|Year : 2014 | Volume
| Issue : 3 | Page : 185-188
Awareness of emergency drugs uses among students and teaching faculty in a dental college in Coorg, Karnataka
CB Sudeep1, Peter Simon Sequeira2, Jithesh Jain2, Nithin Prataap3, Vipin Jain4, Mathew Maliyil2
1 Department of Public Health Dentistry, MES Dental College, Perinthalmanna, Malappuram, India
2 Department of Public Health Dentistry, Coorg Institute of Dental Sciences, Virajpet, Coorg, India
3 Department of Oral and Maxillofacial Surgery, PSM Dental College, Thrissur, Kerala, India
4 Department of Public Health Dentistry, KLE Dental College, Bengaluru, Karnataka, India
|Date of Web Publication||15-Nov-2014|
C B Sudeep
Department of Public Health Dentistry, MES Dental College, Perinthalmanna, Malappuram, Kerala
Source of Support: None, Conflict of Interest: None
Introduction: Effective management of an emergency situation in the dental office is ultimately the dentist's responsibility. The lack of training and inability to cope with medical emergencies can lead to tragic consequences and sometimes legal action. It is logical to provide training on emergency care during undergraduate years ensuring basic competence in all graduating healthcare students. Previous surveys of medical and dental schools have highlighted deficiencies in such training. This survey sought to assess awareness of emergency drug use among students and teaching faculty in a dental college in Coorg, Karnataka. Materials and Methods: The study was carried out among a convenience sample of 250 dental students (III rd BDS, IV th BDS, Interns, and post graduates) and teaching faculty at the Coorg Institute of Dental Sciences, Coorg, Karnataka. The Closed - ended questionnaire containing selected basic multiple choice questions was used to assess the awareness. Results: About 60% of the responders scored < 50% marks, 15.6% of the responders scored between 50% and 59% marks, 14% of the responders scored 60-69% marks, 4.8% scored marks between 70% and 79% marks, only 5.6% of the responders scored between 80% and 89% marks. Conclusion: Awareness of emergency drug use among dental students and teaching faculty needs to be improved and updated.
Keywords: Awareness, basic life support, dental students, emergencies, emergency drugs, questionnaire
|How to cite this article:|
Sudeep C B, Sequeira PS, Jain J, Prataap N, Jain V, Maliyil M. Awareness of emergency drugs uses among students and teaching faculty in a dental college in Coorg, Karnataka. J Indian Assoc Public Health Dent 2014;12:185-8
|How to cite this URL:|
Sudeep C B, Sequeira PS, Jain J, Prataap N, Jain V, Maliyil M. Awareness of emergency drugs uses among students and teaching faculty in a dental college in Coorg, Karnataka. J Indian Assoc Public Health Dent [serial online] 2014 [cited 2019 Aug 19];12:185-8. Available from: http://www.jiaphd.org/text.asp?2014/12/3/185/144791
| Introduction|| |
Life-threatening emergencies can occur anytime, anywhere and to anyone. Such situations are somewhat more likely to occur within the confines of the dental office due to the increased level of stress which is so often present. For example, Fear and anxiety may make these patients prone to medical emergencies such as syncope and hyperventilation.  Effective management of an emergency situation in the dental office is ultimately the dentist's responsibility. The lack of training and inability to cope with medical emergencies can lead to tragic consequences and sometimes legal action. For this reason, all health professionals including dentists must be well prepared to attend to medical emergencies.
The extent of treatment by the dentist requires preparation, prevention and then management, as necessary. Prevention is accomplished by conducting a thorough medical history with appropriate alterations to dental treatment as required. The most important aspect of nearly all medical emergencies in the dental office is to prevent, or correct, insufficient oxygenation of the brain and heart.
Drugs that should be promptly available to the dentist can be divided into two categories. The first category represents those which may be considered essential. The essential category of emergency drugs includes oxygen, epinephrine, nitroglycerine, antihistamine, albuterol/salbutamol, and aspirin.  The second category contains drugs that are also very helpful and should be considered as part of the emergency kit. These additional drugs present within the operator are glucagon, atropine, ephedrine, hydrocortisone, morphine/nitrous oxide, naloxone, lorazepam/midazolam, flumazenil. The precise composition of the drug kit can vary as the presence of the drugs in this latter group may depend on the individual dentist's needs and the nature of the dental practice. 
