Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Medical Emergencies in the Dental Office: Prevention and Preparedness

Dr. Sonal Ugalmugle, Dr. Lina Chaban, Dr. Archana Nimale, Dr. Manjiri Chakor, Dr. Sruthi Kalakota, Dr. Monica Milagros Parra Rodil, Dr. Sandeep Singh*, Dr. Ridhi Bhola

MDS, Post Graduate Institute of Dental Sciences, Rohtak, India

Abstract: Medical emergencies, though infrequent, can occur unexpectedly in the dental office and may pose serious risks to patient safety if not promptly recognized and managed. The increasing prevalence of medically compromised patients, dental anxiety, and the use of local anesthesia and sedation have heightened the likelihood of such events in routine dental practice. This narrative review aims to provide a comprehensive overview of commonly encountered medical emergencies in the dental setting, with emphasis on their prevention and preparedness. Key areas discussed include patient assessment and risk identification, preventive strategies to minimize emergency occurrence, essential emergency drugs and equipment, staff training, and basic principles of emergency management. Emphasis is placed on the role of systematic preparation and regular training in improving outcomes. By enhancing awareness and preparedness, dental professionals can ensure timely intervention, reduce morbidity, and improve patient safety in the dental office.

Keywords: Medical emergencies, dental office, prevention, preparedness, patient safety

Received January 16, 2026; Revised February 18, 2026; Accepted February 25, 2026

Citation: Dr. Sonal Ugalmugle, Dr. Lina Chaban, Dr. Archana Nimale, Dr. Manjiri Chakor, Dr. Sruthi Kalakota, Dr. Monica Milagros Parra Rodil, Dr. Sandeep Singh, Dr. Ridhi Bhola, Medical Emergencies in the Dental Office: Prevention and Preparedness. American Journal of Clinical Medicine Research, 14 (1). 1-7. January 2026. doi:10.12691/ajcmr-14-1-1

1. Introduction

Medical emergencies in the dental office, although relatively uncommon compared with other clinical settings, represent a significant challenge due to their potential for rapid deterioration and serious patient harm if not managed promptly and effectively. These emergencies can range from benign vasovagal syncope to life-threatening conditions such as myocardial infarction, anaphylaxis, and airway compromise. Syncope is the most frequently reported emergency encountered in dental practice, followed by hypoglycemia, allergic reactions, seizures, and cardiovascular events, underscoring the spectrum of possible acute presentations during routine dental care. [1]

The increasing complexity of dental patients, with a rising prevalence of chronic systemic diseases and the greater use of pharmacologic sedation and anesthesia in dental practice, is likely to augment the incidence of medical emergencies. Notably, surveys of practicing dentists reveal that a substantial majority have encountered at least one medical emergency during their clinical career, yet preparedness and confidence in managing such events vary widely. [2]

Prevention and preparedness are central to mitigating the consequences of these events. Systematic patient evaluation, including comprehensive medical history taking and vital signs assessment, helps identify individuals at risk. [3] Moreover, the establishment of an office emergency plan, access to appropriate emergency drugs and equipment, and regular team training in basic life support are critical components of effective emergency readiness. [4]

Despite the recognized importance of emergency preparedness, gaps persist in training, equipment availability, and confidence among dental professionals, emphasizing the need for continuous education and structured emergency protocols tailored to the dental office environment. [5]

2. Methodology

Articles published in English between 2000 and 2024 were considered. Peer-reviewed original research articles, review articles, clinical guidelines, and consensus statements relevant to medical emergencies in dental settings were included. Studies focusing exclusively on hospital-based emergencies, non-dental settings, or lacking relevance to prevention and preparedness in dental practice were excluded. Relevant articles were selected based on title and abstract screening, followed by full-text review. Additional references were identified through manual screening of the reference lists of selected articles to ensure comprehensive coverage of the topic.

