Dental Management Dental Management Of Medically Of Medically Compromised Compromised

PatientsPatients

Respiratory Respiratory SystemSystem

The definition of a “medically The definition of a “medically compromised” patient is not compromised” patient is not precise and in this context, it precise and in this context, it is interpreted as the presence is interpreted as the presence of a medical factor which of a medical factor which may have implications for the may have implications for the provision of dental careprovision of dental care..

The Respiratory SystemThe Respiratory SystemThe tube which carries the air from the mouth is called The tube which carries the air from the mouth is called the Trachea or Windpipe, this later divides into two at the Trachea or Windpipe, this later divides into two at which point it becomes the Bronchi and divides the air which point it becomes the Bronchi and divides the air equally to each lung. Once the air enters the lungs it equally to each lung. Once the air enters the lungs it passes through a fine spongy structure which contains passes through a fine spongy structure which contains an extensive network of blood vessels, these vessels an extensive network of blood vessels, these vessels bring carbon dioxide into the lungs for removal, and bring carbon dioxide into the lungs for removal, and take oxygen from the lungs to the body.take oxygen from the lungs to the body.

This is collectively known as the respiratory system.This is collectively known as the respiratory system.

It deals with the exchange of gases (i.e oxygen & carbon It deals with the exchange of gases (i.e oxygen & carbon dioxide) in and out of our bodies.dioxide) in and out of our bodies.

Respiratory DiseasesRespiratory Diseases

Categorized into:Categorized into:

1.1. Upper Airway DiseasesUpper Airway Diseases

2.2. Lower Airway DiseasesLower Airway Diseases

Upper Airway DiseasesUpper Airway Diseases

• SinusitisSinusitis• Viral Upper Respiratory Viral Upper Respiratory

InfectionsInfections• Allergic Rhinitis & ConjunctivitisAllergic Rhinitis & Conjunctivitis• Laryngitis & Laryngitis &

LaryngotracheobronchitisLaryngotracheobronchitis• Pharyngitis & TonsillitisPharyngitis & Tonsillitis

inflammation of the epithelial inflammation of the epithelial lining of the paranasal sinuses.lining of the paranasal sinuses.

causes mucosal edema and causes mucosal edema and increase in mucosal secretions.increase in mucosal secretions.

SinusitisSinusitis

Relations To DentistryRelations To Dentistry

→ Patients complain of tooth ache when they have Patients complain of tooth ache when they have sinus infections therefore it is important to sinus infections therefore it is important to differentiate between a odontogenic infection and a differentiate between a odontogenic infection and a sinus pain.sinus pain.

→ Chronic sinus infections causes a patient to breath Chronic sinus infections causes a patient to breath through the mouth leading to dry mouth and is through the mouth leading to dry mouth and is susceptible to gingivitis.susceptible to gingivitis.

→ Use of decongestants causes dry mouth.Use of decongestants causes dry mouth.→Use of antibiotics that patients has been used for Use of antibiotics that patients has been used for

another condition, even in increased dosage will another condition, even in increased dosage will not work because the body has gained resistance not work because the body has gained resistance to it.to it.

Viral Upper Respiratory Viral Upper Respiratory InfectionsInfections

Viral infections are the most Viral infections are the most common cause of acute common cause of acute respiratory illness in children.respiratory illness in children.

It is transmitted by person-to-It is transmitted by person-to-person contact through person contact through respiratory dropletsrespiratory droplets

Relation To DentistryRelation To Dentistry

→The most common oral manifestations of The most common oral manifestations of this is the presence of small round this is the presence of small round erythematous macular lesions on the soft erythematous macular lesions on the soft palate and the enlargement of lingual palate and the enlargement of lingual tonsillar tissue at the lateral borders of the tonsillar tissue at the lateral borders of the tongue.tongue.

→Treatment for upper respiratory infections Treatment for upper respiratory infections are decongestants which causes a decrease are decongestants which causes a decrease in saliva flow leading to xerostomia.in saliva flow leading to xerostomia.

Allergic Rhinitis & Allergic Rhinitis & ConjunctivitisConjunctivitis

Is a chronic recurrent inflammatory Is a chronic recurrent inflammatory disorder of the nasal mucosa and an disorder of the nasal mucosa and an inflammatory disorder involving the inflammatory disorder involving the conjunctiva. conjunctiva.

When they occur together it is When they occur together it is called rhinoconjunctivitis, which is called rhinoconjunctivitis, which is an allergic hypersensitivity.an allergic hypersensitivity.