Those with training in advanced cardiac life support would also have additional drugs. Dentists who are trained to administer general anesthesia or intravenous sedation would be expected to have additional drugs. These dentists should have a patent intravenous line in place, and therefore drug administration could use this route, which may be considered ideal.  It may be assumed that dentists without advanced training in anesthesia or sedation may not be proficient in venipuncture. In this case the intramuscular route of administration, which can include the intralingual injection, would be appropriate. The intralingual intramuscular injection should provide a more rapid onset of action compared with the more traditional sites although not as rapid as intravenous.
Bearing in mind that dental students have little understanding of medical emergency management and that there is very little in-depth data about the importance dental students place on acquiring competence in this area of patient care, the purpose of this study was to assess the awareness of emergency drugs used among students and teaching faculty in a dental college in Coorg, Karnataka
| Materials and Methods|| |
The study was carried out among dental students (III rd BDS, IV th BDS, Interns, and post graduates) and teaching faculty In Coorg Institute of Dental Sciences, Coorg, Karnataka Students and Teaching faculty who were present during the study period were included.
Training and calibration of the examiner was done in the Department of Public Health Dentistry, Coorg Institute of Dental Sciences, Virajpet. Investigator was trained and standardized through a series of training exercises including a series of theoretical overviews and discussing issues that might be encountered during the study period.
A specially designed proforma was used to assess the awareness on emergency drugs used in common practice. This was followed by qualitative interview with a focus group of 20 participants whose responses were recorded using the designed proforma to establish a conceptual equivalence and content validity of the present questionnaire. Internal reliability of the questionnaire was pretested using Cronbach's alpha on a pilot sample of 20 participants (focus group) and the α values were found to be 0.71.
The difficulties encountered during the pilot study were overcome during the main study. Those who participated in the pilot study were excluded from the main study. A convenience sample of 250 participants was selected to participate in the study. The study was conducted during the 1 st week of November 2012. Prior to the study, ethical approval was obtained from the Institutional Ethical Committee and written informed consent was obtained from each participant.
The results were analyzed using an answer key prepared with the help of standard text books in medical emergencies in dentistry, , principles and practice of medicine  and pharmacology and therapeutics in dentistry. 
| Results|| |
Of the total responders (n = 250), 205 were dental students which included 45 III rd BDS students, 45 IV th BDS students, 40 interns, and 75 post graduates and 45 were teaching faculty [Figure 1].
[Figure 2] shows the level of awareness of emergency drugs among the responders and it was seen that III rd BDS students scored 35.90%, IV th BDS students had an average score of 38.47%, interns scored 45.11%, and post graduates scored an average of 47.29%. The teaching faculty scored the highest with an average score of 56.89%. It was observed that the level of awareness increased with increased exposure in the practical field.
[Figure 3] describes the level of awareness among the students as a whole and the teaching faculty. It was observed that when students scored an average of 42.42%, where the BDS students scored 39.62%, and post graduates averaged 47.29%. The teaching faculty scored the highest with an average of 56.89%. It was observed and concluded that the teaching faculty had a higher level of awareness when compared with BDS students, interns and post graduates.
[Figure 4] compares the awareness among the graduates and under-graduates. It was evident that the graduates had a higher level of knowledge when compared to the undergraduates, the graduate's average score was 50.89% but at the same time under-graduates scored only 39.62%. The observed reason behind this difference in scores can be attributed to increased exposure in the practical field. Again the level of awareness increased with increased exposure in the practical field.
[Figure 5] describes the scores of responders, it was noted that 70% of the responders scored <50% marks, 14% of the responders scored between 50% and 59% marks, 8% of the responders scored 60-69% marks, 6% scored marks between 70% and 79% marks, only 2% of the responders scored between 80% and 89% marks, whereas none of the responders were able to score above 90% marks.
| Discussion|| |
Similar studies conducted among specialist dentists about medical emergencies in the dental office showed that the preparedness of the specialist dentist was not favorable. ,,,,, Thus, more focus should be placed on the improvement of management of medical emergencies.
