Is There Such A Thing As Fainting In Dental Clinic?

Everyone is likely to be faced with a sudden emergency at some point in time during a lifetime, be it the oral surgery, at home, and to be prepare beforehand. Putting the knowledge to prompt the user may save a life, which justifies the very careful study of this article.

In the surgery, there should be a fixed routine. Dentist, anesthetist, and chairside assistant should know the part which each must play.

The last named should immediately make available any emergency kit, sucker, and oxygen. A doctor or ambulance may be required, so the numbers of these should be kept next to the telephone.

What is the common medical emergency in Dentistry or Dental Health?

Syncope / collapse
Hypoglycemic / hyperglycemia
Shock
Asthmatic attack
Anaphylaxis.

Fainting (vasovagal syncope)

Source:”Juan Fuentes Guerrero” – under creative commons license

If the patient feels faint or appears about to do so (I.e., looks pale, uneasy, and sweating), his head should be lowered between his knees or the chair should be tipped back so that his feet are up in the air and his head is below the level of his heart. This aids circulation of blood and thus oxygen to the brain. Sometimes spirits of ammonia are held below the nose to speed recovery.

If the faint was caused by fear the patient should be reassured as he comes round. A drink of glucose may be given, it sometimes helps to prevent a feeling of faintness if the patient has a good meal before coming to the surgery for a local Anaesthetic.

Sometimes syncope may be just that fainting episode with no medical importance. It may be caused by a serious illness, condition or disorder.

Every case of fainting should be treated as a medical emergency until the cause is known and signs and symptoms have been treated. Anybody who has recurring fainting should contact their doctor.

Symptoms of vasovagal syncope

Feeling warm or hot
Sweating unnecessarily
Yawning most of the time
Dizziness
Blurred vision
Sometimes a feeling of heaviness in the legs
Pallor: they become pale
Cold clammy extremities.

Signs of vasovagal syncope

There may be week pulse
The patient may be slumping
Patient felling over
There may be a drop in blood pressure.

Causes of fainting (vasovagal syncope)

The major causes of fainting are the decreased blood flow to the brain.
It also includes dehydration, alcohol, and diabetes.

Other causes of fainting include:

1. Anxiety,
2. severe pain
3. Reaction to local anesthesia.

Tests and diagnosis of vasovagal syncope

Medical news today further said you should see your doctor if:

When there is chest pain
Irregular heartbeat or palpitations
If there is a history of heart disease
If you are pregnant
If there is diabetes

First aid Management of syncope

Remove all tight-fitting clothes or garment
Check the airway whether the patient is breathing
Check the vital signs I.e pulse rate.

What is the suitable emergency kit for syncope?

Oxygen cylinders
Aspirator
Selection of anesthetic airways
Re-breathing bag
Intubation tubes.
Adult and child size anesthetic face pieces
Laryngoscope
Tongue forceps
Aromatic ammonia
Amyl nitrate capsules
Glucose
Sterile syringes and needles
Other drugs are suggested by the dentist or anesthetist.

These must be continually checked and kept in perfect order.

Cyanotic Breath-Holding

It happens mostly in pediatric dentistry with an individual child between the ages 6 months and 5 years old. They always cry so hard to cut off oxygen and this trigger an automatic response that makes the child faint.

He/she may turn blue, pass out for about a minute, and seem groggy afterward. They don’t do it on purpose. It’s a reflex they can’t control. Though it’s scary to see at first, it’s nothing to worry about and might even happen repeatedly.

Pallid Breath-Holding

This also happens to a younger kid in pediatric dentistry. A sudden fright or pain causes their heart to stop for a few seconds. With no sound, the child might open his mouth before turning very pale and passing out for about a minute. Pallid breath-holding sometimes happens after your child gets hurt. It’s not the injury itself that causes this automatic response, but the shock of it. It should go away by age 5.

Low Blood Sugar

The medical term for this is hypoglycemia. It may make your individual patient dizzy, shaky, tired, confused, and blur their vision. You can usually fix the problem if you get a few grams of carbs from juice or candy. Otherwise, your patient could pass out. If that happens, you need medicine called glucagon to help your patient body release more sugar.

Management of Hypoglycemia in Dentistry

Give oral glucose if the patient is conscious
In unconscious state give intravenous glucose or 5mls of 50% dextrose

Hyperglycemia: This is a medical term used in describing an abnormally high blood sugar level. This usually occurs in a poorly controlled diabetic patient.

Diabetes

Hyperglycemia: This is a medical term used in describing an abnormally. This usually occurs in a poorly controlled diabetic patient.

High blood sugar from diabetes can damage the nerves in your patient body that help keep their blood pressure steady. That could lead to unusually low blood pressure that makes you pass out.

Types of Diabetes

Type 1 – Found in children below 40 years of age, also known as early-onset diabetic mellitose.
Type 2 – Found in adult above 40yrs of age, also known as maturity onset diabetic mellitose.

Signs And Symptoms of Hyperglycemia

Increase in taste
Frequent urination
Diabetic Ketoacidosis (OKA): This is a metabolic disorder found in the diabetic patient.

