Caring for the patient with pulmonary disease Flashcards
Congenital Pulmonary Disease
vs
Acquired Pulmonary Disease
Congenital
(3)
- Cystic fibrosis
- Bronchitis
- Emphysema
Congenital Pulmonary Disease
vs
Acquired Pulmonary Disease
Acquired
(2)
- Industrial
- Recreational
Acquired Pulmonary Disease
(5)
Industrial
* Recreational
* Tobacco
* Cannabis (Marie Juana)
* Cannabidol
Industrial
(4)
- Black Lung (coal miners)
- Asbestosis (miners)
- Bronchitis (Steel mills,
smog) - COPD
- Tobacco
(3)
- Cigarettes, cigars, pipes
- Vaping ( )
- Chew (Snus, chaw, dip, etc.)_
- Cannabis (Marie Juana)
- Cigarettes (joint)
- Cannabidol
- Topical (oils, creams)
Focal Problems
aggravated by
Smoke and Smoking
(2)
- Periodontal Disease
- Asthma
the negative of cigarette smoking on the periodontium is cumulative and dose dependent
the severity of attachment loss is directly related to the amt of smoking measured either as
pack years or number of cugs per day
the more cigs smoked per day and the longer the individual has smoked,
the more severe the level of attachment loss
cig smoking significantly increases the risk for tooth loss by
70%
- Smoking has detrimental effects on the Periodontium.
Although the exact mechanisms are not known, it appears that (2) are significantly affected.
the host response to bacterial plaque and the ability of the wound healing response in the host
- Much of the impairment centers on —
and the
functions of vascularity ie ability to provide (4) to the tissues. - Even slight alteration in the — can have significant effects on the tissues.
vacularity
02, nutrients, cells and growth stimulants
vascularity
Smoking and Periodontal Disease
— alterations
Altered — function
Decreased — production
Decreased — proliferation
Increased prevalence of —
Altered — attachment and function
Difficulty in eliminating pathogens by — therapy
Negative local effects on (2) products
Vascular
neutrophil
IgG
lymphocyte
periopathogens
fibroblast
mechanical
cytokine and growth factor
REFRACTORY PERIODONTITS
- As it is difficult to control the disease in smokers, the smokers become refractory to the traditional periodontal treatment and tend to show more periodontal breakdown than non* smokers after therapy.
in sturdies of pt who failed to respond to the conventional therapy, including different combos of OHI, SRP, surgery and abx, approx –% were smokers
90
Chronic inflammatory airway disorder
(3)
- Airway hyper-responsiveness to stimuli
- Bronchial edema
- Narrowing of the airways i.e., obstruction
Smoking and Asthma
Signs and Symptoms
Recurrent, reversible episodes of:
(4)
*Dyspnea (shortness of breath)
*Wheezing
*Coughing
*Tightness of chest
Which of the following is a “true”
asthma symptom?
Aggravating/Complicating Factors
(2)
● Smoking
● Air pollutants (quality)
- urban
- industrial
Staging Asthma
(3)
- Controlled
- Partially Controlled
- Uncontrolled
Types of Asthma
(4)
- Extrinsic (Allergic)
- Exercise Induced
- Intrinsic
- Drug Induced
- Intrinsic (idiosyncratic, nonallergic, nonatopic)
(5)
- Second most common
- Middle-aged individuals
- Triggered by respiratory irritants (tobacco, air
pollution, emotional stress, gastroesophageal reflux
disease (GERD) - Infrequently associated with family history
- Normal IgE levels
Intrinsic
Allergen
→ lymphocytes
→ activation of mast cells,
basophils and eosinophils
→ bradykinin, histamine,
leukotrienes, interleukins
→ bronchoconstriction
Patient Considerations
Management
➢Medications
o Which medications are you taking for your asthma
skipped
Level of Control/Severity
(6)
o How often do you use your inhaler?
o Does your inhaler have a spacer?
o How many asthma attacks/week?
o Do you have any night time attacks?
o Have you ever been to the emergency room or been
hospitalized for an asthma attack?
o Do you have a spirometer to keep a record of your lung
function
Status Asthmaticus
(2)
→ Severe prolonged asthma attack (more than 24 hours)
→ life threatening
— is the
drug of choice for an acute attack
Short-acting Beta2-adrenergic agonist (inhaler)
Drugs to avoid:
(2)
➢Aspirin, NSAIDs, Narcotics, Macrolide antibiotics
like erythromycin.
➢Sulfite (preservative) containing local anesthetics
may need to be avoided.
