The preparedness of private dental offices and polyclinics for medical
emergencies in Jeddah, Saudi Arabia.
‫الجاهزية واالستعداد في حاالت الطوارئ الطبية لدى عيادات ومجمعات األسنان الخاصة في‬
‫ المملكة العربية السعودية‬،‫مدينة جدة‬
ABSTRACT
Background: Medical emergencies, such as vasovagal syncope, hypoglycemia and
chest pain, can occur anytime in a dental office. The dental office must be well prepared
for these emergencies by training the personnel via the practice of mock-drills,
establishing an emergency protocol and preparing emergency drugs and equipment.
The objective of this study was to assess the preparedness for medical emergencies in
private dental offices in Jeddah city.
Material and Methods: A survey was distributed to 70 dental offices and polyclinics in
Jeddah between October 2013 and January 2014.The questionnaire gathered
information about the prevention of medical emergencies, the preparation of the office
personnel and preparation of emergency drugs and equipment.
Results: For prevention, 92% (n=65) of the offices reported that they obtain a thorough
medical history prior to treatment; however, only 11% (n=8) obtain vital signs for each
visit. Using a preparedness percent scale (0 to 100), the mean level of preparedness of
the office personal in all surveyed dental offices was 55 ± 23. The availability of
emergency drugs was 35 ± 35, and equipment was 19 ± 22.
Conclusion: The dentists were BLS-trained but lacked proper personnel training and
written protocols for specific medical emergencies. The offices were ill prepared for
1
‫‪emergencies with regard to medical equipment and essential emergency drugs. The‬‬
‫‪Ministry of Health, which oversees these clinics, should enforce more stringent‬‬
‫‪regulations for emergency preparedness to avoid disasters in these clinics.‬‬
‫‪ABSTRACT IN ARABIC‬‬
‫الخلفية العلمية‪ :‬إن حاالت الطوارئ الطبية كاإلغماء وانخفاض مستوى السكر في الدم والذبحات الصدرية هو أمر وارد‬
‫الحدوث أثناء عالج األسنان‪ .‬لذلك فإن عيادة األسنان يجب أن تكون ُمجهزة و ُمستعدة في حال ُحدوث أي من هذه الحاالت‪.‬‬
‫هذه التجهيزات تتضمن األدوية وال ُمعدات الالزمة و التدريب للعاملين في العيادات وممارسة اإلنذار التجريبي للطوارئ‬
‫باإلضافة إلى تحقيق نظام دقيق وثابت لكيفية التعامل مع حاالت الطوارئ المختلفة لدى حدوثها‪ .‬إن الهدف من هذه الدراسة‬
‫هو تحديد مدى جاهزية عيادات األسنان الخاصة واستعدادها في حال حدوث حاالت الطوارئ الطبية‪.‬‬
‫الطريقة البحثية‪ :‬اعتمدت هذه الدراسة في ُمجملها على النتائج التحليلية لالستبيان الذي تم توزيعه على العينة المختارة‬
‫والمكونة من ‪ 70‬عيادة أسنان خاصة في مدينة جدة‪ .‬هذا االستبيان شمل أسئلة تتعلق بالوقاية من حاالت الطوارئ و التدريب‬
‫للعاملين في العيادة باإلضافة إلى توفر التجهيزات وأدوية الطوارئ الطبية‪.‬‬
‫النتائج‪ :‬على الرغم من أن ‪ %92‬من عيادات األسنان أكدت أنها تُد ِون التاريخ الصحي الكامل للمريض قبل العالج إال أن‬
‫‪ %11‬فقط كانت تحرص على تسجيل المؤشرات الحيوية للمريض قبل بدء العالج‪ .‬و باستخدام مقياس النسبة المئوية (‪ 0‬إلى‬
‫‪ )100‬كشفت الدراسة أن متوسط جاهزية العاملين في العيادات في حاالت الطوارئ هو ‪ .23 ± 55‬في حين أن توفر أدوية‬
‫الطوارئ يعادل ‪ 35 ± 35‬وتوفر معدات الطوارئ يعادل ‪.22 ±19‬‬
‫الخالصة‪ :‬على الرغم من أن أطباء األسنان كانوا حاملين لشهادات اإلنعاش القلبي الرئوي إال أنهم افتقروا إلى وجود أنظمة‬
‫مكتوبة في كيفية التعامل مع حاالت الطوارئ‪ .‬إن غالبية عيادات األسنان كانت محدودة االستعداد فيما يتعلق باألدوية ومعدات‬
‫اإلسعاف في حاالت الطوارئ‪ ،‬ولذلك فان على الجهات المسئولة عن هذه العيادات ممثلة في وزارة الصحة السعودية تطبيق‬
‫أنظمة أكثر صرامة للتأكد من سالمة المرضى في حال حدوث طوارئ أثناء عالج األسنان‪.‬‬
‫‪.‬‬
‫‪2‬‬
INTRODUCTION:
In practice, dentists deal directly with patients who may be conscious, sedated or under
general anesthesia. They also deal with patients of different physical and psychological
conditions. Although uncommon, medical emergencies can occur in the dental office,
possibly posing a direct threat to the patient’s life and hindering the delivery of dental
care (1).