3. Classification of Medical Emergencies in Dental Practice

3.1. Syncope

3.1.1. Causes

Syncope (fainting) is the most common medical emergency in dental offices, often triggered by stress, anxiety, pain, or vasovagal reflex, leading to transient cerebral hypoperfusion. It may also be precipitated by prolonged upright posture or dehydration. Surveys show syncope represents a high proportion of dental emergencies. [6]

3.1.2. Management

Place the patient in a supine position with legs elevated, maintain a patent airway, and administer high-flow oxygen. Monitor vital signs and reassure the patient; most episodes resolve quickly. If unconsciousness persists, consider basic life support (PABCD: position, airway, breathing, circulation, differential diagnosis). [7]

3.2. Hypoglycemia and Hyperglycemia

3.2.1. Causes

Hypoglycemia occurs when blood glucose drops acutely, especially in diabetics who have missed meals or taken insulin without food. Hyperglycemia can emerge from stress, infection, or poorly controlled diabetes. Both conditions may present during dental care. [8]

3.2.2. Management

For hypoglycemia, if the patient is conscious, provide oral glucose (e.g., glucose tablets/juice). If unconscious, activate emergency services and administer glucagon if available, alongside oxygen support. For hyperglycemia, supportive care and urgent medical assistance are required; avoid oral intake if unconscious. [9]

3.3. Asthma Attacks

3.3.1. Causes

Asthma exacerbations may be triggered by stress, anxiety, respiratory irritants in the dental environment, or underlying asthma. [10]

3.3.2. Management

Position the patient upright, administer bronchodilator (patient’s own inhaler) with a spacer if available, and give supplemental oxygen. If unresponsive to initial therapy or severe bronchospasm develops, intramuscular epinephrine may be considered, and EMS summoned. [11]

3.4. Allergic Reactions and Anaphylaxis

3.4.1. Causes

Allergic reactions in dental settings stem from drugs (e.g., antibiotics like penicillin), latex, or dental materials. IgE-mediated anaphylaxis is the most serious form and can rapidly progress to airway compromise, hypotension, and shock. [12]

3.4.2. Management:

For mild reactions, antihistamines and removal of the trigger may suffice. For anaphylaxis, intramuscular epinephrine (0.3 mg adult dose) is the first-line therapy, followed by high-flow oxygen and EMS activation. Support airway and circulation aggressively. [12]

3.5. Angina Pectoris and Myocardial Infarction

3.5.1. Causes

Chest pain in dental patients may indicate angina or acute myocardial infarction, particularly in individuals with cardiovascular risk factors. Stress and pain can precipitate ischemic events. [13]

3.5.2. Management

Terminate dental treatment and position the patient comfortably. Administer oxygen, sublingual nitroglycerin if prescribed, and chewable aspirin unless contraindicated. Activate EMS immediately for suspected myocardial infarction. Continuous monitoring and basic life support as needed. [13]

3.6. Seizures

3.6.1. Causes

Seizures may occur in patients with a history of epilepsy or be induced by hypoglycemia, local anesthetic toxicity, or cerebral hypoxia. [14]

3.6.2. Management

Protect the patient from injury without restraining forcefully, maintain airway patency, and administer oxygen. After the seizure, position the patient in the recovery position and monitor vitals. If seizures persist or recur frequently, activate EMS. [14]

3.7. Stroke

3.7.1. Causes

Stroke (cerebrovascular accident) may present acutely with focal neurological signs; stress and hypertension in predisposed patients may be triggers. [15]

3.7.2. Management

Recognize signs (e.g., facial droop, speech disturbance) and activate EMS immediately. Support airway, breathing, and circulation; do not give antiplatelet therapy in the dental office. Early hospital stroke protocols improve outcomes. [15]

3.8. Local Anaesthetic Toxicity

3.8.1. Causes

Toxic reactions are usually due to excessive dosage, rapid systemic absorption, or inadvertent intravascular injection of local anesthetics like lidocaine. Symptoms include CNS excitation, dizziness, tinnitus, seizures, or cardiovascular instability. [16]

3.8.2. Management

Stop administration immediately, secure the airway, provide oxygen, and monitor cardiovascular status. Mild symptoms resolve with supportive care, but seizures or cardiovascular compromise require advanced medical support. [16]

3.9. Airway Obstruction and Aspiration

3.9.1. Causes

Airway obstruction can result from soft tissue collapse (e.g., tongue in unconscious patients), foreign body aspiration (dental materials), or severe allergic swelling. [17]

