Dental patients with neurologic and psychiatric concerns

Neurologic emergencies demand that the dentist stop all major procedures and remove all foreign objects from the patient's mouth, secure the ABCs, and do a quick secondary survey to identify possible causes while someone else activates the EMS. Psychiatric emergencies relate mostly to anxiety. They can be anticipated by a thorough medical history, which includes a DAS or DAS-R. Behavioral modifications provide the greatest long-term benefit. Pharmacologic intervention should be considered when other methods fail. It is important to recognize the possible morbidity increase when anxiety is not properly addressed as well as the differential diagnoses to be excluded in cases of sympathetic overexcitation. In preparation for any major dental work, it is important to take a thorough medical history in a nonthreatening environment, including medications, psychiatric history, and drug abuse history. Psychiatric emergencies can be prevented by reducing anxiety. Neurologic problems and drug overdoses can be detected earlier when a high index of suspicion is present, and premedication can be planned.