COPD

Clinical Signs And Symptoms

Medical Management

Dental Management

Oral Complications

COPD

Chronic bronchitis characterized by overproduction of mucus in the airway (trachea and bronchi)which lead to cough and difficulty breathing.Emphysema is caused by years of smoking which irritate the alveolar wall and stimulate macrophages to destroy inflamed alveolar wall which lead to over-inflated alveoli (large alveoli). These alveoli are non-functional, meaning they do not exchange O2 and Co2 with the body. This make muscle of breathing works harder to compensate and eventually they get tired and resign.

CLINICAL SIGNS AND SYMPTOMS

The onset of symptoms take years to develop and usually start after age of 40. Symptoms includes chronic cough with sputum production, and dyspnea (difficulty breathing) especially with exercise.

MEDICAL MANAGEMENT

Management of COPD includes smoking cessation, influenza and pneumococcal vaccinations, and use of short- and long-acting bronchodilators. Other recommended measures include regular exercise, good nutrition, and adequate hydration.

DENTAL MANAGEMENT

Most these patients are smokers, therefore its dentist responsibility to encourage them to quit smoking.Patients who display: shortness of breath at rest, a

productive cough, upper respiratory infection or an oxygen saturation level less than 91% are unstable and contraindicated for routine dental treatment.Patients who are stable with adequate breathing capacity are allowed to be treated, unless there is respiratory infection.Oxygen saturation in the blood should be monitored throughout the procedure with pulse oximetry device. Use of humidified low-flow O2 at rate of 2-3 L/minute is recommended. No contraindication to the use of local anesthetic

has been identified. However, its recommended to avoid bilateral mandibular block or bilateral palatal block because it cause unpleasant airway constriction is some patients.

Avoid rubber dam in patient with severe COPD. If sedative medication is required, low-dose

diazepam may be used. Avoid narcotics and barbiturates because they

cause respiratory depression. Anticholinergics and antihistamines should be

used with caution because they cause dryness and mucus density.

There is no need to adjust systemic steroid dose on the day of treatment in routine dental procedures. However, major surgical procedures require supplemental doses.

Use nitrous oxide with caustion in patient with mild to moderate COPD. Avoid in sever COPD.

Avoid prescribing macrolides (erythromycin, clindamycin, azitrhomycin, clarithrmycin) in patients taking theophylline to avoid theophylline toxicity.

Dental Management of Chronic obstructive pulmonary disease (copd)Osama Asadi, B.D.S, Published for Iraqi Dental Academy Blog

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in united state. Cigarette smoking is the most important etiological factor in this disease. COPD is a diagnostic term used to describe both Chronic bronchitis and emphysema. Their differentiation is difficult clinically and they overlap in symptoms so that most clinicians prefer to use the term COPD or chronic obstructive pulmonary disease.

LECTURE OUTLINE

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Avoid supine position for the patient during treatment. Use semisupine or upright position.

Patient with COPD may have hypertension or other systemic diseases which require specific management.Patient with COPD may have hypertension or other systemic diseases which require specific management.

ORAL COMPLICATIONS

Patients with COPD who are chronic smokers have an increased likelihood of developing hal-itosis, extrinsic tooth stains, nicotine stomatitis, periodontal disease, premalignant mucosal lesions, and oral cancer.

REFERENCE

Little and Falaces Dental Management of Medical-ly Compromised Patients