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Emergency: Oral Surgery Torrance, CA

Emergency: Oral Surgery

Steve Q. is a 62-year-old male who presents for extraction of tooth #19. The patient appears anxious and reports to have a history of high blood pressure. During his consultation his blood pressure read 173/89. The patient reports he forgot to take his metoprolol this morning because he was in a rush to get out of the house.

Following the administration of 2 carpules of 2% lidocaine with epinephrine 1/100,000 via IAN and Buccal, the patient appears diaphoretic and increasingly anxious. The anxiety develops into shooting pain along his left arm and crushing chest pain, with a blood pressure of 227/115.

How would you proceed?

  1. Place the patient in a comfortable position
  2. Give patient 100% oxygen from nasal cannula.
  3. Administer Morphine
  4. Administer Oxygen
  5. Administer Nitroglycerin
  6. Administer Asprin 325mg

This acronym can be remembered as MONA. Morphine will decrease the patient’s anxiety and emotional response to pain. Oxygen via nasal cannula will allow a patient to maintain adequate oxygen level for delivery of oxygen to the myocardium.Nitroglycerin allows for arterial and venous dilatation to decrease the workload of the heart and reduce myocardial oxygen demand. If the patient does not improve, call 911 emergency services.

Multiple factors may have contributed to this patient’s clinical scenario. The first contributing factor would be that the patient didn’t take their metoprolol, thus the patient not being well controlled. The second contributing factor would be the administration of epinephrine in the presence of a non-selective beta-blocker such as metoprolol. If a patient on a nonselective beta-blocker receives a systemic dose of epinephrine, the beta-blocker prevents the vasodilation, leaving unopposed alpha vasoconstriction. The resulting hypertensive reaction can be large, with systolic pressure well over 200 mm Hg. 

As dentists we know the dental chair can be a stressful experiences. The dental team should attempt to make the experience as calm and as relaxing as possible. This begins from the initial patient phone call, to the patient’s very first visit to the office. All the team members should be warm, friendly, and comforting. The dentist should also be a team leader contributing to the patients experience by explaining the procedure and reassuring the patient. In addition the dentist should be aware of the medications their patients are taking and how it interacts with any medication we may administer.

Hypertension is a chronic medical condition in which an individual has elevated blood pressure in the arteries. It is categorized as

  1. Normal blood pressure: <120/80
  2. Hypertension stage 1 120-139/80-99
  3. Hypertension stage 2 >140/100

It is classified as primary (essential) or secondary high blood pressure. Risk factors include: excess salt, body weight, smoking and alcohol. Patients should be approached carefully and evaluated appropriately prior to treatment to assure their safety.

Posted on behalf of Torrance Oral Surgery Center

23451 Madison St #120
Torrance, CA 90505

Phone: (310) 373-0667

Email:

Monday 8AM - 5PM
Tuesday 8AM - 5PM
Wednesday 8AM - 5PM
Thursday 8AM - 5PM
Friday 8AM - 5PM

Address:

23451 Madison St #120
Torrance, CA 90505

Phone:

(310) 373-0667

Office Hours:

Monday 8AM - 5PM
Tuesday 8AM - 5PM
Wednesday 8AM - 5PM
Thursday 8AM - 5PM
Friday 8AM - 5PM

Torrance Oral Surgery Center

Our Client Reviews

5.0/ 5.0

Based on 34 reviews

Paul M.

A positive experience from start to end. I got a sense that this was going to go well and it did. Two extractions, two implants, bone graft and removal of four part bridge. Leaving part of the bridge on one tooth. If there were 10stars they would be for Torrance oral surgery group and Dr. Alicia Wolf / Blanco Demtal Group for recommending Ben.

Mindy W.

This is a very welcoming center. Everyone seemed very competent and helpful. I had an oral biopsy today. No waiting. The staff were ready for me and all was in place. Dr. Yagoubian was warm , cheerful and I felt in extremely capable hands. I am so grateful I was referred to him. Sincerely, Mindy W.

Jessica Z.

The staff here are super friendly and always show genuine concern. I got my wisdom teeth pulled about a year ago and Dr. Yagoubian and his staff made me feel less anxious about the procedure. When I was done, they were thorough with their instructions on how to take care of myself while my wounds healed. They even gave me an ice pack to wrap around my head for the swelling (super useful). Dr. Yagoubian even called to check in on me after the surgery. So when I needed more extractions done this year for orthodontic treatment, I made an appointment here and once again I was well taken care of. Every single person in this office was friendly. During the procedure, they made me feel less anxious even though I was super shaky about getting local anesthesia. They gave me detailed instructions on how to care for my wounds, always gave me an opportunity to ask questions. And once again, Dr. Yagoubian called after the procedure to make sure I was doing well. Now, anytime someone mentions they need their wisdom teeth removed, I tell them Dr. Yagoubian is the man!!

D. W.

What a nice and knowledgeable Doctor! Dr. Ben took the time to answer all our questions about the removal of all four wisdom teeth. He explained in detailed what was going to happen and the reason why he does the procedure. It’s obvious that he loves what he does. His staff is very welcoming and friendly. The nice lady in charge of the billing explained very clearly everything. Dr. Ben even called us the evening after the surgery to check if everything was ok. We highly recommend Dr. Yagoubian!

Chahab S.

Dr Yagoubian is an excellent oral surgeon, supported by a very professional staff. They made the experience as stress-free as possible. Highly recommended.

Dr.Lou T.

Very professional and always available. My patients have always had good experiences with the office.

JOHNNY P.

Dr. Benjamin is awesome I highly recommend him to everyone he is highly efficient and fast he knows how to comply with patient needs and overall is an amazing guy ! Check him out he is awesome!!!

Raj G.

Dr. Yagoubian is excellent. I was in state for business when my wisdom tooth broke. I was lucky enough to find Dr. Yagoubian's office. Everyone there was professional and courteous. The procedure went smoothly. Dr. Y is highly skilled, meticulous, and a very personable health care provider (a rarity in the field, in my opinion). If you need an oral surgeon, I highly recommend him.