New Emergency Preparedness Information Available For Dental

[divyanshee]

New Emergency Preparedness Information Available For Dental Offices

Best practices for managing medical emergencies in dental clinics have evolved over the past decade to account for advances in knowledge and the development of new medications and medical equipment. Morton Rosenberg, DMD, of Tufts University School of Dental Medicine and an expert on dental anesthesiology, integrated existing guidelines with new information to create an updated list of emergency medications and equipment for dental providers, including an emergency preparedness checklist.

“Every dentist will likely manage a medical emergency during the course of their practice. Planning for such an emergency involves preparing and educating clinical staff, ensuring that medical equipment is accessible and functional, and stocking emergency medications,” said Rosenberg, professor in the department of oral and maxillofacial surgery and head of the division of anesthesia and pain control at Tufts University School of Dental Medicine.

Rosenberg provides an updated emergency preparedness checklist to prepare dental providers for medical emergencies that may occur in the clinical setting, as well as a detailed list of emergency medications and equipment. Medical emergencies that may occur in a clinical setting include allergic reaction to medications, hyperventilation, or heart attack.

Rosenberg advises that specific medications be stocked and regularly checked to ensure they have not exceeded their expiration dates, including oxygen, epinephrine, nitroglycerin, glucose and reversal drugs. He proposes a list of emergency medical equipment to be readily available and accessible, including an automated external defibrillator (AED) and a portable oxygen delivery system. In the paper, Rosenberg details the appropriate actions and administration of medication and uses of equipment based on the medical emergency.

“Emergency preparedness includes adequate training so that dentists and staff respond reflexively to an emergency situation and facilitate better diagnosis and care of the patient,” said Rosenberg.

The paper is published in a supplement on medical emergencies in the May 2010 issue of The Journal of the American Dental Association.

Rosenberg is a professor of oral and maxillofacial surgery and head of the division of anesthesia and pain control at Tufts University School of Dental Medicine. He is also an associate professor in the department of anesthesiology at Tufts University School of Medicine. Rosenberg is the co-author of a textbook, entitled Medical Emergencies in Dentistry.

Rosenberg M. The Journal of the American Dental Association. 2010. (May 1); 141 (5): 14S-19S. “Preparing for medical emergencies: the essential drugs and equipment for the dental office.”

        

[gaurang_thanvi2003]

Emergency management and Its Preparation….
Preparation means “Provision by which one prepares for something”…Preparation of emergency in dental is extremely important to prevent most sever medical emergencies. Every Dentist have well equipped and sophisticated emergency Kit but life threatening emergency like seizure,sever allergic reaction,hypo tension with opposite hypertension,still emergencies occur on dental chair of reputed well known dentist…
So I can called them DENTAL PROTOCOLS
For protocol management every member of dental team is responsible. Dentist should be the team leader,and directing all activities of all members.
Following steps should be taken:-
*The leaders should be dental hygienist,especially in an emergencies involving his or her patient or involving the dentist.
*All dental staff should have Basic life Support (BSL)Certificate from regconised school.
*The receptionist needs to be prepared to recognized emergencies that occur in waiting room.He/She has all important emergency service call.
*Regular check up of emergency cart,mobile van,mobilizing the cart in the event of an emergency.
*Biannual or semiannual mock emergency drill to keeps the office prepared.
By above steps up to certain limit we can prevent the following emergencies –
1.Air obstruction
2.Seizure
3.Unstable Hypotension/Hypertension
4.Sever allergic reaction
5.Idatrogenic(Dental)
Gaurang Thanvi
Jodhpur National University,Jodhpur

        

[Anonymous]

Very much informative post, goob job by both of you. Write regarding management of hyperthyroidism patient

        

[divyanshee]

CONSIDERATIONS FOR DENTAL TREATMENT.
BEFORE TREATMENT: ASSESSMENT OF THYROID FUNCTION

Establish type of thyroid condition.

Is there a presence of cardiovascular disease? If yes, assess
cardiovascular status.

