Positive Pressure Demand Valves in the Dental Office

When it comes to dealing with medical emergencies in the dental office, many dentists have positive pressure demand valves, such as the one pictured here to administer ventilations to a patient during a medical emergency. In fact, some companies are still supplying these demand valves to dental offices. However, positive pressure demand valves have fallen out of favor within the medical community for several reasons. First, during the intense and stressful moments of a medical emergency, the rescuer frequently has a tendency to hyperventilate the patient, not allowing the patient to exhale completely. By repeatedly giving breaths to a patient without allowing full exhalation, the breaths become stacked, one on top of the other. With the use of a positive pressure demand valve this can lead to baro-trauma and subsequent pneumothorax. Secondly, by using a positive pressure demand valve to deliver breaths, the rescuer has no way to judge how much oxygen has been given with each push of the button, or whether the ventilations are effective. Finally, after sitting in a closet for years, the springs become weak and the gaskets dry out rendering the demand valve useless when needed.

Twenty years ago, positive pressure demand valves were commonly found in ambulances and emergency rooms throughout the country. However, in California at least, positive pressure demand valves are no longer used in emergency medicine or onboard any ambulance. Instead, the American Heart Association recommends the use of a Bag Valve Mask or BVM. The BVM has become the standard of care when providing ventilatory support. All health care providers, including dentists, hygienists, and dental assistants must maintain current certification in Basic Life Support for the Health Care Provider. The proper use of a BVM is one of the core topics taught in this class through the American Heart Association.

If you currently have a positive pressure demand valve in your office, consider replacing the positive pressure regulator with a flow regulator, and purchase a disposable bag valve mask. The total cost for this is around $100, and it is a cheap price to pay to provide proper care for your patients.

Preparing for a Medical Emergency in the Dental Office

Nobody likes the thought of a medical emergency in the dental office. In fact, most people are downright terrified of the possibility. Medical emergencies in the dental office are rare, unfortunately however, emergencies do happen. The ADA estimates approximately 3,000 life threatening emergencies occur in the dental office every year. As health care providers, it is the responsibility of every RDA, RDH, DDS and DMD to be prepared in the event of a medical emergency. Everyone is required to be trained in CPR and maintain valid certification. But is this enough? The dental professional can be confronted with various emergencies that do not require the compressions and ventilations taught in CPR courses. Anaphylaxis, Chest Pain, and Altered Level of Consciousness are just a few of the emergencies that require prompt action in order to prevent a negative patient outcome.

So how can the dental office prepare itself to face a medical emergency? First, a written comprehensive medical emergency response plan should be developed for every office. The emergency medical response plan should be reviewed by the entire office annually or when any changes in staff occur. The medical emergency response plan should include specific duties for each person within the office. For instance, front office staff should be assigned the task of calling 911, copying the medical records of the patient, and meeting the fire department / paramedics in the parking lot. A licensed staff member should be assigned the task of documenting the medical emergency and maintaining the patient’s airway.

Secondly, every office should have an emergency medical kit with medications to treat the most life threatening emergencies. Most importantly, the dentist must know what medications are in the kit, when and how they are administered, and when not to administer them. For instance, if someone is experiencing cardiac related chest pain, nitroglycerin is the first line drug to relieve the pain. However, it should not be given if the patient has taken an erectile dysfunction drug such as Viagra within the previous 48 hours. Ntiroglycerin should also be withheld if the patient’s systolic blood pressure is below 100 mm/hg. Every medication has an expiration date; therefore, the contents of the kit should be inspected monthly. Medications that every office should have on hand include: Nitroglycerin, Albuterol, baby Aspirin, glucose, Epinephrine and Benadryl. If your office treats children, pediatric doses of Epinephrine and Benadryl should also be included. Every dental office should also have a portable oxygen tank with a liter flow regulator attached.

Finally, the American Heart Association has recently made significant changes in CPR. The new changes took effect June 2006, and much more importance has been placed in the use of Automatic External Defibrillators (AED). Studies have shown that the use of AEDs with CPR has a much higher success rate than the use of CPR alone. In fact, the survival rate is greater than 70% when an AED is used within the first minute of a sudden cardiac arrest. The cost of AEDs have come down over the past few years and certain AEDs are even available over the counter without a physician’s prescription. Anyone can now purchase an AED for under $1,500.00. It is highly recommended that every dental office have an AED available, and that every member of the dental office be familiar with its use.

The American public expects and counts on their dentist and dental team to know how to take care of a medical emergency in the dental chair. They trust that the dentist has both their dental and medical health in mind. There can be no better way for a dental office to show their patients they care, then to be prepared and trained to save their patients lives.