3.9.2. Management

If conscious and choking, perform back blows and abdominal thrusts. If unconscious, open the airway with head-tilt/chin-lift, clear visible obstructions with suction or forceps, and begin basic airway support. Oxygen and EMS activation are critical. [17]

3.10. Cardiac Arrest

3.10.1. Causes

Cardiac arrest in the dental office may be secondary to myocardial infarction, arrhythmia, severe hypoxia, or anaphylaxis. [18]

3.10.2. Management

Immediate recognition and activation of EMS with initiation of CPR (high-quality chest compressions with minimal interruptions) and use of an automated external defibrillator (AED) as soon as available are paramount. Continue until advanced care arrives. [18] Table 1

Table 1. Management of Common Medical Emergencies in the Dental Office

Abbreviations:

CPR-cardiopulmonary resuscitation; IM- intramuscular; IV-intravenous; SubQ-subcutaneous; kg-kilogram; mg-milligram; mL-millilitre; EMS-emergency medical services.

4. Etiology and Risk Factors

Medical emergencies in dental practice do not occur in isolation; understanding their underlying causes and contributing factors is essential for prevention and preparedness. These etiological factors can be broadly categorized as patientrelated, procedurerelated, provider and staffrelated, and environmental or stressrelated triggers.

4.1. PatientRelated Factors

Certain characteristics intrinsic to the patient significantly elevate the risk of a medical crisis during dental care. Systemic health conditions such as cardiovascular disease, diabetes, respiratory disorders, and a history of seizures create a baseline vulnerability to adverse events during dental procedures. Studies have shown that a substantial proportion of emergency episodes involve patients with preexisting systemic diseases, particularly cardiovascular conditions, highlighting the importance of thorough medical history and risk assessment before dental treatment. [19]

Age is another crucial determinant: elderly patients often present with multiple comorbidities and polypharmacy, both of which increase the likelihood of unexpected complications. Likewise, very young patients may have less predictable physiological responses and are more prone to airway issues such as foreign body aspiration. Moreover, patients with poor disease control, such as unstable diabetes or uncontrolled hypertension, are more susceptible to metabolic and cardiovascular emergencies in the dental chair. Thorough evaluation and risk stratification of these individuals reduce the chance of acute episodes. [20]

4.2. ProcedureRelated Factors

The nature of dental procedures themselves can influence emergency risk. Invasive or lengthy treatments evoke greater physiological stress reactions compared with simpler interventions. Evidence indicates that procedure-induced stress correlates with systemic responses, such as elevated blood pressure and increased heart rate that can precipitate emergencies. Administration of local anesthesia, particularly with vasoconstrictors, may provoke adverse cardiovascular responses in susceptible patients. Additionally, the period immediately following anesthetic injection and during active treatment represents a common window for acute events such as syncope or allergic reactions. Complex surgical procedures and pain-provoking interventions can aggravate stress and trigger physiological responses that manifest as medical emergencies, especially in individuals with poorly controlled systemic conditions. [21]

4.3. Dentist and StaffRelated Factors

The knowledge, preparedness, and behaviour of the dental team play substantial roles in risk mitigation. Surveys and scoping reviews have documented gaps in emergency preparedness and confidence among dental professionals, despite widespread acknowledgement of the need for emergency management skills. [22]

Failure to conduct thorough medical history reviews, neglecting to update patient records, and inadequate assessment of risk factors can all lead to unforeseen emergencies. Early signs and symptoms are often recognized through effective communication and clinical vigilance by the dentist and support staff. [23] Training gaps, especially in basic life support (BLS) and mock emergency drills, can delay effective responses during a crisis. Regular refreshers and competency assessments are crucial to ensure the dental team can respond quickly and effectively when emergencies occur.

4.4. Environmental and Stress-Related Triggers

The dental office environment is inherently anxiety-inducing for many patients, and psychological stress itself is a recognized trigger for medical events such as syncope, asthma exacerbations, and angina. Research shows that stress and fear are major contributors to the occurrence of emergencies in dental settings, even in patients without significant comorbidities.

