Dr. Morton Rosenberg

		Dr. Morton B. Rosenberg © Mark Morelli

New book helps dentists handle medical emergencies
by Marjorie Howard

While the majority of visits to the dentist are routine, sooner or later, every dentist will encounter a medical emergency, some minor, but some that are life threatening. Heart attacks, asthma attacks, allergic reactions, dizziness and moreÑall have taken place in the dentist's office. As dentists treat a growing aging population, the likelihood of an emergency only increases.

Dr. Morton B. Rosenberg, professor of oral and maxillofacial surgery at the School of Dental Medicine and head of the Division of Anesthesia and Pain Control, is co-author and editor of a new book, Medical Emergencies in Dentistry (W.B. Saunders, 2001). The book aims to help dentists and their associates recognize what can be the subtle changes of an evolving medical emergency and to determine the appropriate level of intervention. "It's going to happen," Rosenberg said of the array of emergencies dentists may face in their offices. "If you ask your dentist, it's happened."

Rosenberg, who also holds an appointment in the Department of Anesthesia at Tufts-New England Medical Center, said that as dentistry has matured over the years, "what makes the dentist a true health care professional is not only his or her dental skills, but the ability to manage patients with medical conditions that affect dental treatment and therapy. Also, dentists must treat medical emergencies that may arise during the course of dental treatment either directly or indirectly due to treatment. With the advent of lifelong dentistry and continuing medical advances, dentists are treating sicker and sicker patients."

The typical dental school, Rosenberg said, requires courses in the biomedical sciences. Tufts, for example, requires students to take pharmacology and life sciences so they can understand disease processes. Rosenberg and his co-author, Dr. Jeffrey D. Bennett of the University of Connecticut School of Dental Medicine, saw there was a need for a book for the general practitioner to provide the background to diagnose and manage emergencies. The book is meant to be both a textbook as well as a reference book of medical conditions.

The generous use of graphics and tables is intended to make the book readable and accessible as well as comprehensive. Instead of providing hundreds of references, the authors have compiled a list of suggested readings so someone can do further study. Rosenberg said dental schools and dental societies have made inquiries about using the book as a framework for courses and for continuing education.

Published last fall, the book teaches dentists how to prepare their offices for emergencies and what skills and equipment are needed. "Preparation and treatment of a medical emergency in the dental office cannot be relegated to the dentist alone," the book says. "The successful management of a medical emergency depends on a well-trained, collaborative dental team."

Not only do dentists treat people who already have medical conditions, Rosenberg said, there are other reasons dentists need to be prepared. Older patients may be taking medications that interact with each other. The stress of a visit to the dentist may exacerbate conditions such as angina or asthma, which may become acute during dental treatment. Medical advances, including orthopedic prostheses and pacemakers, have medical considerations during dental therapy. Dentists need to be aware of alternative therapies patients may be using, such as herbal medicine. Children, the elderly, pregnant women and patients with substance abuse problems may require a special medical background.

The book is divided into four sections, and each chapter is written by a contributor from academic dentistry. The first part discusses basic emergency drug therapy and explains the use of emergency equipment as well as the specific skills required to treat different types of patients, from children to the elderly. It then addresses the diagnosis and management of medical emergencies by concentrating on the early recognition of signs and symptoms. The next portion of the book discusses the significance of signs and symptoms and the protocols that the dental team should follow, from assessment and initial intervention to definitive diagnosis and more directed treatment.

Part three talks about the onset of emergencies for patients who have existing medical conditions. For example, a fainting episode in a healthy patient initiated by the fear of going to the dentist may actually be a life-threatening event in a diabetic patient.

Finally, the book discusses special patient populations and issues, including the pregnant patient, patients using herbal medications and their potential systemic effects and dental treatment implications and the recognition of child and elder abuse.

In the book's acknowledgements, Rosenberg recognizes the support of both Dr. Lonnie H. Norris, dean of the School of Dental Medicine, and Dr. Maria Papageorge, professor and chair of oral and maxillofacial surgery. The book may be ordered through the publisher's web site, which is www.wbsaunders.com, and is also available at the Tufts health sciences bookstore on the Boston campus.