Relation To DentistryRelation To Dentistry

→The use of decongestants and first The use of decongestants and first generation antihistamines in generation antihistamines in treatments leads to xerostomia.treatments leads to xerostomia.

→Exposure to dental materials such Exposure to dental materials such as methacrylates and natural rubber as methacrylates and natural rubber latex increases the risk for allergic latex increases the risk for allergic respiratory hypersensitivity.respiratory hypersensitivity.

Laryngitis & Laryngitis & LaryngotracheobronchitisLaryngotracheobronchitis

Laryngitis is the inflammation of the Laryngitis is the inflammation of the larynx caused by viral infections.larynx caused by viral infections.

Laryngotracheobronchitis is an Laryngotracheobronchitis is an inflammation involving the larynx, inflammation involving the larynx, trachea & lungs also due to viral trachea & lungs also due to viral infections. infections.

Patients with laryngitis often Patients with laryngitis often complain of fever and sore throat complain of fever and sore throat and later coughingand later coughing..

Relation To DentistryRelation To Dentistry→ Medications used such as Medications used such as

Corticosteroids for reducing vocal Corticosteroids for reducing vocal cord inflammation, used over a cord inflammation, used over a period of time causes candidosis.period of time causes candidosis.

→ Antibiotics used for the bacterial Antibiotics used for the bacterial infections would not be able to be infections would not be able to be used when antibiotic used when antibiotic armamemtarium is given. And armamemtarium is given. And anitbiotics used over a period of time anitbiotics used over a period of time causes candidosis.causes candidosis.

Pharyngitis & TonsillitisPharyngitis & Tonsillitis

It is the inflammation of the pharynx It is the inflammation of the pharynx & the tonsils which is due to either & the tonsils which is due to either viral or bacterial infections.viral or bacterial infections.

Caused by the group A Caused by the group A ββ-hemolytic -hemolytic StreptococcusStreptococcus (GABHS) infections. (GABHS) infections.

Relation To DentistryRelation To Dentistry

→ Patients with GABHS infections Patients with GABHS infections should thoroughly clean their should thoroughly clean their tooth brushes or removable tooth brushes or removable orthodontic appliances or rinse it orthodontic appliances or rinse it with sterile waterwith sterile water..

Lower Airway DiseasesLower Airway Diseases

• Acute BronchitisAcute Bronchitis• PneumoniaPneumonia• AsthmaAsthma• Chronic Obstructive Pulmonary Chronic Obstructive Pulmonary

DiseaseDisease• Cystic FibrosisCystic Fibrosis

Acute BronchitisAcute Bronchitis

is an acute respiratory infection is an acute respiratory infection involving the trachea and bronchi involving the trachea and bronchi (large airways).(large airways).

Caused by either viral or bacterial Caused by either viral or bacterial infection.infection.

Relation To DentistryRelation To Dentistry

• Patients who take amoxicillin Patients who take amoxicillin should be prescribed another should be prescribed another type of antibiotic when it is type of antibiotic when it is needed for an odontogenic needed for an odontogenic infectioninfection..

PneumoniaPneumonia

• Is an infection or inflammatory Is an infection or inflammatory illness of the lung.illness of the lung.

• Caused by viruses, bacteria and Caused by viruses, bacteria and fungi (rarely).fungi (rarely).

• Signs and symptoms include, cough, Signs and symptoms include, cough, sputum and feversputum and fever

Relation To DentistryRelation To Dentistryo Aspirations of oral cavity secretions which contains oral Aspirations of oral cavity secretions which contains oral

bacteria & pneumonia causing pathogens into the bacteria & pneumonia causing pathogens into the respiratory tract, could cause pneumonia.respiratory tract, could cause pneumonia.

o Inflammatory products from the gingival tissue and Inflammatory products from the gingival tissue and pathogenic bacteria can be aspirated into the lower airway pathogenic bacteria can be aspirated into the lower airway promoting lung infection.promoting lung infection.

AsthmaAsthma

• Chronic inflammatory disorder of the Chronic inflammatory disorder of the airways in which it is reversibly airways in which it is reversibly narrow.narrow.

• Narrowing of the airways obstructs Narrowing of the airways obstructs airflow and breathing becomes airflow and breathing becomes difficult to the patient.difficult to the patient.

• Asthma could be developed from Asthma could be developed from factors such as a family history of factors such as a family history of asthma, respiratory infections and asthma, respiratory infections and inhaled pollutants.inhaled pollutants.