Are there symptoms of thyroid disease? If yes, defer elective
treatment and consult a physician.

Obtain baseline thyroid-stimulating hormone, or TSH. Control is
indicated by hormone levels, length of therapy and medical
monitoring. If the patient has received no medical supervision
for more than one year, consult a physician.

Obtain baseline complete blood count. Give attention to druginduced
leukopenia and anemia.

Assess medication and interactions with thyroxine and TSH.

Make proper treatment modifications if the patient is receiving
anticoagulation therapy.

Take blood pressure and heart rate. If blood pressure is elevated
in three different readings or there are signs of
tachycardia/bradycardia, defer elective treatment and consult a
physician.

DURING TREATMENT

Oral examination should include salivary glands. Give attention
to oral manifestations.

Monitor vital signs during procedure:
 Is the patient euthyroid? If yes, there is no contraindication to
local anesthetic with epinephrine.

 Use caution with epinephrine if the patient taking nonselective
β-blockers.

 If the patient’s hyperthyroidism is not controlled, avoid
epinephrine; only emergent procedures should be performed.

Minimize stress–appointments should be brief.
Discontinue treatment if there are symptoms of thyroid
disease.

Make pertinent modifications if end-organ disease is present
(diabetes, cardiovascular disease, asthma).

AFTER TREATMENT
Patients who have hypothyroidism are sensitive to central
nervous system depressants and barbiturates.
Control pain.

Use precaution with nonsteroidal anti-inflammatory drugs for
patients who have hyperthyroidism, avoid aspirin.

Continue hormone replacement therapy or antithyroid drugs as
prescribed.

        

[sushantpatel_doc]

that was very precise and informative..

        

[sushantpatel_doc]

i would like to know what sorts of medical emergencies can a thyroid disorder lead to..

        

[Anonymous]

sushantpatel_doc wrote:

i would like to know what sorts of medical emergencies can a thyroid disorder lead to..

emergencies or no emergencies avoid doing extensive procedures and extractions in patients with thyroid disorders. However, usually thyroid disorders are well controlled

        

[Drsumitra]

The University at Buffalo (UB) School of Dental Medicine has unveiled a new mobile dental van, S-miles To Go.The dental van is a 42-ft-long, three-chair dental clinic built on a semitrailer chassis, according to the university. It features a wheelchair lift, a panoramic x-ray unit, digital radiography, an intake/education area, and electronic patient records.

The UB dental school has served the oral health care needs of children in Chautauqua County for 15 years with its school-based mobile dental van. Chautauqua County is designated as a dental health professional shortage area, with few dentists serving Medicaid-eligible patients. UB’s dental staff has provided care during 38,000 patient visits since 1997.

The dental unit was funded by a grant from the federal Health Resources and Services Administration, the Ralph C. Sheldon Foundation, and the Lenna Foundation, both of Jamestown, NY.

 

        

[drmithila]

While electronic health records (EHRs) offer many advantages to the practice of dentistry, they also open the door to questions of patient privacy and security. Nowhere is this more evident than in the current dental school environment, according to an article on the ethics of EHRs in the Journal of Dental Education (JDE, May 2012, Vol. 76:5, pp. 584-589).

“Electronic health records are a major development in the practice of dentistry, and dental schools and dental curricula have benefitted from this technology,” wrote co-authors Robert Cederberg, DDS, and John Valenza, DDS, of the University of Texas Health Science Center at Houston. “Quick and easy access to patient data has allowed practitioners to be more efficient with the delivery of patient care and has streamlined consultations, referrals, and multispecialty care.”

When compared to paper records, EHRs make it easier to input, duplicate, store, retrieve, manipulate, transmit, and archive patient data, the authors noted. However, the evolution from paper to electronic charts has also prompted concern for the safety and privacy of patient information.

“Even though the EHR offers benefits in the access and management of sensitive patient data … it may also provide the potential for unscrupulous use of this information by persons who may purposely or inadvertently breach ethical principles,” they wrote.

