International Dental Journal

SCIENTIFIC RESEARCH REPORT

doi: 10.1111/idj.12473

Preparedness and attitudes towards medical emergencies in

the dental office among Polish dentists
Jacek Smereka1,2 , Marcin Aluchna3, Alicja Aluchna4 and Łukasz Szarpak5
1
Laboratory of Experimental Medicine and Innovative Technology, Department of Emergency Medical Service, Wroclaw Medical University,
Wroclaw, Poland; 2The Witelon State University of Applied Sciences in Legnica, Legnica, Poland; 3Department of Conservative Dentistry,
Medical University of Warsaw, Warsaw, Poland; 4Medical University of Warsaw, Warsaw, Poland; 5Lazarski University, Warsaw, Poland.

Background: Medical emergencies in dental offices are considered a problem in most countries owing to dentists’ con-
cerns about emergency preparedness, practical skills, lifesaving equipment and staff availability. The prevalence of medi-
cal emergencies in dental offices and dentists’ preparedness have been analysed in several countries but have never been
studied in Poland. Aim: To assess the prevalence of medical emergencies in dental offices in Poland, as well as dentists’
preparedness and attitudes towards medical emergencies. Methods: An 18-item questionnaire was completed by 419 den-
tists. It asked for information on their cardiopulmonary resuscitation training, availability of emergency medical equip-
ment in the dental office, prevalence of medical emergencies and self-assessed competence in various dental office
emergencies. Data were analysed using the Statistica 13.3 software package. Variability was measured with standard
deviation. Pearson’s linear correlation coefficient was used to determine correlation strength. Results: The most common
medical emergencies in Polish dental offices were vasovagal syncope (46.30% of study participants experienced at least
one case in the preceding 12 months), orthostatic hypotension (18.85%), hyperventilation crisis (18.61%), mild allergic
reactions (16.23%), hypoglycaemia (15.99%) and seizures (11.81%). The prevalence of medical emergency situations
requiring an emergency medical service call or medical assistance within the preceding 12 months was 0 for 80.66% of
dentists, one for 12.65%, two for 4.53%, three for 1.20%, four for 0.48%, 5–10 for 0.48% and more than 10 for 0%.
As many as 41.29% of the participants did not feel competent in managing sudden cardiac arrest, 74.47% in managing
hypertensive crisis, 55.61% in managing asthma, 55.13% in managing anaphylactic shock and 52.99% in managing sei-
zures. Conclusion: The prevalence of medical emergencies in dental offices in Poland is comparable with that in other
countries. A large number of dentists do not feel competent enough to manage medical emergencies. Better undergradu-
ate and postgraduate training in medical emergencies is recommended, as well as broader availability of emergency med-
ical equipment in the dental office.

Key words: Dentist, medical emergency, cardiopulmonary resuscitation, dental education

