Diseases of the Respiratory Tract

The MIND Paradigm

• M = metabolic diseases– Hormonal, nutritional, compromised organ systems

• I = inflammatory diseases– Trauma, reactive, Infection, immunologic

• N = neoplastic diseases– Benign, premalignant, malignant

• D = developmental diseases– Disorders of growth & embryologic defects

The Respiratory Tract

• Upper Respiratory Tract– Oral Cavity– Nasal Cavity– Paranasal Sinuses– Nasopharynx– Larynx

• Lower Respiratory Tract– Lungs (alveoli, bronchi, bronchioles)

Definitions

• Pulmonary function tests – physiologic tests that measure the airway space capacities

• Dyspnea – shortness of breath

• Stridor – closing off of vocal cords

• Productive cough – bring up phlegm

• Nonproductive cough – dry hack

• Hemoptysis – coughing up blood

Diseases of the Upper Airway

• Sinusitis, rhinitis

• Sinonasal papillomas

• Sinonasal cancer

• Laryngitis

• Vocal cord paralysis

• Cancer of the Larynx

Sinusitis

• Infectious (Bacterial, viral, fungal)

• Allergic

• Signs and Symptoms– Nasal Blockage/Obstruction (Edema)– Sneezing– Nasal Discharge– Fever (viral and bacterial)

Clouding of the sinus seen on a Radiograph

Sinonasal Polyps

• Arise from respiratory epithelium• Growths with narrow stalk (pedunculated)• Papillary pattern of growth (papillomas)• Nasal Obstruction• Visualization

– Direct in the nasal cavity

– Detected with Radiographs of the sinonasal region

• Certain types can undergo cancerous change

CT scan reveals the patient has a brain, two eyeballs and a polypoid mass (Papilloma) in the nose and sinus

Sinonasal Carcinoma

• Malignant tumors of respiratory epithelium

• In the antrum, may invade into the mouth through the palate

• Associated numbness of the maxilla

• Often fatal

Laryngitis• Overuse of vocal cords (shouting, yelling, singing

loudly, talking naughty)• Trauma• Viral or Bacterial infection of throat and vocal cords• Allergic• Signs and symptoms:

– Hoarseness– Sore throat– Fever when infectious

How to tell a

• Allergy from a• Sinusitis from a• Laryngitis from a• Bronchitis from a• Tonsillitis from a• Pneumonia from an• Ear Ache from a• Flu

NO Temp. 100 F or abovestuffy nose, sneezing

Itchy eyes, nose, throat

Pain around eyes,

thick yellow nasal

discharge

Cat, dust, pollen allergy

Cold plus sinusitis

NO Temp. 100 F or abovestuffy nose, sneezing

• Ear hurts

• Hoarseness

NO

• Uncomplicated Cold

• Cold plus otitis media

• Cold plus laryngitis

Temp. 100 F or aboveNO Headache, chills and sweats, rash, muscle aches, marked fatigue, cough

• Very sore throat and/or swollen neck glands

• Strep throat or tonsillitis

Temp. 100 F or above Headache, chills and sweats, rash,

muscle aches, marked fatigue, cough• Wheezing, coughing

up gray-yellow phlegm

• Painful breathing and/or coughing up rust-colored phlegm NO

• Uncomplicated Fluor Lyme Disease

• Flu plus bronchitis

• Flu plus pneumonia

Diseases of the Lungs

• Chronic Obstructive Pulmonary Disease (COPD

• Pneumonias

• Granulomatous Infections

• Cancer

COPD• Loss of airway space• Major underlying causes

– Bronchitis (smoking)– Emphysema (smoking)– Asthma (allergy, familial, anxiety)

• Signs and Symptoms:– Wheezing (asthma)– Productive cough (bronchitis)– Dyspnea (shortness of breath)

• Cannot walk up a staircase without resting• Sleep with many pillows

Pneumonia

• Bacterial and Viral Etiologies• Filling of air spaces with edema fluid• Requires hospitalization, antibiotics• Symptoms:

– Dyspnea– Cough, productive or nonproductive– Fever

Tuberculosis

• Mycobacterium tuberculosum• Mildly contagious, repeated exposures• Lung Granulomas fill airspaces• Necrosis of granulomas• Signs and symptoms:

– Productive cough– Bloody sputum, hemoptysis– Dyspnea

Lung Cancer

• Bronchogenic Carcinoma– Cigarette smoking is chief

environmental risk factor

• Small Cell Carcinoma

• Both types metastasize

• Predispose lungs to pneumonia

Dental Implications

• Upper tract diseases may cause maxillary pain, mimicking toothache

• Antral tumors may involve the palate• Infections can be transmitted in the dental

operatory setting• COPD and other pulmonary diseases with dyspnea

require frequent uprighting of patient• Asthmatics – keep inhalers in easy reach• Oxygen tank for pulmonary emergencies

Goodbye and Good Luck

Peter J.