EHRs and depersonalization

Academic misconduct has become a hot topic, and the dental community is not immune. In 2006 and 2007, cheating scandals were discovered at dental schools in New Jersey, Nevada, Indiana, and California. And a 2007 survey in the Journal of Dental Education found that 75% of dental students admitted to cheating on exams (August 2007, Vol. 71:8, pp. 1027-1039), while a 2008 JDE study involving data from 14,000 students on three dental school campuses revealed 30 different methods for cheating, a third of them “technologically based” (March 2008, Vol. 72:3, pp. 359-363).

While it is unlikely that the EHR in and of itself can create an environment that fosters cheating in a dental school setting, “the use of an electronic database rather than a paper-based patient record certainly provides a vehicle that may allow the unscrupulous user a much more effective way to cheat,” Drs. Cederberg and Valenza wrote.

Part of the problem with the increasing presence of computers in the operatory is the effect this has on the doctor-patient relationship, they noted. A study in the Annals of Family Medicine found that “conflict exists for the provider between interacting with the EHR and giving patients the needed one-on-one attention” (March 2006, Vol. 4:2, pp. 124-131).

As a result, “dental educators must be aware that any dissociation between today’s dental student and the patient could be further compromised by the electronic tools and opportunities provided to the student via an EHR,” wrote Drs. Cederberg and Valenza in the JDE paper. “This depersonalization … may create an opportunity for an ethical breach.”

In fact, the very thing that makes EHRs so attractive to so many people — easier access to data — also makes them ripe for a breach of ethical conduct, they added. These “opportunities for misconduct” can include the following:

Sharing or stealing passwords or other authentication devices
Misusing procedure codes
Violating patient information security or privacy
Excluding patients from participating in the electronic record because the student may fear the patient will choose a treatment that does not benefit the student’s educational needs
“Many school-based electronic clinic management systems are built to allow access to the data to many different types of users, which in turn may result in increased difficulties with controlling access to certain sensitive areas of the system,” the authors wrote.

Drs. Cederberg and Valenza also contend that alterations to electronic records are easier to hide than with paper-based records.

“While routine and random audits of paper-based records by faculty members can easily spot altered and missing data, it may take an IT specialist with a good working knowledge of the software to find altered or missing entries with the EHR,” they wrote.

Technological safeguards

However, Titus Schleyer, DMD, PhD, director of the Center for Dental Informatics at the University of Pittsburgh, believes that many safeguards are already in place that, while not perfect, reduce the risk of security breaches when using electronic records.

“People talk a lot about the need to educate students and others about ethics, but we also need to look at the technical end to detect unethical behavior,” he said.

For example, in Axium — the clinical management system most widely used in dental schools — any change in any field at any time is logged and a HIPAA-compliant audit trail created. In addition, there are specific HIPAA rules regarding the integrity of patient information when it is inputted and transmitted, Dr. Schleyer noted.

“HIPAA stipulates that the designer and user take precautions to ensure that the data is not altered, so you can encrypt the data to ensure it doesn’t get compromised in transit,” he said. “And if you do this in a conscientious manner, you may not completely eliminate the risk of a security breach, but with high-strength encryption keys you can dramatically reduce the risk.”

In addition to introducing dental students to the advantages of EHRs and how they should be properly used, dental schools need to spend more time in general educating students on ethics and professionalism, according to Drs. Cederberg and Valenza. A recent survey of ethics instructors at 56 U.S. dental schools revealed that “little time is devoted to ethics instruction in the formal curriculum” (JDE, October 2011, Vol. 75:10, pp. 1295-1309).

“The ultimate goal is to minimize the potential for ethical quandaries to arise for students and faculty members,” they wrote. “Dental schools must either create or reinforce an ethical culture on campus that should include students, faculty members, and staff; increase or modify the teaching of ethics to all EHR users; and consider instituting additional technologies to monitor and safeguard the EHR.”

        

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