noticed an increased demand in Poland for participa-

INTRODUCTION
Medical emergency is an acute medical problem, with
an immediate risk to the patient’s life or health if not
dealt with quickly. Several studies on the prevalence
of medical emergencies have revealed that nearly
every general dentist has had to cope with an emer-
gency condition during their professional career1–3.
The prevalence of medical emergencies and dentists’
preparedness have been analysed in several countries3–6
but so far have not been studied in Poland. Many
patients use the services of Polish dentists, including
patients living in other European countries. For sev-
eral years now, the authors of this survey have
© 2019 FDI World Dental Federation
tion in basic life support (BLS) and medical emer-
gency management courses applicable to dental
offices.
Medical emergencies in the dental office are not a
rare phenomenon. In Germany, for example, Muller
et al.2 stated that 57% of dentists encounter at least
three emergencies per year, and 36% face more than
10. According to the literature, the most common
medical emergencies are syncope and presyncope, sei-
zures, anaphylaxis, hypoglycaemia, orthostatic
hypotension and hypertensive crisis1–6. Cardiac arrest
is very rare in the dental office but medical personnel
should be able to manage various medical emergencies
1
Smereka et al.
and, among others, perform cardiopulmonary resusci-
tation (CPR) with the use of an automated external
defibrillator (AED)7.
Medical emergencies are a problem in most coun-
tries worldwide owing to dentists’ and dental stu-
dents’ concerns about emergency preparedness,
practical skills, emergency lifesaving equipment and
staff availability7,8. The number of medical emergen-
cies is increasing because of the aging of the popula-
tion of patients undergoing dental treatment, the
growing prevalence of chronic illnesses, as well as the
rising number of drugs administered to patients and
their possible side effects. Increasing age is a risk fac-
tor for medical emergencies during and after dental
treatment9. It is believed that medical emergencies
more often accompany local anaesthesia, and that
patient’s emotional stress can contribute to a greater
risk for medical emergency10. The prevalence of emer-
gency conditions may also be affected by factors such
as systemic diseases, especially cardiovascular disease.
Many studies have highlighted the need to im-
prove training of dentists in medical emergencies
by participation in BLS courses and specialised pro-
grammes2,7,11. It was emphasised that Advanced Life
Support/Advanced Cardiovascular Life Support (ALS/
ACLS) courses should be more focussed on dentistry-
related issues, practical skill training and BLS compe-
tence7. International guidelines suggest that dentists
should regularly participate in annual practical train-
ing in the recognition and management of medical
emergencies, including those that require CPR and
AED use12. Nogami et al.7 stated that dentists should
update their BLS knowledge and skills periodically –
at least every 2 years, and preferably more frequently.
The European Resuscitation Council (ERC) and the
American Heart Association (AHA) suggest that den-
tists should participate regularly in BLS/ALS courses,
at the optimal frequency of once a year.
Dentists worldwide have to deal with medical emer-
gencies, from those that are benign to life-threatening
conditions such as cardiac arrest, which require CPR
with the use of an AED. The reported rate of cardiac
arrest in dental practice is below 0.1 cases per dentist
per year.11 Some modifications of the initial BLS
sequence have been proposed; these include changing
the position of the dental chair to fully horizontal,
with the support of a stool to enhance stability11.
Endotracheal intubation is not recommended to be
performed by dentists; supraglottic airway devices are
preferred for airway management12–16. In most coun-
tries it is not mandatory for an AED to be included in
dental practice equipment; accordingly, an AED is
present in <5% of dental offices in Europe, in contrast
to the USA, where an AED is available in >10% of
dental offices7. The emergency equipment required in
dental offices depends on local regulations in specific
2 © 2019 FDI World Dental Federation
countries17. In the state of New York, each dental
office has had to be equipped with an AED or other
defibrillator since 1 January 2012; the same applies to
Mississippi and Massachusetts. The ERC recommends
that all dental practices delivering clinical care should
have immediate access to an AED11 and that basic
resuscitation equipment (oxygen, suction, self-inflating
bag with face masks and emergency medications)
should be directly available in all primary-care dental
offices 17. In the UK, the Resuscitation Council quality
standards for CPR practice and training suggest that
all clinical dental areas should have immediate access
to an AED, as well as oxygen and resuscitation equip-
ment for airway management, including suction; how-
ever, in Europe an AED is not mandatory for every
dental office17.
Preparation for medical emergencies in dental prac-
tice includes training of medical personnel, the avail-
ability of appropriate equipment and proper updating
of the patients’ medical histories18. Correctly kept
detailed medical history, comprising allergies, cur-
rent health status, chronic illnesses and concomitant
treatment, can help reduce the risk for medical
emergencies19.
The 5-year university curriculum for dentistry stu-
dents in Poland includes emergency medicine and
BLS/ALS; however, the advances in CPR techniques
and standards may pose challenges for dentists long
after graduation. Important examples are the intro-
duction of new equipment (such as an AED), airway
management appliances (such as supraglottic airway
devices) and techniques (such as pulse oximetry and
intravascular access) 11.
The aim of the study was to assess the prevalence
of medical emergencies in dental offices in Poland, as
well as dentists’ preparedness and attitudes towards
medical emergencies.
METHODS
Participants and procedure
The study was approved by the Institutional Review
Board of the Polish Society of Disaster Medicine (ap-
proval No. 23.04.2016.IRB). The participants were
informed about the study objectives and voluntarily
took part in the survey after providing verbal consent.
The verbal consent was approved by the Institutional
Review Board. The research was conducted between
01 June 2016 to 30 November 2017 in Poland, in full
accordance with the applicable ethical principles,
including the World Medical Association Declaration
of Helsinki (the 2008 version). The questionnaire was
developed by the authors (experienced anaesthesiolo-
gists, dentists and paramedics). When tested among a
group of 50 dentists, before the study, to determine