Management of Hyperglycemia in Dentistry

Give insulin if the person belongs to type 1 type of diabetic
Type 2 – Give oral hypoglycemic drugs then insulin. The First start with insulin then proceeds to oral hypoglycemic drugs.

Certain Medicine

Some medications, like high blood pressure drugs and antidepressants, affect the way your patient heart and blood vessels act when they stand. This can reduce their blood pressure and make them faint.

Insulin is usually given to lower their blood sugar when they have diabetes. Diabetes might cause hypoglycemia that also make them pass out. In older people, different drugs sometimes combine with illness and the situation of your patient. For example individual patient standing in a hot room — this can make them faint during oral surgery.

Seizure

This cause Ia sudden change in the brain’s normal electrical signals. Some symptoms, like eyes rolling back and jerking movements, may be similar to breath-holding. The difference is seizures make your patient unconscious for minutes, not seconds, and might make them lose control of your bladder. And they may experience flashes of light or get unusual smells or tastes with no obvious source. Stop all forms of treatment and call a doctor if you suspect a seizure.

Heart Problems (cardiac syncope)

Damaged heart muscle, blocked or narrowed blood vessels (coronary heart disease), and other kinds of ticker trouble can stop enough blood loaded with oxygen from getting to your patent brain. When it makes them pass out, it’s called cardiac syncope.

It may happen without any sign, sometimes repeatedly over a period of time/weeks. Remove all forms of treatment from your patient mouth and call your doctor right away if you suspect this or your patient also experience chest pain, arrhythmia, fatigue, or other symptoms.

Hyperventilation

You patient feel like they can’t get enough air, so they start to breathe in more quickly. Though it’s unclear why it happens, this makes blood vessels around their brain to shrink, which limits oxygen and makes them lightheaded and possibly faint.

Fear of a dentist, rather than a physical problem, usually causes it, tell your patient to relax and hold their breath. Their hands, feet, and mouth might also tingle.

Excessive Alcohol can cause Fainting (vasovagal syncope)

It causes your patient blood vessels to expand, which can lead to a drop in their blood pressure. They can pass out when they drink so much that you reach a dangerously high blood alcohol concentration.

Too Tight Fitting cloth can cause Fainting (vasovagal syncope)

Carotid sinus syncope, or “tight-collar syndrome,” happens when something pushes your patient nerves too hard towards a wide part of their carotid artery in their neck. This interferes with blood flow to the brain and makes your patient faint. It happens quickly and without other symptoms like nausea, paleness, and sweating. In some cases, if it hasn’t happened before, it may be a sign of narrowed arteries that need treatment.

Asthmatic attack can cause Fainting (vasovagal syncope)

An asthmatic attack is a respiratory disease. Respiratory organ is; nose, trachea, lungs. An asthmatic attack is a chronic inflammatory disease of the respiratory system.

Mechanism of Initiating Attack

Mechanism of initiating attack is the same for both (intrinsic & extrinsic). The allergen or non-allergen factor stimulate the vagus nerve to release acetylcholine which causes or produces constriction of the airways and increased glandular secretion which plugs the small airway in the lungs leading to brioche edema and airway obstruction.

Signs and Symptoms of Asthma.

Shortness of breath
Tightness in the chest
Wheezing and Coughing
Cyanosis shortage of oxygen in the blood
Tachycardia: Increase the pulse rate or heart rate.

Management of Asthmatic Patient During Oral Surgery

Terminate all forms of treatment
Remove all forms of materials and instrument from the patient mouth
Seat the patient in an upright position with the arms throw forward over a chair back
Administer broken dilators
Administer oxygen if needed
Administer hydrocortisone too.
If the patient is not improving please call for medical assistance.

Your Patient is Dehydrated

Dehydration can happen if your patent don’t drink enough or you lose too much fluid. Then their blood pressure drops and nervous system can’t control it as well, which could cause fainting. That’s why it’s a good idea to get plenty of water at hand, especially when it’s a sunny day.

Sources

American Diabetes Association: “Hypoglycemia (Low Blood Glucose).”
American Heart Association: “Syncope (Fainting).”
AsthmaSymptoms.org: “Fainting — A Serious Symptom of Asthma.”
Boston College Alcohol and Drug Education Program: “Blacking Out Vs. Passing Out.”
Child Neurology Foundation: “Breath-Holding Spells.”
Emergency Medicine Journal: “Syncope And Breath Holding.”
Encyclopaedia Britannica: “Syncope.”
Familydoctor.org: “Fainting.”
Harvard Health Publishing: “Hypoglycemia.”
Heart Rhythm Society: “Fainting.”
Mayo Clinic: “Vasovagal syncope,” “Dehydration.”
Medscape: “Carotid Sinus Hypersensitivity.”
Merck Manual: “Shortness of Breath,” “Fainting.”
NHS Choices: “Postural tachycardia syndrome (PoTS),” “Breath-holding spells in children,” “Fainting.”
WebMD Health: “a-to-z-guides slideshow,” “what makes you faint?”