INTRODUCTION

 Hyperventilation is a condition where a person breathes rapid or

excessively deep respirations.
 Hyperventilation is a common occurrence in the dental office, as it is
almost always the result of an episode of anxiety or emotional
stress.
 Therefore, recognition and management of patient anxiety achieve
the prevention of hypertension.

PATHOPHYSIOLOGY

 Hyperventilation leads to the body getting rid of too much carbon

dioxide leading to a reduction of carbon dioxide in the blood.
 This in turn causes a number of consequences as a reaction to this
respiratory alkalosis. There is reflex vasoconstriction of the cerebral
vessels causing a decrease in cerebral perfusion. The increase in
blood pH causes a change in calcium ion concentration in the
blood. As the amount of ionized calcium in the blood decreases,
there is an increase in neuromuscular excitability. Tingling and
numbness in the extremities is seen, as is epigastric pain .

CAUSES
• Anxiety, often precipitated by personal or environmental
stress, is the most common predisposing factor associated
with hyperventilation, these patients respond well to pre-
operative sedation
• Other causes include changes in the body’s acid base
balance, hypoxia, toxins and drugs.
• When hyperventilation is chronic (continuing for a long time or
in recurrent episodes) it is usually referred to as
hyperventilation syndrome. It is associated with psychological
symptoms (i.e. anxiety) or somatic – aka bodily symptoms
(i.e. intestinal, neurological or respiratory).
•
SIGNS AND SYMPTOMS
 The person may complain of:
• Breathlessness:
• Frequent (>20 breaths/min), prolonged sighing inspiration,
sometimes so severe that the patient feels like suffocating
• Light-headedness and dizziness
• Chest pain
• Paraesthesia (a tingling, prickling or burning sensation) in the
fingers and sometimes toes
• Perioral tingling (tingling in or around the mouth)
• Tonic muscle spasm
• Tetani can occur because with severe respiratory alkalosis
• Abdominal cramps
• Palpitations
• Syncope

 The person will:

• Look very anxious and be struggling to breathe
• Find it difficult to speak
• Be using the accessory muscles of respiration
 Signs of deterioration: vital signs unstable
 Signs of recovering: breathing returns to normal
 Signs of the cause.

TREATMENT
 Hyperventilation brought on by anxiety/panic can usually be treated
by:
• Remove what caused the anxiety from the patients line of
vision. (syringe, handpiece, forceps.)
• Remove foreign objects that can become aspirated/airway
obstructions from the patient’s mouth.
• Position patient upright, which is the position most
hyperventilating patients are comfortable.
• Reassure the patient all is well in a calm relaxed
manner. Have the patient breath slowly and regularly.
 • If patient is not responding, should be hospitalized with
monitor ing of vital signs
• If the patient becomes unresponsive, no normal breathing,
and no palpable pulse consider the diagnosis of cardiac
arrest, Immediate CPR and defibrillation.
• Discharge Patient when the episode is over.
• Pre-op sedative medications can be used for the next dental
appointment to prevent this from occuring again.
 Hyperventilation from other causes Patients who relate a history of
hyperventilation secondary to a medical condition (other than
anxiety) should not receive pre-operative sedation and may need:
• Relaxation sessions
• Breathing exercises
• Medication
• Management of associated disorders

Refrences:
 https://www.dentalcare.com/en-us/professional-education/ce-
courses/ce516/hyperventilation
 https://www.dentalnursenetwork.com/news/451-recognition-and-
treatment-of-hyperventilation.html
 http://www.erikrichmond.com/medemerg/5-catagories-of-
common/respiratory-emergencies/hyperventilation.html
 http://www.oralcareindia.com/dental_emergencies/hyperventilation.a
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