The prevalence and severity of medical emergencies has been reported in various
dental settings (academic or private) in many countries, such as the UK (2), USA (3),
and Brazil (4), with vasovagal syncope as the most common emergency (2, 5). On
average, a dentist will treat a vasovagal syncope every six months and a non-syncope
emergency every 1.4 years (2). In a study published in 2009, Wilson et al. found that the
most prevalent medical emergency reported by dentists over a 12 month period was
syncope (1.9 cases per year), followed by angina and hypoglycemia (0.17 per year) and
epileptic fit (0.13 cases per year) (6).
Preparedness of the dental office includes doctor training, staff training, mock drills, a
medical emergency plan, an emergency drug kit and proper equipment (7, 8). The
preparedness of dental offices was addressed through questionnaires for studies from
different countries where a general consensus was needed for continuous training and
3
more stringent guidelines for medical emergencies (6, 9, 10).
In one study performed in the UK, 20.8% of dentists felt competent to diagnose the
cause of a collapse during dental surgery, greater than 50% felt unable to manage a
myocardial infarction or anaphylaxis, and 49.7% did not know how to insert an oral
airway or perform an intravenous injection (2)7).
In Saudi Arabia, the health care system is unique in that there remain many patients
who do not have access to proper medical care, yet seek dental treatment for the
alleviation of pain. This may lead to a wide range of undiagnosed and under-treated
medical conditions. Furthermore, Saudi Arabia has a high prevalence of diabetes,
obesity and hypertension (11-13), all of which contribute to a higher occurrence of
medical emergencies.
There is no current literature in Saudi Arabia on the prevalence, types or severity of
medical emergencies in government dental clinics, dental schools or private dental
practice.
It is the responsibility of the dental health care professional to seek proper training and
knowledge to prevent and manage medical emergencies in the dental setting. It is also
mandatory for dental offices to possess the proper drugs and equipment to manage
acute medical emergencies that occur in the office. Preparing for emergencies begins
with a team approach by the dentist and staff members who have up-to date
certification in basic life support (BLS) for health care providers. The ability to react
immediately to the emergency at hand, including telephoning for help and having the
4
equipment and drugs necessary to respond to an emergency, can be the difference
between successful management and failure (14).
To the best of our knowledge, there is no information regarding the preparedness of
personnel, drugs and equipment in private dental offices in Saudi Arabia. The Ministry
of Health oversees the licensing and operation of these clinics. However, we could not
verify whether the Ministry of Health mandates a standardized emergency protocol or a
list of minimum drugs and equipment and whether such a protocol exists.
The objective of our study was to assess the preparation and training of the office
personnel, and availability of emergency drugs and equipment in private dental
practices and polyclinics.
MATERIAL AND METHODS:
The Research Ethics Committee of the Faculty of Dentistry (REC-FD), at King
AbdulAziz University, Jeddah, Saudi Arabia, approved this study.
