Anxiety-induced emergencies such as vasodepressor syncope and hyperventilation are well known to most practitioners. Despite advances in pain control, reconstructive dentistry, and behavior management techniques, the prevalence of dental fear in the general population remains fairly high. Fearful dental patients, who exist in each of our practices, are often expected to submit to dental treatment with little consideration given to their emotional state. Although many are capable of enduring their own high arousal state with various behavioral or cognitive distraction methods, the occasional young adult succumbs to syncope or hyperventilation. The practitioner should be able to prevent the onset of most psychogenic emergencies by amending the medical and dialogue history to include questions that preoperatively explore dental fears. Additionally, a brief physical examination should be incorporated into the initial visit and at the onset of subsequent treatment visits. When a positive history of fainting or panic attack is obtained, the practitioner should consider numerous available modalities to prevent recurrence during dental treatment. Behavioral modification strategies provide the greatest long-term benefit; however, pharmacologic sedation may be necessary to accomplish short-term dental goals.

Emergencies that arise out of psychophysiologic responses are rarely lifethreatening and can be managed readily by the alert dental office team. It is imperative, however, to use all available information during the emergency assessment. Inaccurate diagnosis and treatment as a result of confusion between presyncope and hyperventilation may result in an accelerated onset of the emergency episode. Rapid recognition of an impending alteration of consciousness should minimize the progression toward or reduce any period of unconsciousness. If unconsciousness occurs, basic life support and supine positioning with supplemental oxygen should be provided immediately. Finally, the dental team should be prepared to treat other life-threatening emergencies that might initially present as syncope, such as cardiac arrest, stroke, or anaphylactic reactions.