Pulmonary DiseasePresented by: Bobbie Jo Bennett,

Kristen Franklin,& Lacey McGallion

Chronic obstructive pulmonary disease (COPD)

A large group of lung diseases characterized by obstruction of air flow that interferes with normal breathing.

2 common typesChronic bronchitisEmphysema

EtiologyThe primary etiology is use of tobacco and

exposure to occupational and environmental pollutants. Dental hygienists should motivate patients with

COPD using tobacco to begin a smoking cessation program.

OccurrenceChronic bronchitis

2009- estimated 9.9 million AmericansEmphysema

2009- estimated 4.9 million Americans

PopulationChronic bronchitis

Race: non-hispanic whiteAge: 45-64 years oldSex: women almost 2x likely Location: South of the United States

Emphysema Race: non-hispanic whiteAge: 65+ years oldSex: men

TreatmentNo cureMedication intervention Home oxygen therapy Pulmonary rehabilitation Surgery (lung transplant & LVRS)–severe cases onlyPatients are encouraged to…

Stop smoking Adequate nutritionDrink plenty of waterExercise regularlyDecrease exposure to pollutants

MedicationsPneumonia and influenza vaccinesBronchodilators and other medications

similar to those used for asthmaBeta-agonists Anticholinergics Systemic or inhaled corticosteroids Antibiotics

Dental ConcernsIndications Contraindications

Nitrous oxide-oxygen analgesia for clients with chronic bronchitis

Use of local anesthesia: without epinephrine

Low-flow supplemental oxygen is helpful

Low dose of oral diazepam if needed to reduce stress

Semiupright/upright chair position to facilitate breathing

Diazepam/Lorazepam Supine chair positionAvoid use of ultrasonic debridementAvoid use of rubber cup and air

polishing Avoid use of rubber damAvoid use of Nitrous oxide-oxygen

analgesia in clients with Emphysema Avoid use of barbiturates and narcotics

because of their respiratory depressant properties

If client is on Theophylline (bronchodilator) avoid use of erythromycin, macrolide antibiotics and ciprofloxacine- it will increase levels of Theophylline

How will oral health be impacted?

Chronic smokers with COPD have a higher risk of developing:HalitosisNicotine stomatitisPeriodontal infectionsOral cancerExtrinsic tooth stains

Medical Treatments impact on oral healthThere is no cure for COPD. Encourage patients to:

stop smoking have adequate nutrition drink plenty of water exercise regularly decrease exposure to pollutants.

Medical interventions strategies include: Pneumonia and influenza vaccines. Bronchodilators and other medications similar to those used

for asthma.

Medications impact on oral healthMedications: Side effects

-        B-adrenergic agonists xerostomia-        Antiholinergics xerostomia-        Bronchodilators:Theophylline xerostomia and bad taste-        Corticosteroids xerostomia and candidiasis

Periodontal Management Interventions that improve oral hygiene and

possibly lower oral inflammation may prove to lower risk of lung infection in susceptible populations.

Expected/Accepted Treatment OptionsPre-med

No- controversial Patient positioning

Semi-supine or upright chair position to facilitate breathing

Appointment lengthShorter appointments

Ultrasonic useAvoid use- Pathogens may be aspirated into the lungs

Recall intervals Semi-annual appointments- unless other

medical/dental issues involved

Dental Hygiene CareBefore you begin…

Review medical historyAvoid treating if upper respiratory infection is

presentTreatment may be performed on stable

patients with adequate breathing.Identify patients who may experience

exacerbation of symptoms under emotional stress

May use local anesthesia without epinephrineNitrous oxide-oxygen inhalation sedation

should be avoided with severe COPD and emphysema

Question #1Dental hygienist should motivate patients

with COPD to…A. Stop smokingB. Drink plenty of waterC. Exercise dailyD. All of the above

Question #2Chronic smokers with COPD have a higher risk for developing oral cancer. Chronic smokers with COPD have a higher risk for developing periodontal infections. A. Both statements are true.B. Both statements are false.C. The first statement is true, and the second

statement is false.D. The first statement is false, and the second

statement is true.

Question #3Chronic bronchitis is most commonly seen in

which race? A. HispanicsB. Non-hispanic- whiteC. African AmericansD. Asians

ReferencesWilkins, E.M. (2009). Clinical Practice of

Dental Hygiene 10th edition. Baltimore, MD Online

http://www.lung.org/finding-cures/our-research/trend-reports/copd-trend-report.pdf

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/chronic-obstructive-pulmonary-disease/

http://www.fidanoski.ca/dentalhygiene/2011/COPD.htm