Caring for the Patient with Pulmonary Disease Flashcards
what are the two categories of pulmonary disease
- congenital
- acquired
what are the types of congenital pulmonary disease
- cystic fibrosis
- bronchitis
- emphysema
what are the types of acquired pulmonary disease
- industrial
- recreational
what are the causes of industrial pulmonary disease
- black lung (coal miners)
- asbestosis (miners)
- bronchitis (steel mills, smog)
- COPD
what are the causes of recreational pulmonary disease
- tobacco (cigarettes, cigars, pipes, vaping, chew)
- cannabis
- cannabidol- topicals
what are the problems aggravated by smoke and smoking
- periodontal disease
- peri implantitis
- asthma
the negative of cigarette smoking on the periodontium is:
cumulative and dose dependent
the severity of attachment loss is directly related to:
the amount of smoking measured either as pack years or number of cigarettes per day
cigarette smoking significantly increases the risk for tooth loss by:
70%
what are the effects of smoking on the periodontium
the host response to bacterial plaque and the ability of the wound healing response in the host are significantly affected
- the functions of vascularity - ability to provide O2, nutrients, cells and growth stimulants to the tissues
what parts of angiogenesis are altered from smoking
- induction of VEGF signaling
- formation of tip cells
- stalk cell development
- vessel outgrowth
- anastomisis and perfusion
- maturation and stabilization
what are the effects of smoking on periodontal disease
- vascular alterations
- altered neutrophil function
- decreased IgG production
- decreased lymphocyte proliferation
- increased prevalence of periopathogens
- altered fibroblast attachment and function
- difficulty in eliminating pathogens by mechanical therapy
- negative local effects on cytokine and growth factor products
what is refractory periodontitis
the smokers become refractory to the traditional periodontal treatment and tend to show more periodontal breakdown that non smokers after therapy
in studies of pts who failed to respond to the conventional therapy, including different combinations of OHI, SRP, surgery and anitbiotics, approximately ___ were smokers
90%
what is chronic inflammatory airway disorder
- airway hyper responsiveness to stimuli
- bronchial edema
- narrowing of the airways- obstruction
what are the signs and symptoms of asthma
- recurrent, reversible episodes of:
- dyspnea (shortness of breath)
- wheezing
- coughing
- tightness of chest
which of the following is a true asthma symptom
shortness of breath/constriction of airway/dyspnea
what are the aggravating/complicating factors for asthma
- smoking
- air pollutants - urban or industrial
what are the stages of asthma
- control
- partially controlled
-uncontrolled
what are the controlled asthma daytime symptoms, limitations of actions, nocturnal symptoms, need for rescue meds, and lung function
- twice or less per week
- none
- none
- twice or less per week
- normal
what are the partially controlled asthma daytime symptoms, limitations of actions, nocturnal symptoms, need for rescue meds, and lung function
- more than twice a week
- any
- any
- more than twice a week
- less than 80% predicted
what are the uncontrolled asthma daytime symptoms, limitations of actions, nocturnal symptoms, need for rescue meds, and lung function
three or more features of partially controlled asthma present in any week
what are the types of asthma
- extrinsic (allergic)
- exercise induced
- intrinsic
- drug induced
describe intrinsic and other names for it
- idiosyncractic, nonallergic, nonatopic
- second most common
- middle aged individuals
- triggered by respiratory irritants (tobacco, air pollution, emotional stress, gastro reflux)
- infrequently association with family hx
- normal IgE levels
what is the pathway for intrinsic asthma
- allergen -> lymphocytes -> activation of mast cells, basophils, and eosinophils -> bradykinin, histamine, leukotrienes, interleukins -> bronchoconstriction
what are the considerations for patients with asthma
- medications
- level of control/severity
- how often do you use your inhaler
- does your inhaler have a spacer
- how many attacks per week
- do you have any night time attacks
- have you ever been to ER or hospitalized from an attack
- do you have a spirometer to keep a record of your lung function
what is status asthmaticus
severe prolonged asthma attack ( more than 24 hours ) -> life threatening
what is the drug of choice for an acute asthma attack
short acting beta 2 adgrenergic agonist (inhaler)
what drugs should you avoid with asthma
