Dental Problems in Patients with Respiratory Disease

Question 1

What to ask patients who have or have had respiratory problems?

Answer 1

Effectiveness of treatment (eg inhalers)
What is required to precipitate problems

Question 2

What are the general points of assessing the severity of respiratory disease? (5 points)

Answer 2

Shortness of breath - at rest or on exertion (SOBAR or SOBOE)
Cough
Production of sputum - colour
Necessity or otherwise for hospital in-patient treatment
Use of steroids

SOB could be due to primary cardiac cause or left ventricular failure

Question 3

What is the commonest inhaler used?

Answer 3

Salbutamol

Question 4

Mechanisms of each inhaler:
1. Salbutamol
2. Terbutaline
3. Ipratropium bromide
4. Beclometasone

Answer 4

1. Salbutamol: Beta2 agonist
2. Terbutaline: Beta2 agonist
3. Ipratropium bromide: antimuscarinic
4. Beclometasone: steroid

Question 5

The common name and colour of each inhaler:
1. Salbutamol
2. Beclometasone

Answer 5

1. Salbutamol = ventolin = blue
2. Beclometasone = becotide = brown

Question 6

What condition is steroid inhalers predispose to?

Answer 6

Oral candidosis

Question 7

How to prevent or improve the condition of oral candidosis for steroid inhalers?

Answer 7

Technique
Rinse with water after inhaler use
*Consider other oral causes of candidosis

Question 8

For patients with oral candidosis, what diseases or conditions should be considered?

Answer 8

Diabetes mellitus
Immunosuppression (inherent or induced)
Denture related issues (wearing dentures to sleep)

Question 9

During patient examination with respiratory problems, what should we look out for? (7 points)

Answer 9

Colour (pink puffer or blue bloater)
Signs of anaemia (eg pale lower eyelid, spoon nails)
Finger clubbing
Radial pulse (bounding in COPD due to CO2 retention)
Use of accessory muscles of respiration (eg trapezius rather than mastoid)
Respiratory rate (12-20 breaths per min is normal for adults; reduced RR implies respiratory arrest)
Trachea position (abnormal if not central)

bounding = strong throbbing; radial felt on wrist under thumb