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Physiology Review Air is inhaled through the nasal cavity and enters the lungs. Air is exhaled with CO 2 leaving the body. Gas exchange- occurs in the alveoli at the ends of the bronchioles.
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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