Dr. Stanley F. Malamed
professor of Anesthesia and Medicine at University of Southern
California's School of Dentistry actually hopes it snows in Chicago
during the Midwinter Meeting
He'll be teaching two courses, "Is
Your Practice Ready for a Medical Emergency?
" and "The
Renaissance of Local Anesthesia
This transcript is edited from an e-mail exchange that took place
in November 2009.Q: What drew you to the topic of medical emergencies in the
dental office?Dr. Stanley F. Malamed
: I am a dentist
anesthesiologist, a member of a small group--several hundred in the
U.S.--of dentists who have completed an anesthesiology residency.
Given that background, and being in an academic environment, one of
the subjects that is closely associated to anesthesia is emergency
medicine--essentially how to keep a person alive, which is what
anesthesiologists do on a daily basis.Q: Are there any recent events that make this a
particularly important topic today?SFM:
On a regular basis we hear, through the
media, of "disasters" that occur in the dental office. In Chicago
the principal of an elementary school died in a dental office
while having root canal treatment. It made the national press.
Unfortunately, when a person dies in a dental office, it comes as a
surprise to non-dental people, who make up most of the world. Yes,
unfortunately this does happen, albeit rarely.Q: What are the most common medical emergencies that occur
in dental offices?SFM:
Syncope, or fainting, is far and away number
one, accounting for about 50 percent of the emergencies we see.
Other common emergency situations include mild allergy, anginal
chest pain, seizures, asthmatic attacks, and low blood sugar.Q: Which emergencies do you think dental offices are least
prepared to handle?
From surveys I have done asking doctors about
their level of confidence in recognizing and managing specific
emergency situations, the lowest levels of confidence occur with
local anesthetic overdose, sedative overdose, and bronchospasm, or
acute asthmatic attack.Q: What is the number-one preventative step you will be
Knowing your patient-medical history,
monitoring vital signs, knowing when not
to treat. Having
said that, about 75 percent of all medical emergencies seen in
dentistry are preventable; however 25 percent are not. Stuff still
happens.Q: Do you have any anecdotes relating to emergency
At the Hinman Dental Meeting
years ago, as I was walking into the Georgia World Congress Center
to give a talk on medical emergencies, a man walking about 20 feet
in front of me collapsed on the ground in cardiac arrest. Helping
the paramedics, I ventilated, and the man survived. A memorable way
to start a lecture on medical emergencies.Q: You're coming from sunny southern California! How do you
feel about visiting Chicago in February?
coming to the Midwinter in
February. It's my four or five days of winter. I hope every year
that it snows and is really cold. I like to run in the park in the
snow … knowing that in three or four days I'll be able to return to
L.A. and run in the nice warm "winter" weather at about 60 to 80
degrees. Q: Would you be willing to share any anecdotes about your
early experiences as a dentist?SFM:
Two anecdotes about my early experience as a
dentist, before I became the "famous" Dr. Malamed, the expert on
local anesthesia as well as emergency medicine:
Taking my state board examination in NY in 1969, a very good friend
of mine was the patient. After getting an OK to start, I pulled out
a local anesthetic syringe and proceeded to stick the needle right
through his lower lip! We both started laughing, which broke the
tension of the exam and I then proceeded to successfully pass it.
Happily the examiner never found out!
Another story: While in my anesthesia residency, my wife was to
have her four third molars extracted by a rather prominent oral
surgeon. He asked me to help him by simply getting her "numb."
Needless to say I missed
all four teeth!
About ten years later while I (by now an "expert" on local
anesthesia) was giving a lecture on "How to Teach Local Anesthesia
to Dental Students," a hand went up in the audience. The question,
from the oral surgeon mentioned above, was "Would you tell the
audience about the day I asked you to get your wife numb?" It was