Situational stressors include fear of needles, drills, or pain, compounded by anticipatory anxiety. Such responses may provoke hyperventilation, fainting, or cardiovascular changes, particularly in predisposed individuals. The physical environment, including noise, uncomfortable positioning, and immobility during procedures, can further exacerbate stress responses. Being mindful of these factors and implementing stressreduction strategies (such as clear communication, pain control, and patient reassurance) can help mitigate risk. [24]

5. Prevention of Medical Emergencies

Prevention remains the most effective strategy for minimizing the occurrence of medical emergencies in the dental office. A systematic approach encompassing comprehensive patient assessment, individualized treatment planning, and prudent pharmacological management significantly reduces risk and enhances patient safety.

5.1. Patient Assessment

A thorough and updated medical history forms the cornerstone of emergency prevention in dental practice. Identification of systemic diseases such as cardiovascular disorders, diabetes, respiratory illnesses, and seizure disorders allows clinicians to anticipate potential complications and modify care accordingly. Studies have shown that inadequate or outdated medical histories are frequently associated with adverse medical events in dental settings [25]

The American Society of Anesthesiologists (ASA) physical status classification is widely used to stratify patients according to systemic health and predict peri-procedural risk. Higher ASA classifications are associated with increased incidence of medical complications during dental treatment, emphasizing the need for heightened vigilance and preventive measures in medically compromised individuals. [26]

Routine vital signs monitoring, including blood pressure, heart rate, respiratory rate, and oxygen saturation, aids in early detection of physiological instability. Pre-operative and intra-operative monitoring is particularly important in elderly patients and those with cardiovascular disease. [27] Implementation of stress reduction protocols, such as short morning appointments, effective communication, adequate pain control, and anxiolytic measures, has been shown to significantly reduce anxiety-related emergencies such as syncope and angina. [28]

5.2. Treatment Planning

Dental treatment plans should be individualized based on the patient’s medical status. Medically compromised patients often require procedural modifications, including minimally invasive techniques, staged treatment, and avoidance of excessive physical or emotional stress. Failure to adapt treatment plans has been identified as a contributing factor in preventable dental emergencies. [29]

Appointment timing and duration play a critical preventive role. Shorter appointments scheduled earlier in the day are recommended for patients with cardiovascular disease, diabetes, or severe anxiety, as fatigue and stress accumulation later in the day may precipitate emergencies. Evidence suggests that prolonged procedures are associated with increased physiological stress responses. [29]

5.3. Pharmacological Considerations

A careful review of drug interactions is essential, particularly in patients on anticoagulants, antihypertensives, antidiabetic agents, and central nervous system depressants. Polypharmacy significantly increases the risk of adverse drug reactions during dental care. Appropriate calculation of local anesthetic dosage, with strict adherence to maximum recommended limits, is crucial to prevent systemic toxicity. Accidental intravascular injection and overdose remain common causes of local anesthetic adverse events in dentistry. [30] When sedation is employed, patient selection, dosage titration, and continuous monitoring are essential. Sedation-related complications are more likely in patients with undiagnosed obstructive sleep apnea, obesity, or significant systemic disease, reinforcing the need for careful risk assessment and preparedness. [31]

6. Preparedness in the Dental Office

Despite preventive efforts, medical emergencies may still occur; therefore, comprehensive preparedness is essential to ensure rapid and effective response. Preparedness encompasses the availability of appropriate drugs and equipment, as well as ongoing training of the dental team.

6.1. Emergency Drugs

An essential emergency drug kit should be readily accessible in every dental office. Core medications typically include oxygen, epinephrine, antihistamines, bronchodilators, glucose, nitroglycerin, aspirin, and benzodiazepine antagonists, where sedation is practiced. The presence of a well-maintained emergency kit has been shown to improve outcomes during acute medical events. Proper storage and maintenance, including regular checks for expiration dates and functionality, are critical. Lack of familiarity with emergency drugs and expired medications remain common deficiency identified in surveys of dental practices. [32] Table 2

