Abstract Patients die in dental offices every year. Some of these fatalities are the direct result of dental procedures, while others occur coincidental to the patient's being in a dental office when stricken. The emergencies and complications that can lead to serious disability and even to death are the direct concern of every practicing dentist. Under other circumstances, it would be within the province of a physician to handle such conditions. However, when an acute emergency arises in the dental office, where a physician is not available, it is the dentist who must assume responsibility for the immediate diagnosis and treatment. Many skills are needed to achieve accurate diagnosis and to institute correct therapy. The dentist must have a knowledge of pharmacology, physical diagnosis, anatomy, physiology, and pathology. In this article an attempt has been made to review the basis for such therapy and to recommend specific techniques and dosages. Moreover, one should keep in mind that it is wiser to prevent trouble than to be able to correct it after it occurs. Safe practices should be employed in all procedures. This applies to treatment of the routine patient as well as the patient who requires special attention. The interpretation of an adequate history plus a check with the patient's physician should result in the elimination of many potential risks. Once an emergency has occurred, successful treatment will depend upon the realization that such a condition exists, the availability of proper equipment and drugs, and a quickly instituted plan designed for just such an occasion. Since life-and-death emergencies occur but rarely, some dentists may feel that this subject is mostly a tempest in a teapot. To the patient whose life hangs in the balance and to the dentist who is called upon to treat him, statistics are of little comfort.