comprehension and unambiguity, the questionnaire
was confidential, anonymous and could be safely
stored. The final version was distributed among Polish
dentists during scientific meetings and congresses held
in Poland.
The questionnaire consisted of 18 questions:
• Questions 1–5 considered age, gender, work experi-
ence, specialisation and type of dental practice
• Questions 6–8 were related to the latest training in
CPR and the use of sedative agents in the dental
practice
• Question 9 referred to the availability of emergency
medical equipment in the dental office
• Question 10 was related to the prevalence of medi-
cal emergencies during the preceding 12 months
• Question 11 collected information on self-assessed
competence in various dental office emergencies
• Questions 12–14 involved anamnesis, documenting
vital signs, and the number of medical emergencies
in the preceding 12 months that required an emer-
gency medical services (EMS) call for assistance or
medical assistance
• Questions 15–18 dealt with the patient’s position
during CPR in a dental office, the dentists’ attitude
towards intravenous and intraosseous routes, as
well as signs of cardiac arrest.
Statistical analysis
Data were analysed using the statistical package Sta-
tistica 13.3 27 (TIBCO Software Inc., Tulsa, OK,
USA). Descriptive statistics were used to analyse the
demographic variables. During data analysis, statisti-
cal description measures were selected, as appropri-
ate, to measure the values obtained in the response
scales used for each variable. Measures of descriptive
statistics and methods of statistical deduction were
used.
Variability was measured using standard deviation.
Pearson’s linear correlation coefficient was used to
determine correlation strength. To compare the distri-
butions and average results between two independent
groups, the Student’s t-test was applied if the assump-
tions regarding normality of distribution in particular
groups and homogeneity were met. If any of the
assumptions was not met, a non-parametric alterna-
tive was used, namely the Mann–Whitney U-test.
When comparing the distributions of a continuous
dependent variable and its average results in more
than two groups, a one-way parametric analysis of
variance (ANOVA) was employed. For multiple com-
parisons, post-hoc testing was carried out using Dun-
can’s parametric test, which is insensitive to group
non-grouping and non-homogeneity of variations. We
tested the normality of variable distributions with the
Kolmogorov–Smirnov test, and the homogeneity of
© 2019 FDI World Dental Federation
Medical emergencies in the dental office
variance with the Fisher–Snedcore F test and Levene’s
test. When generalising conclusions, we employed the
conventional significance levels (alpha) equal to 0.05.
RESULTS
In total, 700 active dentists working in Poland were
asked to participate in the study. Of those, 422
agreed, which gave a participation rate of 60.3%.
Three questionnaires were returned partially filled in,
and therefore were rejected; accordingly 419 question-
naires were included in our analysis. In the final
group of 419 participants, 376 (89.74%) were female.
The median age of respondents was 44 (mean:
42.43  10.70) years, and mean work experience was
17.01  10.57 years.
Of the participants, 72.55% worked in a private
dental office, 34.13% in dental clinics with at least
two dentists employed and 5.73% in hospitals.
Among the study subjects, 9.55% used sedatives in
their dental practice and 90.45% did not.
Data concerning the dentists’ participation in CPR
training and type of training are shown in Tables 1
and 2. The emergency equipment available in dental
offices in Poland is summarised in Table 3. Table 4
presents the prevalence of medical emergencies
in dental offices in the 12 months preceding the
study.
An automated external defibrillator or manual
defibrillator was available in 17.90% of dental offices
in Poland, an oxygen source in 21.48%, a supraglottic
airway device in 35.80% and a self-inflating bag
resuscitator in 82.34%. The most common medical
emergencies in Polish dental offices were vasovagal
syncope (46.30% of study participants had at least
one experience of this in the preceding 12 months),
orthostatic hypotension (18.85%), hyperventilation
crisis (18.61%), mild allergic reactions (16.23%),
hypoglycaemia (15.99%) and seizures (11.81%).
As many as 41.29% of the study participants did
not feel competent in managing sudden cardiac arrest,
74.47% in managing hypertensive crisis, 55.61% in
managing asthma, 55.13% in managing anaphylactic
shock and 52.99% in managing seizures.
Table 1 Dentists’ participation in cardiopulmonary
resuscitation training before the study
Period n (%)
Within the last 12 months 104 (24.82)
Within the last 2–5 years 168 (40.10)
Within the last 6–10 years 74 (17.66)
10 or more years ago 38 (9.07)
Never since graduation 35 (8.35)
Total 419 (100.00)
3
Smereka et al.

