Letters to the editor

Abdominal spasms or cramping can be described as the involuntary contractions of the abdominal muscles that can also occur on the dental chair.¹ This emergency must therefore be included as one other medical emergency that can occur in a dental clinic.

A 65-year-old Indian man was being examined at the Dental Postgraduate Clinic at MAHSA University for a crown preparation of his root-treated UR4. Medical history indicated an episode of panic attack and the patient also had undergone a laparoscopic Nissen fundoplication to prevent reflux of gastric contents from the stomach.⁵ Local anaesthesia with 2% mepivacaine with adrenaline had been administered for the UR4 (buccally and palatally) using the infiltration technique. The gingivectomy procedure commenced using the electrocautery machine for crown lengthening. As the patient was required to gargle, the reclined dental chair was made upright. During the process of reaching for the cup, the patient felt a sudden acute pain in the upper quadrant of the abdomen. This cramping pain continued until the patient indicated for the chair to be reclined. The patient subsequently stretched his body and abdomen and even extended his spine, in an attempt to reverse the cramping. All procedures were stopped, and the patient was asked to relax by walking around the clinic for a few minutes. This temporary episode of cramping and pain subsided, and the patient was then ready to resume dental treatment. A conversation with the patient indicated that he had a previous history of cramping while tying his shoelace. This too was a temporary episode and uneventful. He, however, admitted that this was a side effect of Nissen fundoplication because he had a limited ability to belch and had been unable to vomit after this antireflux surgery.