Subjects and questionnaire:
A questionnaire was distributed to a sample of private practice dental offices and
polyclinics. Random sampling was achieved by choosing offices from different
geographic locations of Jeddah city. The questionnaire was distributed and collected
between October 2013 and January 2014. The participating offices participated on a
voluntary basis and were assured confidentiality of the responses. The questionnaire
was administered by one of the authors through an interview with the supervising
dentist.
The questionnaire sought information regarding the following:

The type of the practice: solo dental office or polyclinic.
5

Prevention of medical emergencies:
o Recording of vital signs (never, once during the initial visit, every visit)
o Taking a thorough medical history prior to treatment.

Preparation of the office personnel;
o Basic life support (BLS) certification among the dentists, dental assistants
and staff.
o Presence of a written emergency protocol and flow-sheet available to all
staff.
o Knowledge of the emergency number to dial in cases of an emergency.
o Presence and implementation of mock emergency drill.
o Presence of a registered nurse in the office.
o Ability to perform advanced puncture techniques, such as an intravenous
or intramuscular injection.

Preparation of drugs, including the availability of essential emergency drugs.

Preparation of emergency equipment, including the availability of essential
emergency equipment.
Data and Statistical Analysis:
The data were entered into a spreadsheet and analyzed using the IBM SPSS software,
version 22 (SPSS, Inc. IBM, Chicago, IL, USA). The variables were the as means and
standard deviations, whereas the difference in responses between the dental offices
and polyclinics was analyzed using a t-test. The level of significance was set at p< 0.05.
A rating scale was used to score the preparation of the following; a) office personnel, b)
availability of drugs and c) availability of equipment, based on the responses to the
6
preparation questions. The responses were numerically scored 0 and 1, and 1 is a
positive score whereas 0 is a negative score. A pooled score was collected from the
answers and converted to a 100 percent scale to represent the essential training and
knowledge, availability of drugs and availability of equipment. A preparedness score of
0 is no preparation at all, whereas 100 is 100% preparedness.
RESULTS:
A total of 70 private practices participated in this survey, with 55 dental offices and 15
polyclinics. The response rate was 100%. All participating dental practices performed
dentistry under local anesthesia, and none performed intravenous sedation or
ambulatory general anesthesia. Fifty-three percent of theses dental offices performed
pediatric dentistry, whereas 45% performed oral surgery in addition to general dentistry.
Prevention: Ninety-two percent (n=65) of the offices reported that they obtained a
thorough medical history prior to treatment. However, only 11% (n=8) obtain vital signs
(blood pressure, heart rate and respiratory rate) every visit, 34.3% (n=24) obtain vital
signs at the initial visit only and 57% (n= 40) never take vital signs. Additional vital signs
(temperature, height and weight) were only taken by 17% (n= 12) and 8.5% (n=6) of the
7
clinics, respectively. This is shown in figure 1.
Preparation of office personnel: All dentists working in these dental offices were BLS
certified, whereas 81.2% (n=56) and 15% (n=10) of dental assistants and other staff
(receptionists and lab technicians) were BLS certified, respectively. Only 58.6% (n=41)
of office personnel knew the number to dial in case of an emergency. The number of
offices that reported performing periodic practice (mock) drills for medical emergencies
was 9 of 70 (12.9%). The presence of a registered nurse among the office personnel
was 60% (n= 42) of the offices. More than half of the dental offices have an auxiliary
staff member trained in intravenous injections (57%, n=40) and intramuscular injections
(60%, n=42). Very few, (20%, n=14) clinics have a written protocol and flow chart for
medical emergencies available to the office personnel, as shown in figure 2.
8
Preparation of drugs: Oxygen was the most available drug in 52.9% (n=37) of the
surveyed offices, followed by epinephrine (48.6%, n=34) and aspirin (47.1%, n=33). The
two least available drugs were ammonia inhalants and an oral anti-histamine at 10%
(n=7) and 15.7% (n=11), respectively. Table 1 shows the drugs available in the
surveyed dental clinics.
Table 1
Oxygen
Epinephrine
Aspirin
Nitroglycerin
Oral Glucose
Hydrocortisone
Glucagon
Bronchodilator
Oral Antihistaminic
Ammonia inhalant
N=70
37
34
33
29
27
24
21
20
11
7
%
52.9
48.6
47.1
41.4
38.6
34.3
30.0
28.6
15.7
10.0
In response to the question about verifying the expiration rate of the drugs, only 45.6%
(n=31) responded positively.