The medical history for each patient was taken
orally with medical record documentation by 188
(44.86%) dentists, as a questionnaire filled in by the
patient by 130 (31.03%) dentists and, in selected
cases, either orally or in writing, by 101 (24.11%)
dentists. Vital signs (respiratory rate, blood pressure,
heart rate and temperature) were never recorded by
164 (39.14%) respondents, were unlikely to be
recorded by 209 (49.88%), were likely to be
recorded by 42 (10.02%) and were recorded each
time by four (0.96%). The prevalence of medical
emergency situations requiring an EMS call or medi-
cal assistance within the preceding 12 months was as
follows: none (80.66%) for 338 dentists; one
(12.65%) for 53; two (4.53%) for 19; three (1.20%)
for five; four (0.48%) for two; 5–10 (0.48%) for
two; and > 10 for (0%) none.
Table 2 Type of cardiopulmonary resuscitation train-
ing attended by dentists before the study
Type of training
Lecture only 93
Practical manikin training only 18
Lecture + practical manikin training 275
No training 33
Total 419
A total of 48.44% of the dentists maintained that
the patient could be taken down from the dental chair
and laid on the floor, and 61.34% claimed that the
dental chair can be reclined to a horizontal position,
with a stool applied to stabilise its head, to perform
chest compressions in cardiac arrest. Moreover, 9.78%
of dentists reported that they would use both methods.
In the case of necessity to obtain intravenous access,
0.48% declared that they would never be able to per-
form it, 21.24% that they would rather not do it,
38.66% responded ‘difficult to say’, 22.67%
responded ‘rather yes’ and 16.95% were always ready
for the procedure. Regarding obtaining intravascular
access for fluid infusion and drug delivery, 45.10%
declared that they would never perform it, 28.88%
that they would rather not do it, 16.47% indicated
‘difficult to say’, 8.12% as ‘rather yes’ and 1.43%
were always ready for the procedure.
When enumerating other than typical signs of sud-
den cardiac arrest, 80.91% of the participants speci-
fied lack of normal breathing, 26.49% slow and
n (%) abnormal breathing, 8.35% gentle and 5.01% loud
snoring, 29.59% gasping and 8.35% pointed that
(22.20)
(4.30)
none of these symptoms indicated sudden cardiac
(65.63) arrest.
(7.87) We aimed to find correlations between the overall
(100.00)
self-assessed competence in managing medical

Table 3 Emergency medical equipment available in dental offices in Poland (n = 419)

Equipment Not available (%) Available only in some Available (%)
dental offices (if the dentist
works in more than one) (%)

