The Pharmaceutical Journal
Vol 270 No 7238 p302
1 March 2003

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Letters to the Editor

Dentistry

Use of diazepam in dental emergencies

From Ms S. M. S. Wagle, MRPharmS

Kevin Smith (PJ, 15 February, p228) seeks information on the use of diazepam in emergencies that a dental surgeon might face.

NHS Dental Surgeons are issued with the Dental Practitioners' Formulary (DPF) every two years; the most recent one was published in October 2002. The DPF includes a section on medical emergencies in dental practice, together with a list of medicines that are likely to be needed in such emergencies.

For epileptic seizures in the dental surgery, in addition to general advice on ensuring that the patient does not come to any harm during the seizure, the DPF advises that "medication should only be given if convulsive seizures are prolonged (convulsive movements lasting 5 minutes or longer) or repeated rapidly" and that "intravenous administration of diazepam 10mg is often effective but should be used with caution because of the risk of respiratory depression" (BNF 44, p240).

The BNF states that absorption of diazepam from intramuscular injection is too slow for treatment of status epilepticus. The rectal solution of diazepam is absorbed rapidly but, as Mr Smith points out, there is considerable anxiety over the emergency use of rectal preparations in dentistry as well as in general medicine.

A number of emergencies call for the administration of drugs by the intravenous route: these include glucose intravenous infusion for severe hypoglycaemia unresponsive to glucagon, hydrocortisone injection for severe asthma unresponsive to a beta₂ agonist, and chlorphenamine for secondary treatment of anaphylaxis.

The Dental Formulary Subcommittee has taken considerable advice on the management of medical emergencies in the dental surgery. The advice is constantly validated by appropriate experts and it is applicable throughout the United Kingdom. Any local policies would do well to take into account the DPF's advice.

Shama Wagle
Assistant Editor,
BNF/DPF

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