Preparation of equipment: A total of 7 of 70 offices (10%) reported that they have at
least one type of supplemental oxygen delivery device, such as a facemask, non9
rebreathing mask, nasal cannula or nasal hood. Eighteen dental offices (26%, n=18)
owned a glucose-meter and disposable strips. Sixteen dental offices (22.9%) have an
automatic blood pressure monitor or sphygmomanometer with different size cuffs
(small, medium and large). A total of 9 of 70 (12.9%) offices reported having a
laryngoscope, and only one office (1.4%) had a McGill forceps in their emergency kit.
Only 7 of the 70 (10%) offices had an automated external defibrillator (AED) and bagvalve mask (BVM) for the delivery of oxygen. A full list of the available emergency
equipment in each dental office is shown in table 2.
Table 2
Stethoscope
Glucometer and disposable strips
Sphygmomanometer or automated BP cuff
IV Cannula
IV line and IV fluid (Normal saline or Ringer’s Lactate)
Laryngoscope
Bag-Valve Mask (BVM)
Supplemental Oxygen delivery devices
(Nasal cannula, Nasal hood, Non-rebreathing mask,
Facemask)*
Automated External Defibrillator (AED)
Large Suction tip (Tonsillar-type)
Oro-pharyngeal airway
Magill Forceps
N=70
22
18
16
15
12
8
7
%
31.4
25.7
22.9
21.4
17.1
11.4
10
7
10.0
7
6
4
1
10.0
8.6
5.7
1.4
Preparedness Score: Using the preparedness percent scale (0 to 100), the mean level
of preparedness of the office personal in all surveyed dental offices was 55 +/- 23. The
10
preparation of the essential emergency drugs was 35 +/- 35 and the equipment was 19
+/- 22 (Table 3).
Table 3
N
Preparation and training of office personnel
Preparation of emergency drugs
Preparation of emergency equipment
70
70
70
Mean
Score
55.3
34.7
19.2
SD
23.2
35.4
22.7
When comparing private dental practices to polyclinics, the latter had statistically
significantly higher preparation scores for all three aspects of preparation, office
personnel, drugs and equipment, with p=0.19, p<0.001 and p=0.008, respectively. Table
4 shows these results.
Table 4
Type of Practice
Preparation and training of office personnel
Preparation of emergency drugs
Preparation of emergency equipment
N
Office
Polyclinic
Dental Office
Polyclinic
Dental office
Polyclinic
55
15
55
15
55
15
Mean
score
52.5
65.8
26.7
64
14.5
37.5
SD
24.1
16.6
31.4
34.8
19.1
26.9
pvalue
.019*
.001*
.008*
DISCUSSION
Last year, the death of a 20-year-old healthy woman in a private dental office in Jeddah,
Saudi Arabia was reported in a Saudi newspaper. Her death was secondary to an
undisclosed emergency that the dentist could not manage. Moreover, 13 deaths in
dental offices were reported in Jeddah, in which the Directory of Health Affairs is
11
currently investigating with a forensic committee (15). The Ministry of Health, which
oversees the private dental offices, conducts periodic checks on valid practice licensing
and proper infection control. The Ministry of Health could not verify whether there were
requirements, unannounced visits or field-checks for emergency training and availability
of emergency drugs and equipment. Therefore, it is fair to assume that no protocol or
minimum requirements exist.
The average emergency response time of emergency response systems varies from
one country to another. The only study assessing the response time in Saudi Arabia
was in the capital city of Riyadh, where the average response time to the scene of an
emergency was 10.23 min. +/- 5.66 (16). No similar data were found in the Western
region of Saudi Arabia or Jeddah city. The response time may vary according to the
traffic and availability of units in the nearby vicinity. In Makkah and Jeddah and during
the Holy month of Du-Hijja, where the annual Islamic Pilgrimage takes place, Red
Crescent units are dispatched near the Holy City where approximately 3 million people
aggregate to perform the Hajj pilgrimage. This creates a serious potential delay in the
response of an ambulance.