Automated external defibrillator 344 (82.10) 44 (10.50) 31 (7.40)

or manual defibrillator
Oxygen source 329 (78.52) 49 (11.69) 41 (9.79)
Supraglottic airway device 269 (64.20) 52 (12.41) 98 (23.39)
(laryngeal mask airway,
laryngeal tube, I-gel, etc.)
Pocket mask 255 (60.86) 40 (9.55) 124 (29.59)
Self-inflating bag resuscitator 74 (17.66) 77 (18.38) 268 (63.96)
Portable suction device 323 (77.09) 38 (9.07) 58 (13.84)
Oropharyngeal airway 147 (35.09) 66 (15.75) 206 (49.16)

Table 4 Prevalence of medical emergencies in dental offices in the preceding 12 months (n = 419)
Emergency Never (%) 1–3 times (%) 4–9 times (%) ≥10 times (%)

Sudden cardiac arrest 411 (98.09) 8 (1.91) 0 (0) 0 (0)

Vasovagal syncope 225 (53.70) 158 (37.71) 28 (6.68) 8 (1.91)
Orthostatic hypotension 340 (81.15) 68 (16.23) 10 (2.39) 1 (0.23)
Hyperventilation crisis 341 (81.39) 69 (16.47) 8 (1.91) 1 (0.23)
Mild allergic reaction 351 (83.77) 66 (15.75) 2 (0.48) 0 (0)
Anaphylactic shock 410 (97.86) 8 (1.91) 1 (0.23) 0 (0)
Seizures 372 (88.79) 44 (10.50) 2 (0.48) 1 (0.23)
Hypoglycaemia 352 (84.01) 62 (14.80) 2 (0.48) 3 (0.71)
Angina 393 (93.79) 24 (5.73) 2 (0.48) 0 (0)
Hypertensive crisis 410 (97.85) 9 (2.15) 0 (0) 0 (0)
Asthma 406 (96.90) 12 (2.86) 1 (0.24) 0 (0)

4 © 2019 FDI World Dental Federation

 Medical emergencies in the dental office

Table 5 Self-assessed competence to cope with medical emergencies in the dental office (n = 419)
Emergency Definitely not (%) Rather not (%) Rather yes (%) Definitely yes (%)

Sudden cardiac arrest 72 (17.18) 101 (24.11) 236 (56.32) 10 (2.39)

Vasovagal syncope 43 (10.26) 62 (14.80) 240 (57.28) 74 (17.66)
Orthostatic hypotension 77 (18.38) 107 (25.54) 186 (44.39) 49 (11.69)
Hyperventilation crisis 83 (19.81) 104 (24.82) 206 (49.16) 26 (6.21)
Mild allergic reaction 69 (16.47) 110 (26.25) 223 (53.22) 17 (4.06)
Anaphylactic shock 84 (20.05) 147 (35.08) 176 (42.00) 12 (2.87)
Seizures 84 (20.05) 138 (32.94) 178 (42.48) 19 (4.53)
Hypoglycaemia 64 (15.27) 72 (17.18) 242 (57.76) 41 (9.79)
Angina 70 (16.71) 120 (28.64) 204 (48.69) 25 (5.96)
Hypertensive crisis 126 (30.07) 186 (44.40) 102 (24.34) 5 (1.19)
Asthma 86 (20.53) 147 (35.08) 169 (40.33) 17 (4.06)

