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Oral Medicine > Lecture 1: Dental Management of Patients with Respiratory Conditions > Flashcards

Lecture 1: Dental Management of Patients with Respiratory Conditions Flashcards

1
Q

COPD: 3 ways to prevent potential problems

A
  • Suggest smoking cessation
  • Awareness of potential comorbid conditions (hypertension and coronary heart disease)
  • Awareness of drug interactions
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2
Q

6 potential oral complications if COPD patient is a chronic smoker

A 
Halitosis
Stains
Nicotinic stomatitis
Periodontal disease
Premalignant mucosal lesions
Oral cancer
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3
Q

Define nicotinic stomatitis

A

White patches and red dots on palate

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4
Q

Potential oral complication if COPD patient is taking anticholinergic drug

A

Dry mouth

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5
Q

Potential oral complication if COPD patient is taking theophylline

A

Rare instances of induced Stevens-Johnson syndrome (SJS)

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6
Q

Define SJS

A

A life-threatening skin condition, in which cell death causes the epidermis to separate from the dermis

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7
Q

Method of determining the potential issues or factors of concern for the dental management of respiratory patients

A

ABCDEF

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8
Q

List the 5 categories under A for potential issues

A 
Analgesics
Antibiotics
Anesthesia
Anxiety
Allergy
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9
Q

List the 2 categories under B for potential issues

A

Bleeding

Blood pressure

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10
Q

List the category under C for potential issues

A

Chair position

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11
Q

List the 2 categories under D for potential issues

A

Devices

Drugs

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12
Q

List the 2 categories under E for potential issues

A

Equipment

Emergencies

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13
Q

List the category under F for potential issues

A

Follow-up

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14
Q

Antibiotics: What to avoid in a patient taking theophylline (for COPD)

A

Erythromycin
Macrolide antibiotics
Ciprofloxacin

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15
Q

What to be aware of in terms of COPD patients who have received antibiotics for upper respiratory infections

A

Oral and lung flora may include antibiotic resistant bacteria

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16
Q

COPD: things to consider in terms of anesthesia

A

Local anesthesia can be used without change in technique. Avoid outpatient general anesthesia

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17
Q

COPD: things to consider in terms of anxiety management

A

Avoid nitroud oxide-oxygen inhalation sedation for COPD stage 3 or worse
Alternative = low does oral diazepam or another benzodiazepine (may cause oral dryness)

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18
Q

COPD: optimal chair position

A

Semisupine or upright chair position

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19
Q

COPD: considerations for device use

A

Avoid rubber dams in patients with severe disease
Use pulse oxymetry to monitor O2 sat.
Spirometry readings helpful to determine control level

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20
Q

COPD: drugs to avoid

A

Barbiturates and narcotics can depress respiration

Antihistamines and anticholinergic drugs can further dry mucosal secretions

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21
Q

COPD: corticosteroid use prior to dental visit

A

Normal morning dose should be taken on the day of surgical procedures

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22
Q

COPD: Equipment considerations

A

Monitor O2 sat during sedation and invasive procedures

Use low flow (2 - 3 L/min) supplemental O2 when drop <95%

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23
Q

COPD: follow up considerations

A

Encourage patient to quit smoking
Examine oral cavity for lesions that make be related to smoking
Avoid treatment if upper respiratory infection is present

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24
Q

Potential oral complication of inhaled corticosteroids (COPD and asthma patients)

A

May contribute to development of oral candiasis if used improperly or excessively (should wash mouth after every use)

25
Q

Define oral candiasis

A

A type of yeast in mouth

26
Q

Potential complication of systemic corticosteroids

A

Possible adrenal suppression; cushingoid features with long term use

27
Q

Adverse drug interactions with phosphodiesterase (PD) inhibitors such as theophylline

A

Erythromycin
Azithromycin
(Serum levels should be monitored)

28
Q

Most serious manifestation of asthma

A

Status asthmaticus

29
Q

Define status asthmaticus

A

Sever prolonged asthmatic attack (1 hr to longer than 24 hours)

30
Q

Associated conditions to status asthmaticus

A

Respiratory infection leading to exhaustion, severe dehydration, peripheral vascular collapse and death (uncommon)

31
Q

Number of deaths per year due to asthma complications

A

4000 deaths per year in USA in >45 year olds

32
Q

5 things to consider in order to prevent asthma complications during dental treatment

A

History (determine severity and stability of disease)
Type (allergic/nonallergic; precipitating factor)
Frequency and severity of attack; current/past
Spirometer
Oximeter

33
Q

If asthma is sever and uncontrolled, what do you do?

A

Postpone treatment until stabilization

34
Q

If the patient experiences nocturnal asthma attacks, what do you do?