Table 2. Emergency Drugs Recommended for the Dental Office

6.2. Emergency Equipment

Oxygen delivery systems are universally regarded as the most important emergency equipment in dental offices, given their role in managing hypoxia across a wide range of emergencies. Supplemental oxygen should be available with appropriate delivery interfaces such as masks and nasal cannulae. [33] The availability of an Automated External Defibrillator (AED) has been strongly advocated due to the possibility of sudden cardiac arrest in dental settings. Early defibrillation significantly improves survival outcomes, and dental offices are increasingly recognized as appropriate sites for AED placement. Suction devices and airway adjuncts, including oropharyngeal airways and bag-valve-mask systems, are essential for maintaining airway patency and supporting ventilation during emergencies such as syncope, seizures, and anaphylaxis. [34]

6.3. Training and Simulation

Regular certification in BLS is mandatory for dental professionals, while Advanced Cardiac Life Support ACLS training is recommended for those performing sedation or managing high-risk patients. Evidence indicates that regular resuscitation training improves response time and adherence to emergency protocols. Clearly defined staff roles and responsibilities during emergencies reduce confusion and improve efficiency. Assigning tasks such as airway management, drug preparation, and EMS activation enhances coordinated response. Conducting mock emergency drills and simulation exercises reinforces knowledge retention, improves team communication, and increases confidence in managing real-life emergencies. Simulation-based training has been shown to significantly enhance preparedness in dental settings. [35,36]

6.4. General Principles of Emergency Management (ABCDE Approach)

The ABCDE approach provides a systematic framework for the initial assessment and management of all medical emergencies and is widely recommended for non-hospital settings, including dental offices.

• A - Airway: Ensure the airway is open and unobstructed; remove foreign bodies and use airway adjuncts if necessary.

• B - Breathing: Assess respiratory rate and oxygen saturation; administer high-flow oxygen to correct hypoxia.

• C - Circulation: Evaluate pulse, blood pressure, and signs of perfusion; control bleeding and initiate CPR if required.

• D - Disability: Assess neurological status, including level of consciousness and blood glucose levels when indicated.

• E - Exposure: Identify visible signs such as rash, trauma, or swelling while maintaining patient warmth and dignity.

The ABCDE method enables rapid prioritization of life-threatening conditions and has been shown to enhance emergency response effectiveness in dental and outpatient settings. [37]

7. Discussion

Medical emergencies in the dental office, though relatively infrequent, remain a critical concern due to their unpredictable nature and potential for serious consequences. The findings of this narrative review are consistent with previous studies reporting that syncope, hypoglycemia, allergic reactions, and cardiovascular events constitute the most commonly encountered emergencies in dental practice. Earlier surveys and observational studies similarly highlight that most dentists will experience at least one medical emergency during their professional career, reinforcing the relevance of preparedness and prevention strategies. [38]

Despite widespread acknowledgement of the importance of emergency management, gaps in knowledge and practice persist. Several studies have demonstrated deficiencies in dentists’ confidence, familiarity with emergency drugs, and adherence to recommended protocols, particularly for low-frequency but high-risk events such as anaphylaxis and cardiac arrest. Inadequate updating of medical histories, inconsistent vital sign monitoring, and insufficient rehearsal of emergency protocols further contribute to preventable adverse outcomes. [39]

Implementation challenges remain multifactorial. These include time constraints in busy dental practices, limited access to continuing medical education, cost-related barriers to maintaining emergency equipment such as AEDs, and variable regulatory requirements across regions. Additionally, infrequent exposure to real-life emergencies may lead to skill decay, underscoring the importance of regular simulation and refresher training. [40].

Looking ahead, future directions should focus on standardizing emergency preparedness guidelines across dental institutions, integrating simulation-based training into undergraduate and postgraduate curricula, and promoting interdisciplinary collaboration with medical emergency services. Advances in digital training platforms, virtual simulations, and decision-support tools may further enhance preparedness and confidence among dental professionals.

8. Conclusion

This narrative review highlights that medical emergencies in the dental office, while uncommon, represent a significant risk to patient safety if not promptly recognized and effectively managed. The most frequently reported emergencies include syncope, hypoglycemia, allergic reactions, asthma exacerbations, and cardiovascular events, many of which are preventable through appropriate risk assessment and stress-reduction strategies.