emergencies (Table 5) and different variables. We
observed that gender did not differentiate the self-
assessed competence in medical emergencies
(P = 0.66)20. The correlation between age and work
experience and self-assessed competence was very weak
(linear Pearson coefficient r = 0.18; P < 0.000212 in
both cases). The type of workplace or specialisation did
not differentiate self-assessed competence in medical
emergencies.
DISCUSSION
In recent years, a number of publications on medical
emergencies in dental offices in different countries
have appeared5,6,9,10,21–26. Much research on the atti-
tudes and skills of dentists has focussed on CPR in
dental office settings and the dentists’ preparedness.
Any comparison is hindered by differences in respon-
sibility, and in undergraduate and postgraduate educa-
tion and training of dentists in various countries.
Also, there are different requirements for postgraduate
courses and dental office equipment7.
In our study, vasovagal syncope was the most
common medical emergency (46.30% of dentists re-
ported at least one case in the preceding 12 months,
37.71% reported one to three cases, 6.68% reported
four to nine cases and 1.91% reported at least
10 cases), followed by orthostatic hypotension
(19.85%), hyperventilation crisis (18.61%), mild
allergic reaction (16.23%), hypoglycaemia (15.99%)
and seizures (11.21%). Anaphylactic shock was sus-
pected by 1.91% of dentists. During the 12 months
preceding the study, 80.66% of the dentists did not
encounter an emergency situation requiring an EMS
call or medical assistance, 12.65% faced one such
case and 4.53% experienced two. The prevalence of
medical emergencies in dental offices in other coun-
tries is varied. In the UK, Atherton et al.9 reported
at least one medical emergency in a 10-year time
period among 70.2% of dentists. Syncope was the
most common emergency situation among British
dentists. In Germany, Muller et al.2 stated that
© 2019 FDI World Dental Federation
vasovagal syncope, hypertension, epilepsy and hypo-
glycaemia were the most common medical emergen-
cies in dental offices. Malamed1 observed that in the
USA, the most frequent medical emergency in dental
practice was syncope. According to a 2010 publica-
tion by Anders et al.27, there were 164 medical emer-
gencies per million dental appointments in US dental
clinics. Collange et al.28 stated that, in France, life-
threating medical emergencies in dental practice were
rare, but one in 20 general dentists would have to
cope with CPR at least once during their professional
career. In Belgium, the most frequent emergencies
were vasovagal syncope (34.3%), epilepsy and dia-
betic problems (8.4%), anaphylactic shock (3.8%)
and cardiac arrest (0.4%)10. In Brazil, the most com-
mon were presyncope, orthostatic hypotension, mild
allergic reactions, hypertensive crisis and syncope21.
In Slovenia, 67.5% of dentists reported one medical
emergency during 12 months, 39.8% reported up to
three and 26.3% reported three to 10, with the high-
est prevalence of emergencies being syncope followed
by hypoglycaemia22. The prevalence of medical emer-
gencies varies from country to country, which may
be caused by the lack of a clear definition of medical
emergencies, but syncope and presyncope predomi-
nate in all countries and some medical emergencies,
including anaphylaxis, seizures, hypoglycaemia,
hypotension and hypertension, are among the most
prevalent.
The dentists’ self-assessed competence in medical
emergencies varies among countries. In our study, it
depended on the type of emergency. More than
half (58.71%) of dentists declared being competent
in CPR. The majority declared competence in the
management of vasovagal syncope (74.94%), ortho-
static hypotension (56.08%), hyperventilation crisis
(55.37%), mild allergic reaction (57.28%), hypogly-
caemia (67.55%) and angina (54.65%). However,
only 44.86% perceived themselves as competent in
coping with anaphylactic shock in the dental office,
47.01% with seizures, 44.39% with asthma and
25.53% with a hypertensive crisis.
5
Smereka et al.
Girdler and Smith3, in a study published in 1999,
stated that only 12.9% of British dentists considered
themselves competent to perform a correct diagnosis
of a medical emergency. Marks et al.10, analysing the
awareness of dental practitioners in Belgium to cope
with medical emergencies, observed that after BLS
training, dentists had a better level of self-assessed
competence to diagnose emergency situations. It was
found that myocardial infarction and cardiac arrest
were most difficult to diagnose for dentists; the easiest
were asthma and convulsions. Arsati et al.21, in their
analysis of the self-assessed ability of Brazilian den-
tists to diagnose the cause of a medical emergency,
noted that 41% of dentists felt capable of doing so,
whereas 50.2% did not feel capable. They also
reported the percentage of dentists who did not per-
