Medical emergencies in dental offices can manifest from various conditions due to the unique stressors that the dental environment imposes on patients. Common emergencies encountered in dental practices include cardiovascular events, allergic reactions, respiratory issues, and episodes of syncope.
A systematic review of the literature indicates that vasovagal syncope is among the most frequently reported emergencies. For instance, it has been shown that syncope occurs more frequently in patients undergoing procedures that elicit greater physiological stress, such as restorative treatment and dental surgery (Atherton et al., 2000; , Sorenson et al., 2021).
Cardiovascular events, including angina pectoris and hypertensive crises, also rank highly among emergencies encountered in dental settings. Data suggest that these emergencies are commonly linked to the anxiety and stress of dental procedures (Cangül et al., 2025; , (Kumarswami et al., 2015). Additionally, research highlights that cardiac conditions are prevalent in dental settings, underscoring the importance of emergency preparedness among dental practitioners (Kumarswami et al., 2015). Research indicates that while the incidence of cardiac arrest in dental settings is relatively low, reported at approximately 0.003 cardiac arrests per dentist per year, other emergencies such as vasovagal syncope are more common (Laurent et al., 2009), and maybe difficult to distinguish between a uncomplicated syncope event and a syncope event with acute coronary syndrome, without the use of a 12 lead ECG.
Dental procedures often involve the administration of local anesthetics, which can impact cardiovascular stability, especially in patients with pre-existing conditions. The use of epinephrine in local anesthetics is a significant factor, as it can lead to cardiovascular complications in susceptible patients (Meechan et al., 2002). Therefore, dentists are advised to be aware of the systemic health of their patients and manage risks effectively by adjusting anesthetic protocols as necessary. Additionally, the dental office environment poses unique challenges, such as the aspiration of dental materials, which can lead to asphyxia and potentially cardiac arrest if not managed appropriately. Studies highlight critical interventions, such as the use of supine abdominal thrust for asphyxia relief in a dental chair setting (Awata et al., 2019), and emphasize the importance of immediate response actions to cardiac emergencies when conventional methods fail (Awata et al., 2019). These studies suggest that dentists should be trained in emergency response, including cardiopulmonary resuscitation and management of airway obstructions, with frequent renewal and competency training.
Furthermore, cardiovascular health is often intertwined with oral health, particularly in cases of periodontal disease, which has been identified as a potential risk factor for cardiovascular disease (CVD) (Zhou et al., 2021). The inflammatory markers associated with periodontal conditions can influence overall cardiovascular health, suggesting that the management of oral health issues may contribute to reducing cardiac emergencies in dental settings. This does raise the risk of acute coronary syndromes for patient in these settings.
Allergic reactions, particularly anaphylaxis, are critical considerations in dental practice. For example, a survey identified anaphylactic reactions associated with medications like diclofenac among dental patients (Sanuki et al., 2010). Furthermore, certain allergens, such as latex and penicillin, are significant triggers for allergic responses in dental clinics (Sanuki et al., 2010).
Respiratory emergencies, specifically asthma attacks and hyperventilation, also feature prominently among the commonly encountered medical emergencies in dentistry. Studies indicate that approximately 63% of dental practitioners have encountered such emergencies, often exacerbated by the anxiety of undergoing dental treatment (Edwin et al., 2020; , (Anders et al., 2010.
Hypoglycemia is regularly listed among the most common medical emergencies in dental offices, particularly among diabetic patients. It is crucial for dental professionals to recognize hypoglycemic symptoms promptly, as they can escalate quickly (Anders et al., 2010; , Muller et al., 2008).
Training for dental practitioners on how to handle medical emergencies has been shown to vary, with evidence indicating a need for improved education and simulation exercises (Muller et al., 2008). This is crucial, as many medical emergencies, although not frequently life-threatening, require timely intervention to prevent the deterioration of the patient into a life-threatening event (Laurent et al., 2009; Muller et al., 2008). Continuing education in emergency medical response is essential in ensuring that dental professionals are prepared to handle such critical situations effectively, particularly in light of realistic EMS response times to the dental facility.