The review emphasizes that prevention and preparedness are fundamental pillars of safe dental practice. Comprehensive patient assessment, individualized treatment planning, judicious pharmacological use, and adherence to structured emergency management protocols significantly reduce the likelihood and severity of emergencies. Equally important is the availability of essential emergency drugs and equipment, alongside regular team training and clearly defined staff roles. In conclusion, dental practitioners must maintain a proactive approach toward emergency preparedness by engaging in continuous education, regular emergency drills, and systematic review of office protocols. Such measures not only improve clinical outcomes but also enhance patient confidence and uphold the standard of care in dental practice.

References

[1]   | Obata K, Naito H, Yakushiji H, Obara T, Ono K, Nojima T, et al. Incidence and characteristics of medical emergencies related to dental treatment: a retrospective single-center study. Acute Med Surg. 2021; 8(1):e651.
[2]   | Varoni EM, Rigoni M, Lodi G, Sardella A, Muti P, Vitello A, et al. Medical emergencies in dental practice: a nationwide web-based survey of Italian dentists. Heliyon. 2023; 9(3): e13910.
[3]   | Nunn P. Medical emergencies in the oral health care setting. J Dent Hyg. 2000; 74(2): 136–151.
[4]   | Malamed SF. Medical emergencies in the dental surgery. Part 1: preparation of the office and basic management. J Ir Dent Assoc. 2015; 61(6): 302–308.
[5]   | Vaughan M, Park A, Sholapurkar A, Esterman A. Medical emergencies in dental practice: management requirements and international practitioner proficiency—a scoping review. Aust Dent J. 2018; 63(4): 455–466.
[6]   | Špiljak B, Firić M, Sikora M, Brailo V. Self-assessment of readiness and equipment of dental clinics for managing medical emergencies in the Republic of Croatia. Acta Stomatol Croat. 2024; 58(4): 348–361.
[7]   | Reed KL. Basic management of medical emergencies: recognizing a patient’s distress. J Am Dent Assoc. 2010; 141(Suppl 1) 20S–24S.
[8]   | Vranić DN, Jurković J, Jeličić J, Balenović A, Stipančić G, Čuković-Bagić I. Medical emergencies in pediatric dentistry. Acta Stomatol Croat. 2016; 50(1): 72–80.
[9]   | Lowe RN, Williams B, Claus LW. Diabetes: how to manage patients experiencing hypoglycaemia. Drugs Context. 2022; 11: 2021-9-11.
[10]   | Demirbilek H, Vuralli D, Haris B, Hussain K. Managing severe hypoglycaemia in patients with diabetes: current challenges and emerging therapies. Diabetes Metab Syndr Obes. 2023; 16: 259–273.
[11]   | Shenoi RP, Timm N; AAP Committee on Drugs; AAP Committee on Pediatric Emergency Medicine. Drugs used to treat pediatric emergencies. Pediatrics. 2020; 145(1): e20193450.
[12]   | Kazem Pour M, Shokri F, Fozooni Moqadam B, Shokri M. Respiratory and pulmonary allergic emergencies in dental and periodontal surgery: a systematic review of identification, management, and prevention strategies. Bull Emerg Trauma. 2025; 13(3): 127–139.
[13]   | Wilson MH, McArdle NS, Fitzpatrick JJ, Stassen LF. Medical emergencies in dental practice. J Ir Dent Assoc. 2009; 55(3): 134–143.
[14]   | Lovik K, Murr NI. Seizure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
[15]   | Peskin RM, Siegelman LI. Emergency cardiac care: moral, legal, and ethical considerations. Dent Clin North Am. 1995; 39(3): 677–688.
[16]   | Beecham GB, Nessel TA, Goyal A. Lidocaine. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
[17]   | Pan J, Liao X, Zhang Z. Dentists should improve the ability to deal with medical emergencies in dental clinic. Hua Xi Kou Qiang Yi Xue Za Zhi. 2015; 33(4): 336–338.
[18]   | Collange O, Bildstein A, Samin J, Schaeffer R, Mahoudeau G, Féki A, et al. Prevalence of medical emergencies in dental practice. Resuscitation. 2010; 81(7): 915–916.
