Transforming and Supporting Patient Care - Health Professions ...

207Chapter 8 – Profession of Dental Hygienecan also impair the function of the immune system and worsen infections.HPRAC is not convinced that dental hygienists have appropriate educationand training to make an appropriate differential diagnosis of infections,therefore HPRAC is not convinced that topical corticosteroids would onlybe used on inflamed tissue and not on undiagnosed infections.Dental EmergenciesA recent study indicates that medical emergencies in a dental office aremost likely to occur during and after local anaesthesia, primarily duringtooth extraction and endodontics. Over 60 percent of the emergencies aresyncope (temporary loss of consciousness), with hyperventilation the nextmost frequent at seven percent. Other dental emergencies seen are allergicreactions, angina pectoris/myocardial infarction, cardiac arrest, posturalhypotension, seizures, bronchospasm and diabetic emergencies. There aretwo categories of drugs considered for a dentist’s emergency kit. The firstcategory is essential drugs to manage potentially life-threatening situationsand the second category is supplemental and might be included dependingon the type of dental practice. Essential drugs include: oxygen for almostany medical emergency; epinephrine for treatment of anaphylaxis or asthmaunresponsive to bronchodilator; nitroglycerin for angina pain; antihistaminefor allergic reactions; albuterol/salbutamol for asthmatic bronchospasm;and aspirin for myocardial infarction (heart attack). 55HPRAC has reviewed carefully the request of the dental hygiene professionfor an emergency kit. The evidence is that most dental emergencies occurin dental care that is out of the scope of practice of dental hygienists.HPRAC is not recommending changes to the scope of practice and hasconcluded that an emergency kit is not necessary in routine dental hygienepractice, even when that practice is not co-located with dentistry oranother health profession. However, knowledge of emergency procedures isan important function for dental hygienists.HPRAC has noted that the CDHO has a requirement in its quality assuranceprogram and practice guideline that dental hygienists must ensure theprovision of services/programs in emergency situations by:• knowing the practice environment’s emergency protocols;• knowing the location of emergency supplies and oxygen; and• maintaining current certification in basic cardiopulmonaryresuscitation.This requirement applies to all practice settings, and HPRAC recommendsthat the CDHO consider whether additional emergency protocols should bedeveloped for dental hygienists in independent practice who practise innon-traditional settings.55Haas, D.A. “Management of Medical Emergencies in the Dental Office: Conditions in Each Country,the Extent of Treatment by the Dentist,” Journal of Japanese Dental Society of Anesthesiology.2005; Vol. 33:153–157.HPRAC Critical Links January 2009