Chandrasekaran et al. 2010 conducted a study on medical, dental, nursing students and doctors and reported that only 0.19% had secured 80-89% marks versus 5.6% in the present study and 84.82% had secured <50% marks versus 60% in the present study. 
Dentistry is a health science profession that should focus on the whole patient instead of being limited to the oral cavity, medical emergencies do occur in the dental office, but students minimal knowledge about these incidents and their etiology causes feelings of insecurity, dissatisfaction, and a limited appreciation of the dentists responsibility, and the inability to respond positively and administer the drugs during an emergency in the dental office is the ultimate consequence. 
The results of the study confirmed that undergraduate dental students require more intensive education in medical emergencies. Undergraduate health courses need to develop strategies to teach professionals and student's appropriate behavior and attitudes when facing life-threatening emergencies. The authors would also like to add that theoretical information with demonstrations but without practice is probably is not enough to ensure competence. From the above results, it was concluded that awareness of emergency drugs used in common practice was found to be poor in all the student groups when compared with the teaching faculty.
| Conclusion|| |
Awareness of emergency drugs used among dental students, and teaching faculty needs to be improved and updated. Dentistry in India has made tremendous progress in different sub-specialties of dentistry. A better knowledge of medical emergencies is essential for further development of dentistry. This will ensure the provision of better and safer dental healthcare services for the population.
Recommendations and suggestions
This study should be carried out in various other medical, dental and paramedical institutions, and the awareness on basic life support and emergency drugs among the students and faculty should be assessed. The authors would also recommend future studies to assess the practical skills of subjects and their attitude toward basic life support and medical emergencies which were not assessed in the present study.
The participation of educational institutions to improve the training of students and professionals for cardiopulmonary resuscitation and other medical emergencies that can occur in the dental office is also necessary. Also, steps need to be taken to create awareness in almost all corners and sectors of our society, with the intention of creating numerous emergency care responders.
| References|| |
Amirchaghmaghi M, Sarabadani J, Delavarian Z. Preparedness of specialist dentists about medical emergencies in dental office-Iran. Aust J Basic Appl Sci 2010;4:5483-6.
Haas DA. Management of medical emergencies in the dental office: Conditions in each country, the extent of treatment by the dentist. Anesth Prog 2006;53:20-4.
Malamed SF. Medical Emergencies in the Dental Office. 6 th
ed. Missouri, United States: Mosby; 2007.
Bennett JD, Rosenberg MB. Medical Emergency in Dentistry. I st
ed. Philadelphia, United States: W B Saunders; 2002.
Colledge C, Haslitt HC, Boon NA. Davidsons Principles and Practice of Medicine. 19 th
ed. London, United Kingdom: Churchill Livingstone; 2002.
Yagiela JA, Dowd F, Neidle EA. Pharmacology and Therapeutics for Dentistry. 5 th
ed. Missouri, United States: Mosby; 2004.
Chapman PJ. Medical emergencies in dental practice and choice of emergency drugs and equipment: A survey of Australian dentists. Aust Dent J 1997;42:103-8.
Girdler NM, Smith DG. Prevalence of emergency events in British dental practice and emergency management skills of British dentists. Resuscitation 1999;41:159-67.
Atherton GJ, Pemberton MN, Thornhill MH. Medical emergencies: The experience of staff of a UK dental teaching hospital. Br Dent J 2000;188:320-4.
Gonzaga HF, Buso L, Jorge MA, Gonzaga LH, Chaves MD, Almeida OP. Evaluation of knowledge and experience of dentists of São Paulo State, Brazil about cardiopulmonary resuscitation. Braz Dent J 2003;14:220-2.
Morse Z, Murthi VK. Medical emergencies in dental practice in the Fiji Islands. Pac Health Dialog 2004;11:55-8.
Chandrasekaran S, Kumar S, Bhat SA, Saravanakumar, Shabbir PM, Chandrasekaran V. Awareness of basic life support among medical, dental, nursing students and doctors. Indian J Anaesth 2010;54:121-6.
Carvalho RM, Costa LR, Marcelo VC. Brazilian dental students' perceptions about medical emergencies: A qualitative exploratory study. J Dent Educ 2008;72:1343-9.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]