Relations To DentistryRelations To Dentistry

• Dental products and materials such Dental products and materials such as toothpastes, fissure sealants, as toothpastes, fissure sealants, tooth enamel dust and tooth enamel dust and methylmetacrylate is associated with methylmetacrylate is associated with asthma.asthma.

• Oral manifestations include Oral manifestations include candidiasis, decrease in salivary flow candidiasis, decrease in salivary flow and increase in calculus and and increase in calculus and gingivitis. gingivitis.

Chronic Obstructive Chronic Obstructive Pulmonary DiseasePulmonary Disease

• COPD refers to COPD refers to chronic bronchitis and and emphysema, a pair of two commonly co-, a pair of two commonly co-existing diseases of the lungs in which the existing diseases of the lungs in which the airways become narrowed. become narrowed.

• This limits airflow causing shortness of This limits airflow causing shortness of breath.breath.

• COPD is caused by noxious particles or COPD is caused by noxious particles or gas, most commonly from gas, most commonly from tobacco smoking, which trigger an abnormal , which trigger an abnormal inflammatory response in the lung. in the lung.

Relation To DentistryRelation To Dentistry

• Oral manifestations of COPD are Oral manifestations of COPD are halitosis, Oral cancer, periodontal halitosis, Oral cancer, periodontal infections and tooth stains.infections and tooth stains.

Cystic FibrosisCystic Fibrosis

• It is a rare disease but the most It is a rare disease but the most widespread life-shortening genetic widespread life-shortening genetic diseases .diseases .

• is a is a genetic disorder known to be an known to be an inherited disease of the secretory inherited disease of the secretory glands, including the glands that make glands, including the glands that make mucous and sweat. mucous and sweat.

• Mucous secretions obstructs ducts & Mucous secretions obstructs ducts & passages in the pancreas, liver & lungs.passages in the pancreas, liver & lungs.

Relation to DentistryRelation to Dentistry

• Oral manifestations are enlargement Oral manifestations are enlargement of the salivary , xerostomia, of the salivary , xerostomia, gingivitis and halitosis.gingivitis and halitosis.

Dental Management For Dental Management For Patients With Respiratory Patients With Respiratory

Disease.Disease. Consultation with patient’s physician Consultation with patient’s physician

before any treatment.before any treatment.Review the patient’s medical history to Review the patient’s medical history to

see if:see if:

- severity of the disease- severity of the disease

- if they have taken corticosteriods- if they have taken corticosteriods

- the medications taken by the patient - the medications taken by the patient For asthmatic patients, remind them to For asthmatic patients, remind them to

bring their inhalers.bring their inhalers.

When Performing When Performing Treatments:Treatments:

Chair to be in position where patient Chair to be in position where patient can breath easily.can breath easily.

Perform daily bio-film control Perform daily bio-film control measures on teeth and dentures.measures on teeth and dentures.

For local anesthesia, avoid using For local anesthesia, avoid using epinephrine for asthmatic patients. epinephrine for asthmatic patients.

Availability of nitrous oxide or oxygen Availability of nitrous oxide or oxygen for patients with upper respiratory for patients with upper respiratory infection.infection.

Allergy to antibiotics.Allergy to antibiotics. Avoid aspirin or aspirin containing Avoid aspirin or aspirin containing

analgesics for patients who have analgesics for patients who have aspirin-induced asthma.aspirin-induced asthma.

Advice on using antimicrobial mouth Advice on using antimicrobial mouth rinse.rinse.

Avoid triggering a hypersensitive Avoid triggering a hypersensitive airway by placing cotton rolls and airway by placing cotton rolls and suction tips. suction tips.

Follow standard precautions for Follow standard precautions for infection control.infection control.

Do Do NOTNOT use equipments that use equipments that produce aerosols. Eg. Ultrasonic produce aerosols. Eg. Ultrasonic scalers and polishing because of scalers and polishing because of aspiration risks.aspiration risks.

ReferenceReference

• Greenberg, MS Greenberg, MS et al.et al. 2008, “Oral 2008, “Oral Medicine”.Medicine”.

• Willikins, E, “ ClinicalWillikins, E, “ Clinical• http://mayoclinic.com/health/http://mayoclinic.com/health/

laryngitis/DS00366/laryngitis/DS00366/DSECTION=treatments-and-drugs DSECTION=treatments-and-drugs