Signs And Symptoms

Dental Management

Asthmatic Attack

Oral Manifestations

SIGNS AND SYMPTOMS

Attacks usually occur at night, but may also follow exposure to allergen, exercise, respiratory infection, or emotional upset or excitement.Asthma attack characterized by airway hyper-responsiveness (hyper-sensitivity). Symptoms include: wheezing, dyspnea, coughing, chest tightness, and flushing.

DENTAL MANAGEMENT

• Identify asthmatic patients by history. Ask the patient about type of asthma, precipitating factors, severity and frequency of attacks, the time of day that attack most often occur, and whether he has been hospitalized for acute asthmatic attack.

• Patient with unstable disease should be referred for medical care and dental appointment is postponed.

• Patient who has night asthmatic attack should be given late-morning appointment.

• Avoid aspirin, NSAIDs, barbiturates, and narcotics because they may precipitate an asthmatic attack.

• Avoid macrolides antibiotics (clindamycin, azith-romycin, etc..)and ciprofloxacin in patients taking theophylline to avoid theophylline toxicity.

• Ask patient to bring his medication/inhalator with him.

• Prophylactic inhalation before dental procedure is recommended.

• Stress during dental appointment should be avoided to avoid an asthmatic attack.

• Nitrous oxide is a recommended sedative in stressed asthmatic patient because it has no respiratory-depressing properties.

• If oral sedative required, low-dose short acting benzodiazepines (e.g, diazepam) may be used.

• Local anesthesia containing epinephrine or levonordefrin also contain sulfite component which may precipitate asthmatic attack. Therefore plain local anesthesia is recommended, especially in moderate to severe asthmatic patients.

• Asthmatic patient taking long-term systemic steroids may require supplemental dose of his medication in major surgeries (not required in routine dental treatment). However, long-term inhalation of steroids require no supplemental dos-es, unless daily inhalation dose is very high.

ASTHMATIC ATTACK

An acute asthmatic attack require immediate therapy. Fast acting bronchodialtor (Ventolin, Proventil) should be provided immediately and it is most effective. In severe asthmatic attack that not responsive to previ-ous treatment, subcutaneous epinephrine(0.3-0.5 mL, 1:1000) injections are helpful. Other supportive mea-sures include providing oxygen and repeating inhala-tion every 20 minutes. Call ambulance if the situation required.

Dental Management of asthmatic patientOsama Asadi, B.D.S, Published for Iraqi Dental Academy Blog

Asthma is inflammatory disease of the airway that lead to bronchospasm and overproduction of thick mucus in the airway. This lead to symptoms of coughing, dyspnea and wheezing. Every 250 death in the world, 1 death is due to asthma, however, it is a benign reversible disease that can be managed with proper care and most deaths are due to lack of treatment. Types of asthma includes: allergic (extrinsic), non-allergic (intrin-sic), drug-induced and exercise-induced.

LECTURE OUTLINE

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ORAL MANIFESTATIONS

Nasal symptoms, allergic rhinitis, and mouth breathing are common with allergic-type asthmatic patient. Asthmatic patient who are mouth-breather has increased height of palatal vault, greater overjet and higher prevalence of crossbite. Gastroesophageal reflux is common in asthmatic patient which may cause teeth erosion. Some asthmatic medication may affect oral environment such as decreasing salivary flow, and increased prevalence of gingivitis and caries. Rarely, asthmatic patient develop oral candidiasis due to steroid inhalation without a spacer. It is very responsive to antifungal treatment.

REFERENCE

Little and Falace’s Dental Management of Medically Compromised Patient.