ceive themselves as capable of providing initial man-
agement in: acute myocardial infarction (79.7%);
anaphylactic shock (72.9%); cerebrovascular incident
(85.7%); angina (64.9%); asthma (68.5%); cardiac
arrest (68.7%); and mild allergic reaction (48.8%). In
addition, they reported that more than half stated
that they would not be able to perform CPR (54.4%)
or an intravascular injection (61.4%). In New Zeal-
and, more than half of the dentists surveyed were not
satisfied with the medical emergency training given
during their undergraduate education and 14.1% con-
sidered themselves not adequately prepared for an
emergency in practice5. In Kuwait, the majority of
general dentists have inadequate knowledge of CPR
and only 57.2% feel competent in performing CPR;
however, 99% agree that dentists should be able to
apply CPR23. A study conducted in Western Saudi
Arabia revealed that only 11% of dentists assessed
vital signs during each visit, and the mean level of
self-assessed preparedness for medical emergencies
was 55.2  20 on a scale of 0–10024. In Eastern
Saudi Arabia regions, in turn, 44.8% of dentists con-
sidered themselves as skilled in performing CPR25. In
Slovenia, only 51% of the responding dentists esti-
mated that they were competent to provide CPR22.
Considerable differences can be observed in the self-
perceived competence among studies; in fact, the form
of questionnaire collection (e.g. a postal survey in
New Zealand) could have influenced the reported
self-assessment.
It has been argued that the prevention of medical
emergencies is of utmost importance10. Taking the
medical history of a patient and updating it before
dental treatment, as well as assessing basic vital signs,
may help identify patients who are at high risk of
requiring emergency medical treatment. Taking into
account the higher risk of dental procedures enables
modifications to be made in the treatment plan,
including specialist consultations and patient referral
to a more specialised clinic or hospital. In our study,
6 © 2019 FDI World Dental Federation
75.89% of the dentists always took a medical history
(orally or as a questionnaire filled in by the patient),
and only 24.11% of dentists took medical history in
selected cases (either orally or in writing). In Slovenia,
34.3% of dentists mostly take a medical history, 26%
always do it and 29.2% do it only at the first visit22.
In Belgium, 55.3% of dentists take a comprehensive
medical history for each patient, 26.6% usually, 9.1%
sometimes and 8.6% never; 11.1% of dentists who
graduated more than 30 years ago never take any
medical history10. Lack of taking medical history for
each patient may increase the number of medical
emergencies, whereas improvement in this area simply
requires greater professional diligence, with no finan-
cial expenditure.
The preparedness for medical emergencies in den-
tal practice depends on education programmes and
on continuing education by dentists. The ERC sug-
gests that dental care professionals should undergo
annual practical training in the recognition and man-
agement of medical emergencies12. In Poland, there
is a system of continuous postgraduate education
aiming to maintain the professional licence of a den-
tist, but annual participation in BLS training is not
mandatory. However, since 2000 increasing numbers
of dentists have been attending BLS courses and
training in dental office medical emergencies. In our
study, 24.82% of dentists had participated in BLS
training within the preceding 12 months, 40.10%
during the preceding 2–5 years and only 8.35% had
never participated in BLS training since graduation.
In 65.63% of cases, the respondents attended both
theoretical and practical training. The results of the
present study indicate that better postgraduate train-
ing in how to deal with medical emergencies in the
dental office, including practical training in BLS,
should be offered to dentists, with increased empha-
sis on mandatory participation. It is underlined that
the practical training of dental students in medical
emergencies is insufficient29. In Belgium, 31.9% of
dentists reported that they had participated in adult
BLS training during the preceding year; however,
49.4% claimed that they had never taken part in
such training. In addition, 11.6% reported that they
had participated in paediatric BLS training during
the preceding year, but 78.3% had never taken part
in such training10. In Brazil, 59.6% of dentists have
undergone some type of CPR training but 40.0%
have never been trained in this procedure21. In Slove-
nia, 85.1% of dentists reported having undergone
BLS training, of which 87.4% had taken part in it
within the preceding 5 years22. The situation regard-
ing BLS training varies from country to country; in
most cases, however, the ERC recommendation that
all dental staff should receive annual practical train-
ing in medical emergencies remains unmet.

