Introduction

Dentistry is a branch of medical sciences that involves active clinical practices that could be invasive involving injections, surgeries, extractions, and some long-standing tedious procedures. In the event of these procedures, there are possibilities that some complications leading to a medical emergency could be apprehended.  The incidence of these medical emergencies in a dental practice, although not very frequent, is not insignificant [1]. During a dental procedure, the stress-induced could lead to medical emergencies, also the increasing age and reduced general health status could be a possible contributory factor [2]. The various medical emergencies that could be encountered in a dental setup include syncope, foreign-body airway obstruction, heart attack, anaphylactic reaction, convulsions, asthmatic attack, and in rare instances sudden cardiac death [3]. 

Medical emergencies could befall at any time, in any environment, including within a dental practice. On an average, a dentist experiences at least one medical emergency in two years [4]. The incidence of medical emergencies has been reported by Anders et al. at 164 events per million dental visits [5].  A report by Atherton et al. has concluded that a dentist who practices for 40 years will be exposed to between nine and eleven emergency events throughout their career [6, 7].

This necessitates the need for dentists to be able to identify the medical emergency in the early stages and manage it. But, most dental students and even recent graduates lack enough knowledge, confidence, and preparedness in managing such emergencies. This could be attributed to the fact that they wouldn’t have obtained a training course in the management of medical emergencies or it was not effective enough. Even though training for medical emergency management has been provided to the students in various ways and techniques all across the globe, the students have gained a varying amount of knowledge and it is not satisfactory [8-11].  

A dental teaching hospital situated in the northern parts of Karnataka state, India provides mandatory Basic Life Support (BLS) to both undergraduate and postgraduate students. So, this study was conducted to assess the perception of dental students in managing medical emergencies through a questionnaire study.

Materials and Methods

This is a cross-sectional questionnaire study that was carried out amongst the final year BDS students, interns, and postgraduates at a dental teaching hospital, Karnataka. Twenty questions to check the knowledge, attitude, practice, and self-perceived competency in the management of medical emergencies were framed. Face validity and content validity of the questionnaire were checked. The reliability of the questionnaire was checked. Cronbach Alpha value of 0.80 was obtained, which is good. Sample size was calculated using G*Power3.1.9.4 software (Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany). With an effect size of 0.3 and an alpha error of 5%, the sample size was estimated to be 220.  However, a total of 300 subjects were recruited. The study duration was of two months. Before participating in the study, the subjects were informed about the study details regarding the purpose of the study, the procedure followed, and the extent of anonymity and confidentiality and were asked to provide a voluntary written informed consent.

Statistical analysis

The data that was collected from these study participants was then entered on an excel data sheet (Microsoft; Inc, Redmond, Wash). The data were subjected to statistical analysis using the Statistical Package for the Social Sciences (SPSS) software version 21.0 (IBM; Chicago, IL). Frequency and percentages were calculated for the domains of knowledge, attitude, practice, and self-perceived competency of the questionnaires. The overall knowledge, attitude, practice, and self-perceived competency were represented by mean. Analysis of Variance (ANOVA) was carried out to demonstrate the association between the academic year and the knowledge, attitude, practice, and self-perceived competency of the students. Post Hoc Analysis was conducted. Spearman Correlation was applied to record if there was any significant correlation between the academic years and the overall knowledge, attitude, practice, and self-perceived competency of the students. The statistical significance was recorded at a p-value less than 0.05.

Results and Discussion

The response rate was 100%. 34% of the study population comprised males while the majority of them were females accounting for 66% of the population. The results of the questionnaires on knowledge regarding management of medical emergencies in a dental setup are illustrated in Figure 1. The knowledge about the management of syncope was higher than in any other medical emergency procedure. This may be because syncope is the most commonly encountered medical emergency [12, 13], and this might have helped the students acquire better knowledge with practical experience as well.

89.67% reported that they have received some form of training or the other in the management of medical emergencies. Of which, 80.29% received both theoretical and practical training, while 7.88% received only theoretical training and 11.83% received practical training. The institute provides both theoretical and practical training in accordance with the Dental Council of India (DCI) curriculum. Theoretical knowledge is provided as per the DCI syllabus, and for practical training, the BLS training program is mandatorily delivered to the students as a part of the college curriculum in order to achieve the competency as stated by DCI. Figure 2 demonstrates the reason for not receiving any form of training. These reasons could probably be further linked with absenteeism.  So, bearing in mind the need and importance of students receiving this training, it should be taken into consideration that not a single student misses out on any form of training in medical emergency management.

100% of the students believed that recording a proper case history can prevent the occurrence of medical emergencies. Prevention is always better than cure. Likewise, being prepared is also important. Any medical emergency can occur at any given point of time in the clinical operatory. So, recording a precise and elaborate medical history is important as this could indicate any underlying conditions and the need for apprehending medical emergencies and preparedness. Further, 96.67% had a perception that they were skilful in their ability to manage a medical emergency in a dental practice, and yet 75.70% reported that they would be reluctant in performing any medical emergency procedure. Figure 3 demonstrates the various reasons for their reluctance in performing any medical emergency procedure. This indicates that there is a need for further training of dental students in the management of medical emergencies.

Self-perceived competencies in performing various medical emergency procedures are demonstrated in Table 1. The results specify that the students need further training and their competency in performing the various emergency procedures should be assessed time and again.  The overall mean, ANOVA and Post Hoc analysis for knowledge, attitude, practice and the self-perceived competency with respect to the academic years has been demonstrated in Table 2. Table 3 depicts a positive correlation (Spearman correlation) between knowledge (+0.263), attitude (+0.294), practice (+0.190) and self-perceived competency (+0.692) and the academic years.

Table 1. Distribution of percentages of competency in performing various medical emergency procedures

Table 2. Tabulation of the means, ANOVA test and the Post Hoc test of the study subjects based on their academic years and the overall knowledge, attitude, practice and the self-perceived competency

Table 3. Tabulation of correlation between the academic years and the overall knowledge, attitude, practice and the self-perceived competency of the study subjects using Spearman correlation