Mission Magazine - Dominating Dental Emergencies

Dominating Dental Emergencies

November 2005

by Will Sansom

The gentleman came to the Dental School’s student clinic with a complex medical history of diabetes, chest pain and erratic heart rhythms. He also had an aching tooth. As his appointment began, EKG leads were placed on his chest to monitor his heart rhythm. Students kept a precautionary eye on his blood pressure, pulse and oxygen saturation.

As a local anesthetic was injected, his face went pasty white. "I’m going to pass out," he gasped. The two students in the room called urgently to the dentist in the next operatory. Ernest Valdez, D.D.S., assistant professor in the department of oral and maxillofacial surgery, immediately assessed the situation.

"The EKG monitor was beeping, and based on oxygen readings I could tell he had not been breathing for 15 to 20 seconds," Dr. Valdez recalls. "I suspected syncope (fainting). Because of the abnormal EKG readings, we called for an ambulance and started repeating steps."

The gentleman’s vital signs normalized as he came to. He later recovered at a hospital. Afterward, Dr. Valdez went over the experience with the students. They noted times, feelings, things said, medications given. "I teach medical emergency management and preparedness in the dental setting," Dr. Valdez said.

Not every dental student will witness an emergency, but each future dentist will be responsible one day for responding to emergencies in the office. That’s why Dr. Valdez and Stephen Milam, D.D.S., Ph.D., professor and chairman of oral and maxillofacial surgery, are developing a dental office medical emergencies simulator. Funded by a grant from the SBC Foundation, the simulator consists of software that displays, on a computer screen, an office complete with patient, dentist and equipment. It presents all the options that could be explored in basic life support after a heart attack or other episode.

"A student can click on the patient’s medical history, check vitals, administer medications and even explore how different positioning in the chair affects the patient," Dr. Valdez says. "The user does all this with the clock running; he or she has only four minutes before the simulated patient dies if too little is done."

All dentists are required by law to have an emergency kit, said John Littlefield, Ph.D., director of academic informatics services at the Health Science Center. "Having a kit is one thing, but do the dentist and office personnel know how to use it?" Dr. Littlefield asked. "This is a use of technology to train health professionals for infrequent, but very important, events."

The simulator will be invaluable for dentists already in practice. "Our intent was to provide a realistic simulation of medical emergencies in a dental office setting, and make it available for convenient access by clinicians via the Internet," said Dr. Milam, the Hugh B. Tilson Endowed Chair in the Dental School. "We hope that clinicians will take the opportunity to maintain their medical emergency management skills using this tool."

The simulator includes eight different scenarios, such as heart attack, allergic reaction, syncope and hypoglycemia. It can be adjusted to the size and gender of a patient. "This is practicing to a fault," Dr. Littlefield said. "You can make mistakes on a simulator that you would never want to make on a person."

The simulator allows users to review past decisions and sessions. A new phase of programming will bring an important new feature: correlation of performance with various levels of expertise, from undergraduate (pre-dental) student to dental student to physician to emergency room physician.

"We want students to say ‘I’m in control,’ ‘I have my equipment’ and ‘I helped the patient,’" Dr. Valdez says. "The ultimate is to hear grateful patients and family members say we are well-trained, that we knew what to do."

This is not the first technology-based innovation for the Health Science Center’s forward-looking Dental School. In 2000, the Dental School was the first in the country to provide students with laptop computers and textbooks on DVDs. Twelve other dental schools have since followed suit.

"The dental emergencies project represents a new chapter in our desire to give our students the most up-to-date, state-of-the-art, 21st-century education possible," says Kenneth L. Kalkwarf, D.D.S., dean of the Dental School. "Through its generosity, the SBC Foundation is shaping for the better the dentists of tomorrow."