CASE 4

Name Ms. W
Age 22 y.o
Sex Female
Chief Complaint (S) Patient visited to emergency installation at RSD
Balung on wednesday, 16th May 2018 with chief
complain are out of breath and heavy wheezing
from a day before. Patient have a medical history
asthma when she exposed to cold or dust.
Clinical Observation Patient looks anxious, limp, out of breath, and
heavy wheezing.
Temporary Bronchial asthma
Diagnosis

Introduction

Asthma is a chronic airway inflammatory disease (inflammation) characterized by episodic

wheezing, coughing, and chest tightness due to airway obstruction, including in chronic respiratory
diseases. Asthma has a low level of fatality but the number of cases is quite common in society.
The World Health Organization (WHO) estimates that 100-150 million people worldwide suffer
from asthma, the number is expected to grow by 180,000 people every year. Another source said
that asthma patients have reached 300 million people worldwide and has continued to increase
over the last 20 years. If not prevented and handled properly, it is expected that there will be an
increase in prevalence higher in the future and disrupt the process of child development and quality
of life of patients. (GINA, 2016)

Symptoms of asthma are cough, shortness of breath with wheezing is a result of bronchial
obstruction based on chronic inflammation and bronchial hyperactivity. Bronchial hyperactivity is
a hallmark of asthma, the magnitude of this bronchial hypereactivity can be measured indirectly.
This measurement is an objective parameter to determine the severity of bronchial hyperactivity
present in a patient. Various methods are used to measure this bronchial hypereactivity, among
others, by provocation of workload, inhalation of cold air, inhalation of antigen and inhalation of
nonspecific substances (GINA, 2016).
Airway constriction that occurs in asthma is a complex thing. This occurs because of the
release of mediators from mast cells that are commonly found on the surface of the bronchial
mucosa, the lumen of the airway and below the basement membrane. Various triggering factors
can activate sal mast. In addition to mast cells, other cells that can also release the mediator are
alveolar macrophage cells, eosinophils, airway epithelial cells, neutrophils, platelets, lymphocytes
and monocytes. (GINA, 2016).

Oral and Dental Manifestation of Bronchial Asthma

1. Xerostomia (dry mouth)

The impairment of salivary secretion is in direct relation to the drug dose, and the
composition of saliva is also affected. The drugs has an effect decreased salivary production that
caused xerostomia. A posa possible mechanism implicated is could be the intervention of β-
agonists. β-agonists can reduce saliva 25-30%, decreasing pH and make the effect also upon the
salivary glands. (Shashikiran et all., 2007).

2. Candidiasis
Candidiasis is caused by the lack of salivary production causing the fungi population is
more than bacteria in the oral cavity, causing fungi to dominate the bacterial population, resulting
in candidiasis, that can made bad breath (Shashikiran et all., 2007).

3. Dental Carries
The decrease in saliva production causes self cleansing of the oral cavity to decrease too,
so that food debris and plaque easily to sticked on the tooth surface and then cause caries
(Shashikiran et all., 2007).
What Should We Do if the Patient Had an Asthma Relapse During Dental Treatment

If the patient with asthma history comes at dental practice but without showing any asthma
symtomp (Soengkono, 2003)
1. Reduce stress, when dental care takes a long time the treatment is made gradually
2. Dentists may only perform dental treatment in patients who do not show symptoms of
asthma, when the patient comes with symptoms of wheezing and cough even though it
does not show asthma, the dental treatment should be delayed.
3. Use of local anesthesia during treatment should be adjusted to the type and amount with
the bronchodilator drug used by the patient.
4. Beware of using epinephrine to the patient with heart desease, it can cause arrythmia,
angina, and heart failure.
5. Patient with the history of asthma should bring their personal bronkodilator and placed it
on visible and reacheable area when they visit to the dentist.

If the patient with asthma history comes at dental practice, then the asthma relapsed when
dentist still doing treatment (Soengkono, 2003)
1. In the onset are given β2 fast-acting agonists and oral corticosteroids. In adults can be
added ipratropium bromide inhalation, aminophylline IV (bolus or drip). In children have
not been given ipratropium bromide inhalation or aminophylline IV.
2. If necessary, we can give ventolin with nebulizer or oxygen and IV fluids by inhalation to
patient.
3. Maintain the condition and call for help with emergency medical service nearby.

Reference

GINA (Global Initiative for Athsma), 2016, GINA Global Strategy for Asthma Management and
Prevention, New York: USA. Accessed from: www.ginasthma.org
Shashikiran, N. D., V. V. S. Reddy, P. Krishnam Raju, 2007, Effect of antiasthmatic medication
on dental disease: Dental caries and periodontal disease, Davangere: India. Journal of
Indian Society of Pedodontics and Preventive Dentistry. 25: 65-68.
Soengkono, Isnainy. 2003. Perawatan Gigi Mulut Anak Penderita Asma dan Prospek untuk
Pencegahan. Jakarta: Indonesia. Jurnal Kedokteran Gigi Universitas Indonesia. 10: 33-73.