Dental offices must be prepared to diagnose and manage an emergency until an
ambulance arrives and the patient is transported to a hospital setting, particularly those
who exist as solo dental practices or polyclinics not connected to a hospital with a
proper emergency room.
In 1999, a British study measured the prevalence of different medical emergencies and
the most frequently reported emergency was vasovagal syncope (62.9% of reported
cases), hypoglycemia (9.6%), angina (11.9%), epileptic fit (9.9%), choking (4.6%),
12
asthma (4.6%), hypertensive crisis (9.6%) and anaphylaxis (0.9%). Myocardial infarction
and cardiac arrest were extremely rare with an incidence of 0.003 and 0.002 cases per
dentist per year, respectively (2).
In a study at the Buffalo School of Dental Medicine, the incidence of emergency was
164 events per million patient visits. The most common emergencies over an eight and
a half year period were cardiovascular events followed by syncope, anesthesia
complications and hypoglycemia (3).
In another study performed in Brazil in 2010, the most prevalent emergency was presyncope, followed by orthostatic hypotension, moderate allergic reactions, hypertensive
crisis, convulsion, hypoglycemia, hyperventilation crisis, choking and cerebrovascular
accident. Anaphylaxis, myocardial infarction and cardiac arrest were the rarest
emergencies (4).
The six links of survival is a checklist of educational needs and physical items
necessary to fulfill the needs of a dental patient in that time period between the
identification of a medical problem and arrival of outside assistance. The links consist of
doctor training, staff training, mock drills, medical emergency plan, emergency drug kit
and proper equipment (8)
Early recognition of medical emergencies begins at the first sign of symptoms (1). The
basic algorithm for the management of all medical emergencies is position (P), airway
(A), breathing (B), circulation (C) and definitive treatment, differential diagnosis, drugs,
and defibrillation (D). The dentist should assess the airway, breathing and circulation,
and when necessary, support the vital functions of the patient. Drug therapy always is
secondary to basic life support (that is, PABCD)(1, 7).
13
The emergency number to contact in case of an emergency in Saudi Arabia is 997. It
was alarming that only half the dental office staff knew the number. In this study, the
presence or absence of training for office medical emergencies was not asked to the
responsible dentists in the clinics directly. Instead, different components of the training
process were asked, including the presence of a mock drill, knowledge of the
emergency number, and presence of a written protocol. If these essential components
were missing for the office personnel, the training of the dentists and staff in medical
emergencies was likely poor or non-existent.
In one study of British dental practitioners, 96% dentists stated that they underwent
training in cardiopulmonary resuscitation at least once every three years, and 31.1%
dentists had attended a course on the management of medical emergencies.
Furthermore, 11.5% had undergone training in advanced life support. However, the
majority of dental practices, 84.4%, had basic life support training (2).
In a study similar to ours of Brazilian dental practitioners, only 41% of the dentists
judged themselves capable to diagnose the cause of an emergency during a dental
visit. The majority responded that they would be capable of performing the initial
treatment for pre-syncope, syncope, orthostatic hypotension, convulsion, and choking.
However, the majority felt unable to treat anaphylaxis, myocardial infarction or cardiac
arrest and was unable to perform CPR or an intravenous injection (4).
According to the American Heart Association's, brain death and permanent death start
4–6 minutes after cardiac arrest (17). The Saudi Council for Health Care Services
14
(SCHCS) requires proof of valid BLS training for license renewal for dentists and dental
assistants. A health care provider must perform CPR when needed, and whereas 100%
of dentists were BLS certified, very few dental assistants were.
The time to defibrillation is the most important determinant of survival from cardiac
arrest (18). Cardiac arrest can be reversible if treated within a few minutes with electric
shock and ALS intervention to restore a normal heartbeat. Verifying this standard are
studies showing that a victim's chances of survival are reduced by 7%–10% with every
minute that passes without defibrillation and advanced life support intervention. Few
attempts at resuscitation succeed after 10 minutes (19). The use of AED is an essential
skill in BLS training, yet this device was found in only 10% of the dental offices.
Therefore, the dentist may have a BLS certificate to practice, yet lacks the necessary
equipment to implement the BLS protocol set forth by the AHA.