In summary, the prevalence of various medical emergencies in dental facilities, including vasovagal syncope, cardiovascular events, allergic reactions, respiratory issues, and hypoglycemia, calls for comprehensive training and preparedness among dental professionals to manage these situations effectively. As dental practitioners encounter these emergencies with notable frequency, ensuring robust emergency protocols and training is imperative for patient safety and care quality (Clark et al., 2006).
References:
- Anders, P., Comeau, R., Hatton, M., & Neiders, M. (2010). The nature and frequency of medical emergencies among patients in a dental school setting. Journal of Dental Education, 74(4), 392-396.
https://doi.org/10.1002/j.0022-0337.2010.74.4.tb04883.x
- Atherton, G., Pemberton, M., & Thornhill, M. (2000). Medical emergencies: the experience of staff of a uk dental teaching hospital. BDJ, 188(6), 320-324.
https://doi.org/10.1038/sj.bdj.4800469
- Awata, N., Hitosugi, T., Miki, Y., Kawakubo, Y., & Yokoyama, T. (2019). Usefulness of a stool to stabilize dental chairs for external chest compression..
https://doi.org/10.21203/rs.2.9600/v1
- Awata, N., Hitosugi, T., Miki, Y., Tsukamoto, M., Kawakubo, Y., & Yokoyama, T. (2019). Usefulness of a stool to stabilize dental chairs for cardiopulmonary resuscitation (cpr). BMC Emergency Medicine, 19(1).
https://doi.org/10.1186/s12873-019-0258-x
- Cangül, S., Taşyürek, M., & Adıgüzel, Ö. (2025). Evaluation of dentists' knowledge, attitudes, and treatment approaches to emergencies in dental practice: a cross-sectional study..
https://doi.org/10.21203/rs.3.rs-7165716/v1
- Clark, M., Wall, B., Tholström, T., Christensen, E., & Payne, B. (2006). A twenty‐year follow‐up survey of medical emergency education in u.s. dental schools. Journal of Dental Education, 70(12), 1316-1319.
https://doi.org/10.1002/j.0022-0337.2006.70.12.tb04234.x
- Edwin, A., Thangavelu, L., & Mohanraj, K. (2020). Medical emergency in dental clinic - an update. International Journal of Research in Pharmaceutical Sciences, 11(SPL3), 831-839.
https://doi.org/10.26452/ijrps.v11ispl3.3031
- Kumarswami, S., Tiwari, A., Parmar, M., Shukla, M., Bhatt, A., & Patel, M. (2015). Evaluation of preparedness for medical emergencies at dental offices: a survey. Journal of International Society of Preventive and Community Dentistry, 5(1), 47.
https://doi.org/10.4103/2231-0762.151977
- Laurent, F., Augustin, P., Nabet, C., Ackers, S., Zamaroczy, D., & Maman, L. (2009). Managing a cardiac arrest: evaluation of final‐year predoctoral dental students. Journal of Dental Education, 73(2), 211-217.
https://doi.org/10.1002/j.0022-0337.2009.73.2.tb04656.x
- Meechan, J., Parry, G., Rattray, D., & Thomason, J. (2002). Effects of dental local anaesthetics in cardiac transplant recipients. BDJ, 192(3), 161-163.
https://doi.org/10.1038/sj.bdj.4801323a
- Muller, M., Hänsel, M., Stehr, S., Weber, S., & Koch, T. (2008). A state-wide survey of medical emergency management in dental practices: incidence of emergencies and training experience. Emergency Medicine Journal, 25(5), 296-300.
https://doi.org/10.1136/emj.2007.052936
- Sanuki, T., Sugioka, S., & Kotani, J. (2010). Anaphylactic reaction induced by diclofenac: a case report. Oral Science International, 7(1), 34-36.
https://doi.org/10.1016/s1348-8643(10)80011-4
- Sorenson, A., Marusko, R., & Kennedy, K. (2021). Medical emergencies in the dental school setting. Journal of Dental Education, 85(7), 1223-1227.
https://doi.org/10.1002/jdd.12590 ;
- Zhou, M., Dong, J., Zha, L., & Liao, Y. (2021). Causal association between periodontal diseases and cardiovascular diseases. Genes, 13(1), 13.
https://doi.org/10.3390/genes13010013