[19]   | Alhamad M, Alnahwi T, Alshayeb H, Alzayer A, Aldawood O, Almarzouq A, et al. Medical emergencies encountered in dental clinics: a study from the Eastern Province of Saudi Arabia. J Fam Community Med. 2015; 22(3): 175–179.
[20]   | Shampaine GS. Patient assessment and preventive measures for medical emergencies in the dental office. Dent Clin North Am. 1999; 43(3): 383–400.
[21]   | Cristea RA, Ganea M, Potra Cicalău GI, Ciavoi G. Dentophobia and the interaction between child patients and dentists: anxiety triggers in the dental office. Healthcare (Basel). 2025; 13(9): 1021.
[22]   | Johnson TM, Kurt-Gabel C. Compliance with and attitudes towards the management of medical emergencies in general dental practice. Prim Dent J. 2014; 3(1): 41–45.
[23]   | Emery RW, Guttenberg SA. Management priorities and treatment strategies for medical emergencies in the dental office. Dent Clin North Am. 1999; 43(3): 401–419.
[24]   | Valizadeh S, Hosseinzadeh M. Review of dental management considerations for patients with cardiovascular conditions. Multidiscip Cardio Annal. 2024; 15(2): e158488.
[25]   | 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(1): 20–24.
[26]   | Hendrix JM, Garmon EH. American Society of Anesthesiologists Physical Status Classification System. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
[27]   | Chester JG, Rudolph JL. Vital signs in older patients: age-related changes. J Am Med Dir Assoc. 2011; 12(5): 337–343.
[28]   | Kriakous SA, Elliott KA, Lamers C, Owen R. The effectiveness of mindfulness-based stress reduction on the psychological functioning of healthcare professionals: a systematic review. Mindfulness (N Y). 2021; 12(1): 1–28.
[29]   | Nanda A, Sahi H, et al. Evaluating and managing specific medical conditions in dental practice: a review of pre-treatment protocols. Med Res Arch. 2024; 12(10).
[30]   | Jandu JS, Mohanaselvan A, Dahal R, et al. Strategies to reduce polypharmacy in older adults. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
[31]   | Benzoni T, Agarwal A, Cascella M. Procedural sedation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
[32]   | Malamed SF. Medical Emergencies in the Dental Office. 5th ed. St. Louis: Mosby; 2000. p. 58–91.
[33]   | Mart MF, Sendagire C, Ely EW, Riviello ED, Twagirumugabe T. Oxygen as an essential medicine. Crit Care Clin. 2022; 38(4): 795–808.
[34]   | Becker DE, Rosenberg MB, Phero JC. Essentials of airway management, oxygenation, and ventilation: part 1—basic equipment and devices. Anesth Prog. 2014; 61(2): 78–83.
[35]   | Basic life support (BLS) and cardiopulmonary resuscitation (CPR) in the dental practice. Int Dent J. 2022; 72(1): 14–15.
[36]   | Nogami K, Taniguchi S, Ichiyama T. Rapid deterioration of basic life support skills in dentists with basic life support healthcare provider certification. Anesth Prog. 2016; 63(2): 62–66.
[37]   | Manton JW, Kennedy KS, Lipps JA, Pfeil SA, Cornelius BW. Medical emergency management in the dental office (MEMDO): a pilot study assessing a simulation-based training curriculum for dentists. Anesth Prog. 2021; 68(2): 76–84.
[38]   | Lipp M, Kubota Y, Malamed SF, Matsuura H, Sykes P. Management of an emergency: to be prepared for the unwanted event. Anesth Pain Control Dent. 1992; 1(2): 90–102.
[39]   | Gupta S, Mishra S, Behl S, Srikant N, Mascarenhas R. Knowledge of handling medical emergencies among general dental practitioners in India: a cross-sectional survey. BMC Res Notes. 2023; 16(1): 221.
[40]   | Smereka J, Aluchna M, Aluchna A, Szarpak Ł. Preparedness and attitudes towards medical emergencies in the dental office among Polish dentists. Int Dent J. 2019; 69(4): 321–328.