Patients With Respiratory Diseases

Jana, Samantha, and Courtney

Respiratory System

Upper Respiratory Diseases

• Most common disorders are caused by infections or allergic reactions that result in inflammation.

• Modes of Transmissions– Inhalation of airborne droplets– Contamination from hands or soiled mask with

discharge from the nose or throat.

Upper Respiratory Diseases

• Acute– Rhinitis(common cold)– Sinusitis– Pharyngitis/tonsillitis– Influenza(flu)

• Seasonal• viral

• Chronic– Allergic rhinitis (hay

fever)

Dental Hygiene Care

• Disease Prevention– Healthcare professionals need to stay up to date on

immunizations– Prevent the transmission of pathogens from patient to

clinician.• Appointment Management

– Delay treatment until the patient is no longer infectious• Bacterial Resistance to Antibiotics

– Bacteria can become resistant to antibiotics within 14 days

Lower Respiratory Diseases

• Acute– Acute Bronchitis– Pneumonia

• Chronic – Tuberculosis– Asthma– Chronic Obstructive

Pulmonary Disease (COPD)• Chronic Bronchitis• Emphysema

– Cystic Fibrosis

Acute Bronchitis

• Acute Bronchitis– Involves trachea and bronchi– Symptoms: cough with or without phlegm, may

last up to three weeks

Pneumonia

• An infection and inflammations in the lungs caused by viruses, bacteria, fungi, mycoplasma, or parasites.

• Etiology– Viral and bacterial– Fungal

• Categories – Community- Acquired Pneumonia

• Person-to-person

– Healthcare- Associated Pneumonia• Main cause of death in hospitalized patients• Bacteria from the periodontal pocket can cause an infection in the

lungs when aspirated by saliva.

Dental Hygiene Care

• Control oral diseases and periodontal diseases especially in patients in nursing homes and hospitals.

Tuberculosis

• Etiology

• Tr

Asthma

• Chronic respiratory disease• Recurrent episodes of:– Dyspnea– Coughing – Wheezing

• All leading to bronchial inflammation and muscle constriction.

Etiology

• Extrinsic (Allergic)– Most common– Inflammatory response

triggered by: dust, pollen, tobacco, smoke, mold, dust mites, or animal dander.

– Allergic reactions leads to activation of airway epithelial mast cells

• Intrinsic (Non-Allergic)– Triggers: emotional

stress, gastroesophageal reflux disease (GERD)

– Triggers can be unidentified

– Usually seen in adults

Etiology Continue • Drug or Food-Induced

– Aspirin – NSAIDS– Beta-Blockers– Foods: nuts, shellfish, milk, and strawberries– Tartrazine (yellow food dye).– Metabisulfite preservative in food: wine, beer, shrimp, dried fruit– Metabisulfite preservative in drugs: local anesthetic with epinephrine

• Excerise- Induced– Vigorous physical activity– Thermal changes cold air can provoke mucosal irritation and airway

hyperactivity • Infection-Induced

– Lung infections caused by viruses, bacteria, or fungal may provoke asthmatic symptoms.

Signs and Symptoms• Chest tightness, sense of

suffocation• Ineffectiveness of

bronchodilator to relieve dyspnea

• Wheezing, coughing• Flushed appearance, sweating• Confusion due to lack of oxygen • Dilated pupils • Inability to complete a sentence

in one breath• Tachypnea • Tachycardia

• Emergency Care– Recognize signs and

symptoms – Stop dental hygiene

treatment– Rule out foreign body

obstruction – Use patients inhaler– Administer oxygen – Injection or inhalation of

epinephrine– Monitor vital signs – Call EMS

Oral Manifestations

• Beta-2 agonist inhalers– Causes a decrease in salivary flow and dental

biofilm pH. • Increase in (GERD) when using a beta-2

agonist and theophylline, can cause enamel erosion.

• Oral candidiasis can occur with high dosage use of frequency of inhaled corticosteroids.

Dental Hygiene Care

• Before treatment – Remind patient to bring their inhaler– Review medical dental history– Evaluate symptoms– Review medications– Schedule morning appointments – Have a inhaler and oxygen on hand– Medical consultation if patient has unstable or severe

acute asthma – Stress free environment

Dental Hygiene Care

• During treatment – Prevent triggering a hypersenstive airway– Use local anesthetic without sulfites

• After treatment– Home care instructions the patient to rinse the

mouth water after using their inhaler.

Chronic Obstructive Pulmonary Disease (COPD)

• COPD is used to describe pulmonary disorders that obstruct air flow.

• Two of the most common diseases are chronic Bronchitis and Emphysema.

• Etiology – Inhaling tobacco smoke with occupational and

environmental pollutants as contributing factors

Chronic Bronchitis

• Etiology– Excessive respiratory tract

mucus production sufficient to cause a cough with expectoration for at least 3 months of the year for 2 or more years.

– Obstruction caused by narrowing of small airways, increased sputum, and mucus plugging.

– Difficulty breathing present on inspiration and expiration.

• Signs and Symptoms– Chronic cough– Copious sputum – Chest radiographs

abnormalities– Sedentary, overweight,

cyanotic, edematous, breathless, leading to the term “blue bloater”

Emphysema

• Etiology – Emphysema is a

distension of the air spaces distal to terminal bronchioles due to destruction of alveolar walls.

– Smoke injures alveolar epithelium destroying alveolar walls and creating large air spaces.

• Signs and Symptoms – Difficulty breathing only

on expiration – Dry cough– Enlarged chest walls– Weight loss– Chest radiograph

abnormalities – Purse lips to forcibly

expel air, leading to the term “pink puffer”

Oral Manifestations

• Similar to asthma patients• Patients who use tobacco have the risk of:– Oral cancer – Nicotine stomatitis– Halitosis– Periodontal infections – Extrinsic tooth stain

Dental Hygiene Care• Before Treatment

– Precautions are needed when concurrent cardiovascular disease is present. – Assess severity of COPD– Treament can be done on stable patients with adequate breathing– Identify patients who may experience exacerbation of symptoms under

emotional stress.– Monitor vitals– Short appointments– Supine position

• During Treatment– Use antimicrobial preprocedural rinse – Avoid using a power driving scaler and air polisher – Local anesthesia without epinephrine– Nitrous oxide-oxygen sedation: avoid with severe COPD and emphysema

Patient Education

• Encourage patients to stop smoking• Promote oral care and oral health knowledge

in prevention and treatment of COPD.• Discuss the link between periodontitis and

COPD• Schedule frequent periodontal and

maintenance visits.