Awareness of emergency drugs uses among students and teaching faculty in a dental college in Coorg, Karnataka

Abstract

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 (IIIrd BDS, IVth 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.

Full text

185
Journal of Indian Association Of Public Health Dentistry
Vol. 12, Issue 3, | July-September 2014
Awareness of emergency drugs uses among students and
teaching faculty in a dental college in Coorg, Karnataka
C. B. Sudeep, Peter Simon Sequeira1, Jithesh Jain1, Nithin Prataap2, Vipin Jain3, Mathew Maliyil1
Department of Public Health Dentistry, MES Dental College, Perinthalmanna, Malappuram, 2Department of Oral and Maxillofacial
Surgery, PSM Dental College, Thrissur, Kerala, 1Department of Public Health Dentistry, Coorg Institute of Dental Sciences,
Virajpet, Coorg, 3Department of Public Health Dentistry, KLE Dental College, Bengaluru, Karnataka, India
Address for correspondence:
Dr. C. B. Sude ep, Departm ent of Public Heal th Dentistr y, MES Dental Coll ege, Perinthal manna, Malappu ram, Kerala, Indi a. E‑mail: dr.sudeepcb@ymail.com
ABSTRACT:
Introducon: Effective management of an emergency situation in the dental ofce 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 deciencies 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 (IIIrd BDS, IVth 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.
Key words:
Awareness, basic life support, dental students, emergencies, emergency drugs, questionnaire
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DOI:
10.4103/2319-5932.144791
INTRODUCTION
Life‑threatening emergencies can occur anytime,
anywhere and to anyone. Such situations are somewhat
more likely to occur within the connes of the dental
ofce 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.[1] Effective management of
an emergency situation in the dental ofce 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
ofce is to prevent, or correct, insufcient oxygenation
of the brain and heart.
Drugs that should be promptly available to the dentist
can be divided into two categories. The rst category
represents those which may be considered essential. The
essential category of emergency drugs includes oxygen,
epinephrine, nitroglycerine, antihistamine, albuterol/
salbutamol, and aspirin.[2] 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,
ORIGINAL ARTICLE

Sudeep, et al.: Awareness of emergency drugs
186
Journal of Indian Association Of Public Health Dentistry
Vol. 12, Issue 3, | July-September 2014
ephedrine, hydrocortisone, morphine/nitrous oxide,
naloxone, lorazepam/midazolam, umazenil. 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.[2]
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.[2] It may be assumed
that dentists without advanced training in anesthesia
or sedation may not be procient 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 (IIIrd
BDS, IVth 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 difculties 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 1st 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,[3,4] principles and practice
of medicine[5] and pharmacology and therapeutics in
dentistry.[6]
RESULTS
Of the total responders (n = 250), 205 were dental
students which included 45 IIIrd BDS students, 45 IVth
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 IIIrd
BDS students scored 35.90%, IVth 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 eld.
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.
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Sudeep, et al.: Awareness of emergency drugs
187
Journal of Indian Association Of Public Health Dentistry
Vol. 12, Issue 3, | July-September 2014
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 eld. Again the level of awareness increased
with increased exposure in the practical eld.
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 ofce showed
that the preparedness of the specialist dentist was not
favorable.[1,7‑11] 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.[12]
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
ofce, 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
ofce is the ultimate consequence.[13]
The results of the study conrmed that undergraduate
dental students require more intensive education in
medical emergencies. Undergraduate health courses
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Figure 3: Awareness among students and teaching faculty
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Figure 4: Awareness among the graduates and under-graduates
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Figure 2: Awareness of emergency drugs use among the responders
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Figure 5: Responders and their scores

Sudeep, et al.: Awareness of emergency drugs
188
Journal of Indian Association Of Public Health Dentistry
Vol. 12, Issue 3, | July-September 2014
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.
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How to cite this article: Sudeep CB, 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 Pub-
lic Health Dent 2014;12:185-8.
Source of Support: Nil, Conict of Interest: None declared.