of emergencies, participants are not particularly confident to treat emergencies and may require further practical training. Athereton JS's study suggested that up to 44% of dentists may have a patient with a medical emergency in a year. The result of this study also reflects that medical emergencies occur quite frequently because more than half of the dentists claimed to have previously encountered medical emergency during their training. The result of this study suggests a deficiency in dental academy's curriculum on medical emergencies. A curriculum refers to the overall content of what is to be taught about a subject matter. Guidelines are in place for the management of medical emergencies in a dental setting, and the purpose of these guidelines is to set out agreed philosophy and responsibilities of all dentists in relation to resuscitation and management of medical emergencies in the dental surgery. Other important points revealed by this study are that only the theoretical training in medical emergencies seems to be effective.
This study also suggests that the dentists may not be prepared to handling medical emergencies effectively because major claimed not to have been taught how to perform many of the potentially lifesaving procedures. Dentists are members of the medical profession and should be confident in dealing with emergencies which may arise during their work. This result is similar to what was reported among a group of medical students where 85.3% of them had never taken any BLS course. Prevention and preparation are often the best antidotes for an emergency. It should also include questions indicating problems the patient may not be aware of, but which may alter treatment. A list of medication names and dosages that are currently prescribed to the patient should be ascertained. The result of this study amplifies the need to ensure that this recommendation is taken very seriously.
| Conclusion|| |
Based on the above study, it can be concluded that the level of training and the level of knowledge on medical emergencies of the dentist in Chennai are good but not up to the desirable standard. The study has allowed to find deficiencies in the way the dentists were trained dealing with medical emergencies and identify a need for improvement, be by increasing the volume and quality of training which they perceive in order to enhance their capability to recognize and manage a medical emergency and to become well-qualified practitioners. Since they are dealing with the life-threatening situations, it is, therefore, necessary to put proper strategies in place, such as the development of the practical model, to improve the areas of weakness this study identified for the patients in their clinic, and they should be well knowledgeable and trained to deal with the emergency situations in the dental office.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Greenwood M. Medical emergencies in the dental practice. Periodontol 2000 2008;46:27-41.
Sabarinath B, Sivapathasundharam B. Ethics in dentistry. J Educ Ethics Dent 2011;1:24-7. [Full text]
Dentists (Code of Ethics) Regulations, 1976 Extract from the Gazette of India, Part II, Sec. 3, Sub Sec (1) Appearing on Page No. 2223-7.
Hendricson WD, Cohen PA. Oral health care in the 21st
century: Implications for dental and medical education. Acad Med 2001;76:1181-206.
Rafeek RN, Marchan SM, Naidu RS, Carrotte PV. Perceived competency at graduation among dental alumni of the University of the West Indies. J Dent Educ 2004;68:81-8.
Morrison AD, Goodday RH. Preparing for medical emergencies in the dental office. J Can Dent Assoc 1999;65:284-6.
Malamed SF. Knowing your patients. J Am Dent Assoc 2010;141 Suppl 1:3S-7S.
Haas DA. Management of medical emergencies in the dental office: Conditions in each country, the extent of treatment by the dentist. Anesth Prog 2006;53:20-4.
Carvalho RM, Costa LR, Marcelo VC. Brazilian dental students' perceptions about medical emergencies: A qualitative explorative study. J Dent Educ 2008;72:1343-9.
Chapman PJ. Medical emergencies in dental practice and choice of emergency drugs and equipment: A survey of Australian dentists. Aust Dent J 1997;42:103-8.
Coulthard P, Bridgman CM, Larkin A, Worthington HV. Appropriateness of a Resuscitation Council (UK) advanced life support course for primary care dentists. Br Dent J 2000;188:507-12.
Atherton GJ, McCaul JA, Williams SA. Medical emergencies in general dental practice in Great Britain. Part 1: Their prevalence over a 10-year period. Br Dent J 1999;186:72-9.
Laurent F, Augustin P, Nabet C, Ackers S, Zamaroczy D, Maman L. Managing a cardiac arrest: Evaluation of final-year predoctoral dental students. J Dent Educ 2009;73:211-7.
Gupta T, Aradhya MR, Nagaraj A. Preparedness for management of medical emergencies among dentists in Udupi and Mangalore, India. J Contemp Dent Pract 2008;9:92-9.
Fast TB, Martin MD, Ellis TM. Emergency preparedness: A survey of dental practioners. J Am Dent Assoc1986;112:499-501.
Malamed SF. Managing medical emergencies. J Am Dent Assoc 1993;124:40-53.
Matsuura H. Analysis of systemic complications and deaths during dental treatment in Japan. Anesth Prog 1989;36:223-5.
Birang R, Kaviani N, Behnia M, Mirghaderi M. Knowledge and equipment preparedness of Isfah and dentist about medical emergencies in 2006. Iran Educ Med Sci J 2006;5:47-54.
Carvalho RM, Costa LR, Marcelo VC. Brazilian dental students perception about medical emergencies: A qualitative exploratory study. J Dent Educ 2008;72:1343-9.
Amirchanghmaghi, Sarabadani J, Delavarian Z, Mosannen Mozafary P, Shahri A, Dalitsani Z. The knowledge and preparedness of general dentists about medical emergencies in Iran. Iran Red Crescent Med J 2011;13:217-8.
Peskin RM, Siegelman LI. Emergency cardiac care. Moral, legal, and ethical considerations. Dent Clin North Am 1995;39:677-88.
Chapman PJ. A questionnaire survey of dentists regarding knowledge and perceived competence in resuscitation and occurrence of resuscitation emergencies. Aust Dent J 1995;40:98-103.
Girdler NM, Smith DG. Prevalence of emergency events in British dental practice and emergency management skills of British dentists. Resuscitation 1999;41:159-67.
Atherton GJ, McCaul JA, Williams SA. Medical emergencies in general dental practice in Great Britain. Br Dent J 1999;186:72-9.
Carvalho RM, Costa LR, Marcelo VC. Brazilian dental students' perceptions about medical emergencies: A qualitative exploratory study. J Dent Educ 2008;72:1343-9.
Adewole RA, Sote EO, Oke DA, Agbelusi AG. An assessment of the competence and experience of dentists with the management of medical emergencies in a Nigerian teaching hospital. Nig Q J Hosp Med 2009;19:190-4.
Atherton GJ, Pemberton MN, Thornhill MH. Medical emergencies: The experience of staff of a UK dental teaching hospital. Br Dent J 2000;188:320-4.
Broadbent JM, Thomson WM. The readiness of New Zealand general dental practitioners for medical emergencies. N Z Dent J 2001;97:82-6.
Bilbao PP, Lucido PI, Iringan TC, Javier RB. Curriculum Development. Quezon City: Lorimar Publishing, Inc.; 2008.
Harden RM. AMEE Guide No. 21: Curriculum mapping: A tool for transparent and authentic teaching and learning. Med Teach 2001;23:123-37.
Ahamed, A. and Kumar, M.S. Knowledge, attitude and perceived confidence in handling medical emergencies among dental students. J Pharm Sci Res 2016;8:645-9.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]