Sedation for Dental Anxiety
(2)
➢Nitrous (better)
➢Short-acting benzodiazepine
— for severe persistent asthma
Med Consult
SoD Asthma Emergency
Patient presentation
(3)
- Respiratory rate >25 breaths/min, labored breathing
- Tachycardia >110 beats/min
- Flushed appearance
Stop treatment, inform supervising faculty, administer O2, and call 4444
➢ Remove all items from patient’s mouth
➢ Record the time attack began
➢ Raise the dental chair
➢ Give short-acting β2-adrenergic agonist inhaler
➢ Administer oxygen
o Administer 0.3-0.5 ml of 1:1000 epinephrine –small doses are SM dilators
o Call an ambulance
o Re-administer short-acting β2-adrenergic agonist inhaler every 20
minutes until EMS arrive
o The emergency team will continue treating the patient with
bronchodilators and oral systemic corticosteroids
Focal Problems
from
Smoke and Smoking
(2)
- COPD
- CAD (coronary artery
disease)
- COPD
(2)
- Bronchitis
- Emphysema
. Bronchiolitis (chronic obstruction - small airways)
- Excessive tracheobronchial mucus production to cause
coughing and sputum production for >3 months for >2
consecutive years in the absence of infection or other causes
of chronic cough
II. Emphysema
* Longterm Chronic obstructive bronchiolitis leads to destruction
of (2)
* Decreased —
* Difficulty in maintaining —
lung parenchyma and alveolar walls
elastic recoil
airway opening during expiration
Type – is a progression of Type – leading many to just use these
as descriptive terms for COPD
II
I
Chronic Obstructive Pulmonary Disease (COPD) is the — leading cause of death in USA
3rd
Chronic Obstructive Pulmonary Disease (COPD)
Aggravating/Complicating Factors
(3)
● Smoking
● Air pollutants (quality)
- urban
- industrial
● CVD
- comorbidity
Chronic Obstructive Pulmonary Disease (COPD)
Signs and Symptoms
(3)
- Dyspnea
- Cough
- Sputum
Chronic Obstructive Pulmonary Disease (COPD)
Treatment
(3)
- Inhaled long-acting bronchodilators
- Corticosteroids if asthma also present and/or more reversible
obstruction - Smoking cessation is only intervention that actually lessens
disease progression
Chronic Obstructive Pulmonary Disease (COPD)
Oral Manifestations
(2)
• Dry mouth
• Steven-Johnson syndrome
with theophylline
Exacerbates Smoking Side
Effects of:
(8)
- Halitosis
- Tooth staining
- Nicotine stomatitis
- Periodontal disease
- Oral potentially malignant disorders
- Leukoplakia
- Erythroplakia
- Oral squamous cell carcinoma
Determine stage and severity of COPD
(2)
➢ Medical consultation for mild to moderate COPD to
determine the presence of respiratory failure right-sided
heart failure
➢ If COPD Stage III or higher or who have respiratory and
heart failure
o Consider dental treatment in a hospital setting
If < Stage III COPD
➢ Place the patient in …
➢ Avoid using a —
➢ Avoid treating if — is present
➢ — is acceptable
o May need to limit …
a semi-supine position to avoid respiratory distress
rubber dam
upper respiratory infection
Local anesthetic with epi
epi if concomitant CVD
Avoid medications that cause respiratory depression
(4)
➢Barbiturates
➢Narcotics
➢Nitrous oxide is contraindicated
➢Benzodiazepines (low dose may be acceptable in
certain situations)
o Consult physician
(3) should not be prescribed to COPD
patients already taking theophylline
Erythromycin, macrolide antibiotics (clarithromycin, azithromycin, etc.)
and ciprofloxacin
Low Level Intervention
(5)
- Health/medical evaluation
- Exams
- Dental prophylaxis
- Radiographs
- Optical oral scans
Moderate Intervention
(4)
- SRP (scaling and root planning)
- Simple restorative procedures; 1-2 teeth
- Simple extractions; 1-2 teeth
- Impressions
High Risk Intervention
(6)
- Complex restorative procedures on >2 teeth
- Multiple extractions
- Surgical extractions
- Implant placement
- Full arch impressions
- Dental care under general anesthesia
Vaping
(3)
- Act of inhaling and exhaling the aerosol, often referred to as vapor, which is produced by an e-cigarette or similar device.
- E-cigarettes do not produce tobacco smoke, but rather an aerosol, often mistaken for water vapor, that actually consists of fine particles.
vapor is generated from a solid, semi solid, or liquid substance
vaping components (5)
battery
heating element
atomizer
cartridge/pod
indicator light
e liquid ingredients
(4)
other compounds/chemicals:
(2)
vegetable glycerin
propylene glycol
flavorings
nicotine
diacetyl
benzoic acid
e juice
ingredients may be deemed safe for sure or ingestion but not evaluated for
inhalation and heat
can remain on surfaces for
weeks to months
potential for 3rd hand exposure or accidental ingestion by children
may cause adverse effects during or after
pregnancy
nicotine can cross the placenta
aerosol (4)
volatile organic compounds
nicotine
ultrafine particles
heavy metals: nickel, tin, lead
popularity of devices (4)
easy to get
flavorings make devices appealing
discreet use/sleek design
11-17 year olds think e cigs are less harmful than smoking
cost
variety in cost based on device
single use, disposable e cigs:
rechargeable staterkits:
refill cartridges: monthly cost
$1-15
$25-150
$50-75
EVALI
e cig/vaping product use associated lung injury
name given to vaping related lung illness
-US CDC and prevention
-as of feb 2020: 2807 cases confirmed
all 50 states have confirmed cases
-68 deaths connected to the illness in 29 states
KS and MO have confirmed cases
other health concerns
o Increased ..
* Higher risk for –
* Increased –
o Increase in –
* Increase in –
* “popcorn lung” - –
o May cause – levels to rise
heart rate due to spike in adrenaline
heart attack
blood pressure
bronchitis
lung dispase
bronchiolitis obliterans
blood sugar
EFFECTS ON ORAL HEALTH
(4)
o Chemical vapors produced can alter or damage epithelial cells
o Indicates an inflammatory response in the PDL
fibroblasts
o Sore throat
o Dry mouth
o Chemical vapors produced can alter or damage epithelial cells
(2)
- Oral ulcerations
- Oral cancer may result
o Indicates an inflammatory response in the PDL
fibroblasts
*May lead to greater risk for periodontal disease