In the present study, 17.9% of dentists reported
having access to an AED in their dental office,
21.48% to an oxygen source, 36.80% to supraglottic
airway devices and 22.81% to a portable suction
device. The majority of dental offices are equipped
with a self-inflating bag (82.34%) and oropharyngeal
airway (64.81%). The situation in Poland has gener-
ally improved over the past 15 years30. The use of an
AED does not require any special training; however,
such training enhances performance of such a
device27. The availability of emergency medical equip-
ment is different in various countries. In a study by
Pieren et al.31, published in 2013, the majority of
Ohio dentists and dental hygienists felt that an AED
should be mandatory in the dental setting and 48%
had an AED in their dental clinic. In Slovenia, Umek
and Sostaric22 stated that 40.1% of dental offices
were equipped with an oropharyngeal airway, 58.1%
with a self-inflating bag, 60.6% with a pocket mask,
49.1% with an oxygen source, 40.1% with a blood
pressure monitor, 93.1% with venous access devices
and only 15.5% with an AED. In turn, 70% of Ger-
man2 and 63% of Australian3 dental offices are
equipped with oxygen. These data indicate that in sev-
eral countries there are still a number of dental offices
not equipped with an oxygen source, airway manage-
ment equipment (including supraglottic airway devices
or even a self-inflating bag), a blood pressure monitor,
venous access devices or an AED. Considering the
prevalence of medical emergencies in dental offices,
clarification of the rules and guidelines on the avail-
ability of emergency equipment is necessary.
STUDY LIMITATIONS
The limitations result from the nature of the survey,
which was not an analysis of documented events. The
diagnoses of life-threatening conditions reported by
the responding dentists may have been incorrect. It is
often the case that dentists do not recognise allergic
reactions correctly; by contrast, they properly diag-
nose vasovagal syncope or presyncope28. A detailed
analysis of medical records would help clarify the nat-
ure of some controversial medical emergencies. This
issue has been referred to in several publications1–
3,6,10
; however, in this type of questionnaire survey, it
has to be assumed that the diagnosis of medical emer-
gencies made by the dentists was correct.
Dentists self-assessed their own skills, which was
not an objective measurement.
STRENGTHS OF THE STUDY
This study is the first to analyse the prevalence of
medical emergencies in Poland and explore dentists’
preparedness to deal with such situations, and it was
© 2019 FDI World Dental Federation
Medical emergencies in the dental office
based on a large number of participants (n = 419).
The questionnaire included several aspects of profes-
sional education, CPR training, availability of emer-
gency medical equipment, prevalence of medical
emergencies, self-assessed competence in various den-
tal office emergencies, anamnesis, documenting vital
signs, number of medical emergencies in the preceding
12 months that required an EMS call for assistance or
medical assistance, dentists’ attitude toward intra-
venous and intraosseous routes, as well as signs of
cardiac arrest.
CONCLUSIONS
The prevalence of medical emergencies in dental
offices in Poland is comparable to that in other coun-
tries. A large number of dentists do not feel compe-
tent enough to manage medical emergencies. Better
undergraduate and postgraduate training in medical
emergencies is recommended, as well as broader avail-
ability of emergency medical equipment in the dental
office.
Acknowledgements
The authors would like to thank all the dentists who
participated in the study for their cooperation.
Conflict of interest
The authors declare that the study was conducted
without any commercial or financial relationships that
could be a source of any potential conflict of interest,
and without any financial support.
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Correspondence to:
Jacek Smereka,
Department of Emergency Medical Service,
Wroclaw Medical University,
ul. Parkowa 34,
51-616 Wroclaw, Poland.
Email: jacek.smereka@umed.wroc.pl