Medically Compromised Patient

RESPIRATORY DISEASE
BREE FONTENOT & MORIAH WALLACE

What is it?
The respiratory system includes the sinuses, nasal

cavity, larynx, pharynx, trachea, bronchi, and lungs.

The lack of function results when inflammation

occurs causing an overabundance of mucus and

congestion.

How to Treat Your Respiratory Patient

Those suffering from respiratory diseases are at a

risk for decreased breathing function and drug

interactions.
3 Key Factors to Know:

Tobacco Cessation: Can cause many respiratory diseases

Emergency Treatment: How to react in an emergency
Oral Systemic Link: Periodontal infections can be associated
with respiratory system infections

Most Common Respiratory Diseases

Acute Bronchitis
Pneumonia
Tuberculosis
Asthma
COPD
Cystic Fibrosis

Acute Bronchitis
The tubes that carry air into the lungs are inflamed
Etiology:

Viral (smoke, pollution, dust) and Bacterial Infections

Occurrence and Population:
May last up to 3 weeks.
Viral most prevalent, Bacterial least prevalent
Typically effects: elderly, young children, those with other
health conditions, those lacking immunizations
Treatment:
Bed rest, fluids, cough suppressants, or antibiotics
Medications Used:
Amoxicillin, macrolides, and cephalosporin

Acute Bronchitis
When tubes become

inflamed it causes
narrowing, constriction, and
blockage of the airways,
which leads to symptoms of
bronchitis.
Last less than six weeks
Symptoms: Shortness of
breath, Cough, Production
of mucus
(phlegm),Wheezing, Fever,
Fatigue

Dental Concerns Associated With Acute Bronchitis

Disease Prevention

Prevent transmission; can be contagious if viral, quit smoking

Appointment Management

Delay treatment until coughing decreases

Position chair so the patient can breath easily

Bacterial Resistance to Antibiotics

Alternative antibiotic may be necessary if needed for oral

infections.

Xerostomia from medications, sleep apnea and Oral

Candidiasis can be symptoms that the patient should

be educated about.

Pneumonia
An infection in the lungs;
Common symptoms of pneumonia include fever, chills, shortness

of breath, pain with breathing, a rapid heart and breathing rate,

nausea, vomiting.
Etiology:

Viruses, bacteria, fungi, mycoplasma, or parasites

Occurrence and Population:

Viral most prevalent, Bacterial least prevalent

Most common in children and young adults

Treatment:

Bed rest, fluids, antibiotics

Medications Used:

Antibiotic therapy or sulfa drugs

Dental Concerns Associated with Pneumonia

Some patients need extra oxygen (given through

small nasal tubes or a face mask) to help them

breathe more easily
Poor oral health, dependence on healthcare provider
for oral care and colonization of periodontal and
respiratory pathogens are associated with
pneumonia.
Prevent aspiration pneumonia by controlling oral
pathogens with proper effective oral hygiene.

Tuberculosis
Chronic, infectious, and communicable disease
Etiology: A bacterial infection spread through aerosols by:

Mycobacterium tuberculosis

Occurrence and Population:

Close contact with those infected by TB, those incarcerated or in

nursing homes. HIV/AIDS and cancer patients undergoing
chemotherapy

Medications Used:

Isoniazid (INH
Rifampin (RIF)
Ethambutol (EMB)
Pyrazinamide (PZA)

Dental Concerns Associated With Tuberculosis

Treatment should be administered in a hospital and

is only permitted in a dental office once disease is

inactive
Be able to recognize signs and symptoms, stay
educated about TB protocol and infection control
measures
Painful deep ulcerations overall and swelling of
lymph nodes may appear
Xerostomia from medications my occur

When to treat TB:

Active TB: Do not treat in dental office .
History of TB: Use caution, consult with physician

prior to treatment
If have signs or symptoms of TB: postpone treatment
and refer.
A diagnosis of respiratory TB should be considered
for any patient with symptoms including coughing
for more than 3 weeks, loss of appetite, unexplained
weight loss, night sweats, hoarseness, fever, fatigue
or chest pains.