The data presented by M P Muller and colleagues in Germany shows that 84% of the
responding dentists own an emergency bag, which contains a ventilation bag, airway
equipment and oxygen. Only 2% of the dentists own a defibrillator, and many dentists
report that they store equipment for advanced life support (ALS), such as a
laryngoscope and a broad variety of drugs (5).
For emergency drugs in the dental office, a dentist should never administer a poorly
understood medication because there is no drug that can take the place of properly
trained health care professionals in diagnosing conditions and treating patients in
emergency situations (1, 14).
A significant result of this study was the availability of drugs or lack thereof. Oxygen is of
primary importance in any medical emergency and must be available in a portable E-
15
cylinder. A dental office should be equipped with a device for the administration of
supplemental oxygen to a spontaneously breathing patient or those that require the
delivery of oxygen under positive pressure in situations in which the patient is
unconscious and not ventilating adequately (14). It was interesting to find that while
approximately half the responding offices claim they have an oxygen tank, only 10%
actually have at least one type of oxygen delivery device, including a bag-valve mask.
The oxygen tank becomes a useless piece of equipment that cannot be utilized during
an emergency without a delivery device. Syncope and pre-syncope were the most
common medical emergencies in the dental office according to many studies (20, 21).
The initial treatment of syncope consists of placement in a supine position and oxygen
delivery because the brain lacks sufficient oxygen (22).
The management of emergencies in the dental office starts with prevention by obtaining
a good medical history, vital signs and referral to a specialist for further investigation if
necessary. Monitoring equipment that provides basic information for primary
assessment should include a stethoscope and a sphygmomanometer with adult small,
medium and large cuff sizes. An automated vital signs monitor can provide physiological
data, including systolic, diastolic and mean blood pressure, along with the patient’s
oxygen saturation level, heart rate and temperature (14). Furthermore, the management
of medical emergencies in the dental office is limited to supporting the vital functions of
the patient until emergency medical services (EMS) arrive.
That approximately one-fourth of the surveyed dental offices in this study owned a BP
monitor and glucometer raises a significant concern regarding the proper monitoring of
16
vital signs and blood sugar levels in cases of a medical emergency.
CONCLUSION
Because of the less than optimal health-care system, lack of patient education and undiagnosed medical conditions, one expects that the incidence of medical emergencies
is higher in our region. Dental offices in Jeddah, Saudi Arabia are poorly prepared and
ill-equipped to handle medical emergencies. A preparedness of less than 100% is
unacceptable.
More stringent regulations for the preparedness of dental offices in Saudi Arabia should
exist. There should be periodic unannounced field evaluations of emergency
preparedness in private dental offices. The renewal of clinic licenses should be based
on more stringent criteria, such the implantation of practice emergency drills, availability
of emergency drugs and equipment.
Staff and personnel should have periodic exams to test their knowledge of emergency
phone numbers, basic action plans and protocols. A unified standardized protocol
should exist at MOH for basic action plans and management for the more common
emergencies that occur in the dental office, such as vasovagal syncope, hypoglycemia,
chest pain and seizures.
Continuing education on an annual basis in medical emergencies should be required for
license renewal similar to the mandate for BLS.
Further studies are necessary to identify the most common medical emergencies in
private dental offices over the course of a few years. This enables the health legislator
to custom-fit specific emergency algorithms according to the community’s needs and
health-care problems.
17
REFERENCES
1.
Reed KL. Basic management of medical emergencies: recognizing a patient's
distress. Journal of the American Dental Association. 2010;141 Suppl 1:20S-4S.
2.
Girdler NM, Smith DG. Prevalence of emergency events in British dental practice
and emergency management skills of British dentists. Resuscitation. 1999;41(2):159-67.
3.
Anders PL, Comeau RL, Hatton M, Neiders ME. The nature and frequency of
medical emergencies among patients in a dental school setting. Journal of dental
education. 2010;74(4):392-6.
4.
Arsati F, Montalli VA, Florio FM, Ramacciato JC, da Cunha FL, Cecanho R, et al.
Brazilian dentists' attitudes about medical emergencies during dental treatment. Journal
of dental education. 2010;74(6):661-6.