- aspirin, NSAIDs, narcotics, macrolide antibiotics like erythromycin
- sulfite (preservative) containing local anesthetic may need to be avoided
- nitrous (better)
- short acting benzodiazepine
what is the presentation of an asthma emergency
- respiratory rate greater than 25 breaths/min, labored breathing
- tachycardio greater than 110 beats/min
- flushed appearance
what should you do with asthma attack emergency
- stop treatment, inform supervising faculty, administer O2 and call 4444
- remove all items from pt mouth
- recrod the time attack began
- raise the dental chair
- give short acting beta 2 adrenergic agonist inhaler
- administer O2
- administer 0.3-0.5mL of 1:1000 epi - small doses are Sm dilators
- call an ambulance
- re administer short acting B2 adrenergic agonist every 20 minutes until EMS arrives
- the emergency team will continue treating the pt with bronchodilators and oral systemic corticosteroids
what are the types of COPD
- bronchitis
- emphysems
what is bronchiolitis
- chronic obstruction of small airways
- excessive tracheobronchial mucus production to cause coughing and sputum production for greater than or equal to 3 months for greater than or equal to 2 consective years in the absence of infection or other causes of chronic cough
what is emphysema
- longterm chronic obstructive bronchiolitis leads to destruction of lung parenchyma and alveolar walls
- decreased elastic recoil
- difficulty in maintaining airway opening during expiration
what is type II
type II is a progression of type I leading many to just use these as descriptive terms for COPD
COPD is the ______ leading cause of death in the US
third
what are the aggravating/complicating factors for COPD
- smoking
- air pollutants - industrial or urban
- CVD - morbidity
what are the signs and symptoms of COPD
- dyspnea
- cough
- sputum
what is the tx for COPD
- inhaled long acting bronchodilators
- corticosteroids if asthma also present and/or more reversible obstruction
- smoking cessation is the only intervention that actually lessens disease progression
what are the meds to treat asthma/COPD
- short acting beta 2 agonists : albuterol
- anti cholinergics: atrovent and spiriva
- methylxanthines: theophylline
- corticosteoids: dexxamethasone, fludrocortisone, methylprednisone, prednisone
- leukotriene receptor antagonists: singulair
- combination inhalers: advair (fluticasone/salmeterol) and symbicort (budesonide/formoterol)
what are the oral manifestations of COPD
- dry mouth
- steven johnson syndrome with theophylline
dry mouth and steven johnson syndrome with theophylline exacerbate smoking side effects of:
- halitosis
- tooth staining
- nicotine stomatitis
- periodontal disease
- oral potenitally malignant disorders: leukoplakia and erythroplakia
- oral SCC
when do you need a med consult for COPD
in mild to moderate COPD to determine the presence of respiratory failure right sides heart failure
when do you consider dental tx in a hospital setting
COPD stage III or higher or who have respiratory and heart failure
what do you do with greater than stage III COPD pt
- place the pt in a semi supine position to avoid respiratory distress
- avoid using a rubber dam
- avoid treating if upper respiratory infection is present
- local anesthetic with epi is accetable - may need to limit epi is CVD too
what do you avoid in treatment of COPD pt
- barbituates
- narcotics
- NO is contraindicated
- benzodiazepines- low dose may be acceptable in certain situations- consult physician
- erythromycin, macrolide ABs such as clarithromycin, azithromycin and ciprofloxacin should not be presscribed to COPD patients already taking theophylline
- can cause theophylline toxicity
what are the general, cardiovascular, respiratory, GI, and neurological symptoms of theophylline toxicity
- general: agitation, irritability, restlessness
-cardiovascular: sinus tachycardia, ventricular tachycardia atrial fibrillation, supraventricular tachycardia, hypotension, cardiac arrest - respiratory: tachypnea, acute lung injury, respiratory alkalosis
- GI: nausea, vomiting, abdominal pain
- neurological: tremors, hallucinations, seizures
what are the low level interventions
- health/med eval
- exams
- dental prophy
- radiographs
- optical oral scans
what are the moderate level interventions
- SRP
- simple restorative procedures; 1-2 teeth
- simple extractions; 1-2 teeth
- impressions
what are the high risk interventions
- complex restorative procedures on more than 2 teeth
- mulitple extractions
- surgical extractions
- implant placement
- full arch impressions
- dental care under general anesthesia