Asthma
Chronic lung disease that makes it harder to move air in

and out of your lungs

Etiology:

Cause is unknown

Occurrence and Population:

Often seen in children

Medications Used:
Long Term Control: Short Term Control:
Corticosteroids Anticholinergics
Mast Cell Stabilizers Systemic Corticosteroids
Immunomodulators
Methylxanthines

DH Care for Asthmatic Patients

Before Treatment:

Assess risk level, remind patient to bring inhaler, schedule

morning appointments, provide a stress-free environment

During Treatment:

Use local anesthetics without sulfites, fluoride treatment for all

patients with asthma, if attack occurs, cease treatment and call
911.

After Treatment:

Rinse mouth to prevent oral candidiasis

Dental Concerns Associated With Asthma

Avoid aspirin and NSAIDS
Oral Manifestations:

Xerostomia
Possible increase in dental caries
GERD: can cause erosion
Oral Candidiasis

Questions to Ask Your Patient

At the Dentist :
Bring your inhaler to all of your appointments. Also
bring a list of the drugs that you take. Tell your
dentist about:
Your latest asthma attack
How often you have asthma attacks
What triggers your attacks
How serious your asthma is
Any asthma-related hospital visits, including trips to
the emergency room

Chronic Pulmonary Obstructive Disease

Pulmonary disorders that obstruct the airflow
2 Common Types:

Chronic Bronchitis
Emphysema

Etiology:

Inhalation of tobacco smoke and environmental pollutants

Occurrence and Population:

Affects over 11 million in the U.S. and is the 3rd leading cause of death

Treatment:

No cure. Decrease exacerbations with smoking cessation, eliminating exposure

to environmental pollutants, have adequate nutrition, drink water, and exercise
regularly.

Medications Used:

Aerosol bronchodilators, inhaled corticosteroids, and other medications similar

to those used to treat COPD.

Dental Concerns Associated With COPD

Increased risk for oral cancer, nicotine stomatitis,

halitosis, periodontal infections, and staining

Patient Education:

Encourage smoking cessation, discuss oral and systemic link

between periodontitis and COPD.

Cystic Fibrosis
An inherited disease that causes thickened mucus to

form in the lungs, pancreas, and other organs.

Etiology:

Genetic

Occurrence and Population:

Progressive and ultimately fatal

Many live beyond 30-40 years of age with proper health care.
Can worsen with age.

Treatment:

Antibiotics including inhalation solution

Airway clearance therapy

Dental Concerns Associated With Cystic Fibrosis

No specific oral lesions are related.
Gingivitis associated with dry mouth
To facilitate breathing and adapt chair position

Summary:
DH Care for Respiratory Disease

Signs & Symptoms:

Cough/dyspnea at rest, wheezing, chest pain

Reduce Stressful Situations:

Short, morning appointments

Position patient semi-reclined or upright

Avoid local anesthesia with sulfite
Nitrous oxide-oxygen may be contraindicated
Avoid aspirin and NSAIDS
Ultrasonic and polishing is contraindicated

Question 1
1. The use of the ultrasonic in an individual with

respiratory disease is contraindicated. The

pathogens found in bacterial plaque and
periodontal pockets may be aspirated into the
lungs.
Both statements are true.
Both statements are false.
The first statement is true, and the second is false.
The first statement is false, and the second is true.

Question 2

2. Which organism causes tuberculosis?

Streptococcus pyogenes
Mycobacterium tuberculosis
Candida albicans
Mycobacterium leprae

Question 3

3. Which of the following are oral manifestations of

asthma?
Caries
Candidiasis
Xerostomia
All of the above

References
American Lung Association . (n.d.). Retrieved November 12, 2016, from

http://www.lung.org/
Chronic Obstructive Pulmonary Disease (COPD) Includes: Chronic

Bronchitis and
Emphysema. (2016). Retrieved November 12, 2016, from http
://www.cdc.gov/nchs/fastats/copd.htm
Lozano, A. C., Perez, M. S., & Esteve, C. G. (2011). Dental considerations in

patients with respiratory problems. Retrieved November 12, 2016, from

http://www.medicinaoral.com/odo/volumenes/v3i3/jcedv3i3p222.pdf
Wilkins, L. W. (2011). Clinical practice of the dental hygienist. Place of

publication not identified: Wolters Kluwer Health.