A

Schedule for late morning appointments

35
Q

Operatory odorants (methyl methacrylate) and asthma: what to do

A

Reduce

36
Q

Follow up with asthmatic patients

A

Instruct to use regularly their medication; bring their inhalers

37
Q

Oral premedication for asthma

A

Benzodiazepine
Hydrozyizine (reasonable alternatives with children)
Ketamine (bronchodilation)

38
Q

Drugs to avoid with asthmatic patients

A

Barbiturates and narcotics (particularly meperidine) since histamine releasing = can provoke attack
Outpatient anesthesia

39
Q

Asthma and sulfite preservative found in local anesthetic containing epinephrine

A

Less than normally found in certain foods but acute asthma attack has been reported
Advisable to not use epinephrine with moderate to sever condition and discuss any past allergic responses (talk to MD)

40
Q

Sedation for anxious asthmatics

A

Nitrous oxide-oxygen inhalation sedation and/or small doses of oral diazepam

41
Q

Allergy concerns in asthmatics

A

Asthmatics with nasal polyps at increased risk for allergy to aspirin, so avoid use

42
Q

Blood pressure and asthmatics

A

Monitor BP in event of asthma attack to observe for development of status asthmaticus

43
Q

Optimal chair position for asthmatics

A

Semisupine or upright

44
Q

Signs and symptoms of a severe asthma attack (8)

A

Inability to finish sentences in one breath
In effectiveness of bronchodilators to relieve dyspnea
Recent drop in FEV
Tachypnea with a respiratory rate of 25/min
Tachycardia with HR of 110 bpm
Diaphoresis
Accessory muscle usage
Paradoxical pulse

45
Q

Protocol if patient is experiencing a severe asthma attack

A

1) Administer fast acting bronchodilator, oxygen, and (if needed) subcutaneous epinephrine (0.3 - 0.5 mL)
2) Activate emergency medical system (EMS)
3) Repeat administration of fast acting bronchodilator every 20 min until EMS arrive

46
Q

Initial careful workup of tuberculosis patient (information to acquire) (5)

A

Medical history (i.e. diagnosis and date)
Type of treatment provided
ROS
History of periodic physical examinations
CXR for evidence of reactivation

47
Q

When do you postpone treatment of a TB patient?

A

Questionable adequacy of treatment time
Lack of appropriate medical follow up evaluation since recovery
Signs and symptoms of relapse

48
Q

How to manage TB patient if positive PPD

A

Verify evaluation by MD to rule out active disease
Verify completion of drug therapy with isoniazid for 9 months
Normal manner

49
Q

How to manage patient if exhibiting signs and symptoms suggestive of TB

A

Refer to MD for evaluation and postpone treatment

If treatment necessary, treat as for patient with sputum positive

50
Q

5 adverse effects of isoniazid

A

1) Hepatotoxicity and elevation in serum animotransferase
2) Cofactor increase risk of hep (i.e. age, daily alcohol intake, previous history of liver disease)
3) GI and neurologic adverse events
4) Adverse interactions with acetaminophen
5) Increases concentration of other drugs (i.e. diazepam)

51
Q

3 adverse effects of rifampin

A

1) Induces Cytochrone P-450
2) Lower plasma level of oral contraceptive, diazepam, midazolam, clarithromycin, ketoconazole, itraconazole, fluconazole
3) Leukopenia, hemolytic anemia, thrombocytopenia = increase risk of infection, delayed healing, gingival bleeding

52
Q

4 oral manifestations of asthma

A
  • Allergic rhinitis
  • Headache
  • Dry mouth and related sequela
  • Opportunistic infection
53
Q

Define allergic rhinitis

A

Mouth breathing leading to increased upper anterior and total anterior facial height, higher palatal vault, greater overjet and higher prevalence of crossbite

54
Q

5 oral manifestations of TB

A

1) Oral lesions –> painful, depp, irregular ulcer on dorsum of tongue (palate, lips, BM, gingiva may also be affected
2) Granular; nodular; leukoplakic and painless
3) Osteomyelitis if extension to jaw
4) Lymphadenopathy –> scrufola
5) Salivary gland or TMJ (rare)

55
Q

What is the potential significance of finding an enlarged neck lymph node?

A

If history of TB, can possibly be reactivation

56
Q

Describe the findings of oral candiasis

A

Wide spread, yellowish membrane that can be removed (peeled off)
Erythema (inflammatory red patch near back of mouth)

57
Q

Describe the findings of nicotinic stomatitis and explain what these are exactly

A 
Wide spread red dots (salivary gland inflammation)
White patch (keratosis)
58
Q

Define leukoplakia

A

White patch without evidence of friction or injury (i.e. idiopathic)

Oral Medicine (5 decks)

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