Dr. Saint Jean, Dr. Saint Jean, I think he is dead…….. I think he is dead!
My heart sank when I heard these words; I remember the day very well. It was a beautiful morning. I had recently moved to Charlotte and had been working as an associate in a dental practice in town. I was in the middle of preparing a crown for a not very cooperative patient. The practice had about 8 people on staff at any time plus the owner and me in addition to patients in operatories and waiting area.
I was trying to figure out who had died.
The assistant ran into the operatory, she looked shaken; I dropped everything and followed her to one of the operatory, which was seldom used, because it was a little out of the way and occasionally used as a storage room. There, I saw a young man with his upper body hanging over the armrest of the dental chair, he looked very pale, but more importantly he was unconscious.
I had never seen him before and was unaware that he had been in this room or how long he had been there. Thankfully I had recently renewed my “Emergency in the Dental Office” training, which kick in and aided by the staff we were able to revive him before the arrival of EMT who showed up with remarkable promptitude, less than 10 minutes after they were called.
A review of his medical history form the patient file did not reveal any health issue or allergies, which was what I initially thought was the cause of his discomfort; He had been given a shot of local anesthetic (3.4 cc of lidocaine 2% with 1:100,000 epinephrine) to prepare him for the planned emergency treatment.
However when we brought in his female companion in the room to gather more information, we learned that he suffered from a heart condition named Torsade de Pointes, which is a rare and distinctive form of arrhythmia (irregular heart beat) characterized by a gradual change in the amplitude and twisting of the QRS complexes around the isoelectric line. Torsade de pointes, is also associated with a fall in blood pressure in the arteries, which can cause the subject to lose conscience (syncope).
The condition usually is self limiting and ends spontaneously; but frequently recurs and may degenerate into ventricular fibrillation, which will lead to sudden death if not medically addressed. In light of the established diagnosis, the EMT staff was able to stabilize the patient who was then carted out to one of the local hospital for observation.
I am quite confident that most of this episode could have been prevented had the patient been upfront and honest about his condition and he never would have been given epinephrine, which probably exacerbated his condition and pushed him into a crisis situation where he could have lost his life.
The main reason of the medical history form in the dental office is to gather information (past or present) about the health of a patient who is seeking care at a dental practice. Its main purpose is to help the practitioner in preparing a custom treatment plan for the patient, based on the health information gathered. Armed with this information, a practitioner can stage a plan for treating patient dental ailments without putting in jeopardy his/her general health.
According to the US government census, almost half of American take at least one prescription medication, and one in 6 American take 3 or more medication. These medications have both therapeutic and side effects which can negatively react with some of the product used in dentistry.
In addition conditions known or unknown by the patient can influence and be affected by our dental products or procedures if proper precautions are not taken. Sharing your health information with your dentist is the safest way to ensure your dental needs are being properly addressed with safety in mind. Most dental procedure have an invasiveness component. The most common is, quite often, a shot in order to control pain, which is still one of the main reason some visit the dentist.
Moreover, some health conditions have well known oral issues; just as the medication used to treat these conditions. Cancer patient in chemo or radiotherapy experience well documented oral side effects, but without that bit of information the dental side effects may be mistaken for other problems, such as meth mouth, bulimia, etc.
The experience of that day reinforced what I had learned in school about the importance of the medical history and I always verify it myself by quizzing the patient to be sure it is complete and correct. Next time you are visiting a dentist, please take a minute to ensure your medical history is up to date and the information is correct. It could be a life saving minute.