Basic Emergency Drugs and Non-intravenous Routes of Administration

The array of emergency drugs appropriate for a general dental practice is relatively simple, although additional antidotal drugs may be required in practices in which oral and/or parenteral sedation may be employed. The use of drugs in emergencies always requires effective blood circulation and should be conservative (Rech et al Ann Emerg Med 70:203–11, 2017). Regardless of the final composition of a dental drug emergency kit, the practitioner and other members of the dental team must be capable of administering an emergency drug by its proper route of administration. Because many dental practices are not equipped or trained for intravenous fluid and drug administration, some emergency drugs may be administered via “simpler” routes, such as sublingual, which are not based on scientific evidence and which, in most cases, result in less-than-optimal responses. There is little evidence for the efficacy of emergency drugs from randomized controlled trials involving human subjects due to obvious ethical limitations, and new evidence has challenged conventional teaching about the management of acute coronary syndrome. Therefore, unlike other categories of drugs covered in this book, systematic reviews of emergency drugs are included here, but they typically do not provide high-level, consistent evidence for their use. However, most of the agents covered in this chapter have been validated over many years of medical use based on outcomes generally reported as retrospective reviews, case reports, or case series.