5.
Muller MP, Hansel M, Stehr SN, Weber S, Koch T. A state-wide survey of
medical emergency management in dental practices: incidence of emergencies and
training experience. Emergency medicine journal : EMJ. 2008;25(5):296-300.
6.
Wilson MH, McArdle NS, Fitzpatrick JJ, Stassen LF. Medical emergencies in
dental practice. Journal of the Irish Dental Association. 2009;55(3):134-43.
7.
Haas DA. Preparing dental office staff members for emergencies: developing a
basic action plan. Journal of the American Dental Association. 2010;141 Suppl 1:8S13S.
8.
Sangrik LJ. The Six Links of Survival: a comprehensive approach to medical
emergency preparedness for dental offices. Texas dental journal. 2011;128(5):464-5.
9.
Amirchaghmaghi M, Sarabadani J, Delavarian Z, Mosannen Mozafary P, Shahri
A, Dalirsani Z. The Knowledge and Preparedness of General Dentists about Medical
Emergencies in Iran. Iranian Red Crescent medical journal. 2011;13(3):217-8.
10.
Morse Z, Murthi VK. Medical emergencies in dental practice in the Fiji Islands.
Pacific health dialog. 2004;11(1):55-8.
11.
Al-Nozha MM, Abdullah M, Arafah MR, Khalil MZ, Khan NB, Al-Mazrou YY, et al.
Hypertension in Saudi Arabia. Saudi medical journal. 2007;28(1):77-84.
12.
Al-Nozha MM, Al-Maatouq MA, Al-Mazrou YY, Al-Harthi SS, Arafah MR, Khalil
MZ, et al. Diabetes mellitus in Saudi Arabia. Saudi medical journal. 2004;25(11):160310.
13.
Al-Nozha MM, Al-Mazrou YY, Al-Maatouq MA, Arafah MR, Khalil MZ, Khan NB,
et al. Obesity in Saudi Arabia. Saudi medical journal. 2005;26(5):824-9.
14.
Rosenberg M. Preparing for medical emergencies: the essential drugs and
equipment for the dental office. Journal of the American Dental Association. 2010;141
Suppl 1:14S-9S.
15.
Report SG. Dentist's error blamed for woman's death. Saudi Gazette. 2013 20
September 2013.
18
16.
Al-Ghamdi AS. Emergency medical service rescue times in Riyadh. Accident;
analysis and prevention. 2002;34(4):499-505.
17.
Safar P. Cerebral resuscitation after cardiac arrest: a review. Circulation.
1986;74(6 Pt 2):IV138-53.
18.
Ecc Committee S, Task Forces of the American Heart A. 2005 American Heart
Association Guidelines for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care. Circulation. 2005;112(24 Suppl):IV1-203.
19.
Writing Group M, Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, et
al. Heart disease and stroke statistics--2010 update: a report from the American Heart
Association. Circulation. 2010;121(7):e46-e215.
20.
Fast TB, Martin MD, Ellis TM. Emergency preparedness: a survey of dental
practitioners. Journal of the American Dental Association. 1986;112(4):499-501.
21.
Haas DA. Management of medical emergencies in the dental office: conditions in
each country, the extent of treatment by the dentist. Anesthesia progress.
2006;53(1):20-4.
22.
Shukla GJ, Zimetbaum PJ. Cardiology patient page. Syncope. Circulation.
2006;113(16):e715-7.
List of Tables
Table 1
List of essential emergency drugs and the availability of these drugs in the surveyed
dental offices.
Table 2
List of emergency medical equipment and their availability in the surveyed dental
offices. * Any of these oxygen delivery devices qualifies as a positive response.
Table 3
The preparation score of the surveyed dental offices and polyclinics. A score of 100 is
100% prepared and 0 is not prepared at all.
Table 4
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The difference in preparation scores between the dental offices and polyclinics. A score
of 100 is 100% prepared and 0 is not prepared at all.
* Statistically significant at p<0.05.
List of Figures
Figure 1
The number of respondents who obtain a medical history and vital signs prior to dental
procedures.
Figure 2
Office personnel and training preparation.
20