Management of Patients with pulmonary complicationsDEH 1802Summer 2012Mrs. Baggs

Respiratory Review

Sinuses, nasal cavity, larynx, pharynx, trachea, bronchi, lungs, and pluera Pleura ---

Physiology Review Air is inhaled through

the nasal cavity and enters the lungs.

Air is exhaled with CO2 leaving the body.

Gas exchange-occurs in the alveoli at the ends of the bronchioles.

Classifications of Respiratory Diseases Upper Respiratory Tract Diseases

Upper respiratory infections Allergic rhinitis (hay fever) Sinusitis Pharyngitis/tonsilitis Influenza

Upper Respiratory DiseasesMode of Transmission Direct oral contact Inhalation of airborne droplets Indirect ( hands or clothing exchange)

Upper Respiratory DiseasesAppointment management Delay dental and dental hygiene

treatment until patient is well or is no longer infectious

Non-infectivity can be determined by temp and regression of oral lesions.

(i.e-No fever for 24 hours or antiviral medication in system for at least 48 hours)

Lower Respiratory Tract Diseases Acute VS Chronic Pneumonia (Acute) Tuberculosis Asthma Cystic Fibrosis Chronic Obstructive Pulmonary Disease

(COPD) Chronic bronchitis emphysema

Pneumonia Viral/bacterial or Fungal (pneumocystis) Community- acquired pneumonia (person to person) Nosocomial pneumonia- affects

debilitated or chronically ill mostly (from biofilm into salivary secretions that are aspirated into the lower respiratory tract.)

Tuberculosis An infectious, communicable disease

spread by inhalation of infected droplets through talking, coughing or sneezing.

Signs and symptoms Cough lasting more than 3 weeks Fatigue Bloody sputum Fever Unexplained weight loss

Tuberculosis (TB)

High risk groups for TB The homeless Prisoners People living in nursing homes Immigrants International travelers HIV/AIDS patients Health care workers who work with high-

risk populations on a regular basis

Dental Management of TB Practice universal precautions Actively update medical histories/social

histories Check you local health departments for

current info Train employees and establish office

protocol

If you encounter….. First goal: separate potential infectious

patient, ask them to wear a mask, and refer for medical attention.

Dental care should be delayed. Urgent care : hospital or a facility

equipped for isolation After treatment of multi-drug therapy

and non infectious state is determined proceed as normal.

TB Oral manifestations

Common TB Medications Isoniazid for 9 months All drugs are a minimum of 6 months of

treatment (INH, Laniazid, Nydrazid, Tubizid) Avoid acetaminophen These drugs increase the concentration of other

drugs, such as Diazepam. Rifampin (Rifadin, Rimactin)

Increase incidence of infection Increase gingival bleeding Delays healing

TB Test Mantoux (determines latent infections) Does not determine clinically active TB

Asthma Chronic inflammatory respiratory

disease characterized by an increased responsiveness of the bronchial airways to various stimuli

Classified as intermittent or persistent (mild, moderate, or severe) depending on quality of life and risk for future exacerbations and/or lung damage

Review What is extrinsic vs. intrinsic? (Which is

Most common?) How do allergens trigger asthma? Medical Treatment? Drugs to avoid? Oral Manifestations? RDH care?

Implications for dental hygiene care (asthma) include:

Assess the frequency, conditions, time of onset and type of asthmatic attacks

Avoid use of air polisher Evaluate children for malocclusion Set goals for meticulous home care

Chronic Obstructive Pulmonary Disease (COPD) Used to describe pulmonary disorders

that obstruct airflow. What are the 2 common disease

associated with COPD? People survive for days without food or

water, but what about oxygen? It is the only one of the four deadliest

illnesses that is preventable, Why? What are the 3 main symptoms?

Emphysema Onset at 60 years old Thin, barrel-chested Cough not prominent Scanty sputum Few respiratory infections Chest radiographs shows small heart Air sacs weaken and collapse definitive dx accomplished through autopsy Damage

Bronchitis Onset 50 years Frequently overweight Chronic productive cough Copious sputum Frequent respiratory infections Chest radiograph shows large heart Airways become clogged with mucus-

obstructed Some damage can be partially improved.

Dental Management of COPD Seat the client in semisupine or upright

chair position Avoid use of rubber dam Avoid nitrous oxide with emphysema Smoking cessation Nutritional counseling Ultrasonic instrumention? Avoid bilateral mandibular blocks Humidified low-flow oxygen

Pharmacological Dental Management Nitrous Oxide, narcotics and

barbiturates should not be used. Macrolide antibiotics (erythromycin)

cause adverse reactions with Tehophylline

COPD is treated with a variety of bronchodilators and antibiotics, oxygen is used as well.

Oral Manifestations of COPD Halitosis Extrinsic tooth stains Stomatitis Periodontal disease Oral cancer Xerostomia

Cystic Fibrosis Complex, genetic, and life limiting disorder Involves pancreas, liver and lungs Progressive Mucous secretions are the critical feature of

cystic fibrosis Pulmonary impairment Pseudomonas aeruginosa/biofilm in the

lungs (bacterial infection) Respiratory failure from pneumothorax

Taylor Age 7 Off to bed. My pillow

will be stained with tears tonight and I will wake up with puffy eyes but I will wear the puffiness with pride. One day soon I will cry tears of happiness because CF will have a cure and I will no longer soak my pillow or awake to swollen eyes:) M.Martin

Clinical Signs and Symptoms Early Stage:

Persistent cough, wheezing, recurrent pneumonia, excessive appetite but poor weight gain, salty skin or sweat and bulky, foul-smelling stools (undigested lipids)

Late stage: Tachypnea, sustained chronic cough with mucus

productions, vomiting, barrel chest, cyanosis, digital clubbing, exertional dyspnea, decreased exercise capacity, pneumothorax, and right heart failure.

Oral Manifestations Gingivitis associated dry mouth Thickening and enlargement of the

salivary glands Lower lip may be enlarged, swollen and

dry Halitosis

Medical Treatment Antibiotics Mucus thinning solution (Pulmozyme) Inhalation solution (Tobramycin-

neublizer) NSAIDS (Ibuprophen) Mucus secretion removal

RDH CARE Medical consult Stress reduction Chair position Anxiety and pain control Analgesia Antibiotics Ultrasonic/Air polisher/Handpiece

Any Questions??

Pop QuizTake out your cell phones!

The End