28/09/2010

Medication of asthma related to dentistry

Asthma is a chronic disease that caused by an inflammatory reaction that occurs within the bronchial airways. The inflammatory reaction is caused by excessive sensitivity of the mucosal membranes and muscles to any number of triggers. Several different stimuli including allergens, respiratory infections, exercise, and certain drugs can trigger an asthma attack. The clinical criterion for asthma is the presence of reversible airway obstruction, cough, shortness of breath, chest tightness, and wheezing. There are several methods of classification for asthma depending on symptoms, severity, frequency and lung capacity such as Traditional Classification, NAEPP Classification etc. For NAEPP Classification, The National Asthma Education and Prevention Program Classification, is based on severity and frequency of symptoms as well as pulmonary function assessment. For instance, there are mild intermittent, mild persistent, moderate persistent and severe persistent. For Traditional classification, asthma has been classified into extrinsic (allergic), intrinsic (non-allergic) and mixed (allergic and non-allergic) types depending on the stimuli that trigger attacks. Extrinsic asthma may be precipitated and triggered by allergens in animal fur, dust mites, pollens, or moulds and it is common in young age. People with this type of asthma are frequently asymptomatic between attacks. Their asthma is associated with overproduction of the antibody immunoglobulin E (IgE) on exposure to allergens and release of mast cell products that cause bronchospasm and edema. Intrinsic asthma is triggered by anything not considered an allergen and usually occurs in elderlies, such as chemicals in cigarette smoke, emotional stress, exercise, cold air, gastro-intestinal reflux or vagally mediated responses. It appears to be related to mast cell instability and hyper-responsive airways. Mixed asthma is the third type of asthma which is the combination of extrinsic and intrinsic types and is triggered by allergens and non-allergens. Treatment of asthma has been traditionally separated into two categories: 1) use of bronchodialtors, e.g. nebulized or liquid 2-adrenergic agonist drugs, to address bronchospasm, and 2) anti-inflammatory drugs, e.g. corticosteroids, to combat airway inflammation and hyper-responsiveness. Newer medications, e.g. leukotriene modifiers, and drug combinations, e.g. inhaled corticosteroids combined with longacting -adrenergic agonists, have dual effects. Now, asthma medications are classified according to their roles in the overall management of asthma, quick relief or long-term control.

Asthma does not cause any specific manifestations in the oral cavity. However, some literature suggests that the medications are taken by individuals with asthma may contribute to several oral conditions. One of the most common oral side effects of inhaled corticosteroids is an increased risk of oral fungal infections (candidiasis). Many of the medications that are used to treat asthma have the potential to cause xerostomia, which is associated with a higher rate of caries and periodontal or gingival infections such as 2-adrenergic agonist drugs. In addition, an increase in gastroesophageal reflux, associated with some asthma medications, can cause a higher than normal oral pH, which is related to enamel erosion. According to a research of the relationship between caries and medication, a Community Health Projects Report, it is shown that there is no statistically significant association with the use of xerostomic drugs such as 2-receptor agonists, plaque accumulation and retention will be increased due to the impaired cleansing function of saliva. Dental hygienists have the opportunity to help individuals with asthma that asthmatic attacks may occasionally be precipitated by anxiety. It is important to attempt to lessen fear of dental treatment by sympathetic handling and reassurance. There is a high chance of asthma sufferers even routine dental treatment can trigger a clinically significant decrease in lung function. Always remind patients to bring their medication to a dental appointment and put it readily accessible throughout the entire dental appointment. If the patient has an acute exacerbation of asthma during treatment: stop treatment and remove all instruments or equipment from the mouth; remain calm as further anxiety will exacerbate the shortness of breath; sit the patient up; give the patients usual medication such as a 2-agonist inhaler. During the appointment, scaling and oral hygiene instruction (OHI) is necessary for asthma patient to remove the calculus which may interfere the plaque control and plaque. Dental hygienists is necessary to maintain the healthy oral tissues of the patients by education them about the adverse effects of the drugs they may be taking. In addition, the dental hygienist should make homecare recommendations focused on controlling the oral effects of the medications, for example, rinse mouth with water after using inhaler to decrease risk of oral fungal infections.

Reference: Clinical practice of the dental hygienist 10 th edit, Esther M. Wilkins Community Health Project 2010, BDS year 4 students, Faculty of Dentistry, HKU General and oral Pathology for the dental hygienist, Leslie DeLong and Nancy W. Burkhart Special care in dentistry: handbook of oral health, careCrispian Scully,Pedro Diz and Dios,Navdeep Kumar Pharmacology ReCap 2.0 for Bachelor of Dentistry Students, Dr. J. G. Buch