|
Preventing a sudden episode of airway obstruction is
essential when treating an asthmatic patient
MANAGEMENT IN DENTAL CARE
Updating patients health
history at every visit about these following factors will help
you identify the risk of an acute exacerbation:
 | Frequency of asthmatic attacks |
| Precipitating agents |
| Types of pharmacotherapy used |
| Length of time since
an emergency visit owing to acute asthma |
As a general rule, elective dentistry should be performed only on
asthmatic patients who are asymptomatic or whose symptoms are
well-controlled.
The symptomatic person should not be
treated, and the
presence of asthmatic symptoms such as coughing and wheezing necessitate
reappointment
Up To Top
Be Aware
Be aware of the
potential for dental materials and products that exacerbate asthma. These
items include:
|
dentifrices |
|
fissure sealants |
|
tooth enamel dust |
|
methyl methacrylate |
|
fluoride trays and cotton rolls also have
been implicated in
promoting asthmatic events |
| corticosteroid-dependent asthmatic people may have
a higher tendency for having an adverse reaction to sulfites. |
Up To Top
Before
Treatment
When an
asthmatic dental patient seeks care, the dental professional must:
|
Assess the patient's risk level by taking an oral history of the
illness. |
|
Ascertaining
the frequency and severity of acute episodes. |
|
Reviewing the patient’s
medications thoroughly (as they provide an indication of disease
severity). |
|
Determining the patient’s specific triggering agents. |
It should be recognized that dental
treatment can invoke a significant decrease in pulmonary function among
asthmatic patients. It has been demonstrated that there is a reduction of lung function in 15 percent of asthmatic
patients studied while receiving dental care.
Up To
Top
During
Dental Treatment
The most likely times for an
acute exacerbation are:
-
During and immediately after local anesthetic
administration.
-
With stimulating procedures such as extraction,
surgery,
pulp extirpation.
At each visit
make sure:
|
Confirm that they have taken their most recent scheduled dose of
medication. Inhaled corticosteroids are used for maintenance
therapy and do not improve an acute attack. |
|
The patient’s own metered-dose inhaler bronchodilator
should be on hand at each visit to minimize the risk of an attack. |
|
Patient’s appointment should be in the
late morning or the
late afternoon. |
|
If the asthmatic patient
does not use a bronchodilator, make sure the
emergency kit has both a bronchodilator and oxygen . |
|
Prophylactic dose of b2
agonist bronchodilator could prevent diminished lung function during
dental treatment. The H1-blocking
antihistamines, too, have been shown to be useful in blunting the
bronchoconstrictor response with a pretreatment dose. Promethazine and
diphenhydramine have the benefit of being antiemetic and sedative as
well as antihistaminic. |
|
Anxiety is a known asthma trigger thus
the dental
environment is a common site for an acute asthmatic attack.
Therefore, it should be ascertained that the patient has taken his or
her most recent scheduled dose of antiasthma medication before
treatment. |
|
Additionally, substantive stress-management techniques should
be used. |
|
The use of N2O
in patients with mild-to-moderate asthma can prevent acute stress
related symptoms.
However, because of its potential for causing airway irritation, N2O
is contraindicated for use in patients with severe asthma.
It is advisable to obtain a medical consultation before administering N2O
to such patients. |
|
Consequently, patients with severe persistent asthma
and those who are prone to severe abrupt episodes of airway obstruction
are best given dental treatment in the hospital. |
Up To Top
During treatment check
for:
-
Improper positioning of suction tips
-
If fluoride trays
or cotton rolls could trigger a hyperreactive airway response in your
patient.
-
Rubber dams should be used cautiously to avoid
possible respiratory compromise or aggravation.
-
Avoid prolonged supine positioning.
-
Bacteria-laden aerosols from plaque or carious lesions
and
ultrasonically nebulized water also can be asthma triggers in the
dental
setting.
-
Additionally, aeroallergens such
as tooth-enamel dust and methyl methacrylate have been reported to
trigger asthmatic attacks.
Up To Top
| Emergency
Protocol for Managing Asthmatic Exacerbation: |
Assessment of Severity
Acute exacerbations are manifested by episodes
of bronchospasm and resulting hypoxia and hypercarbia.
Management
strategy is directed at determining the level of hypoxia and
correcting it.
The following indicate that the
exacerbation is severe:
|
peak expiratory flow rate, or PEFR, is at
or below 50 percent of reference value;
|
|
oxygen saturation is below 91 percent;
|
|
bronchodilator does not improve PEFR by at
least 10 percent after two treatments;
|
|
patient has difficulty speaking;
|
|
patient is struggling for
air.
|
Managing an Acute Asthmatic
Attack
-
Discontinue the dental procedure and allow the patient to
assume a comfortable position.
-
Establish and maintain a patent airway and administer b2
agonists via inhaler or nebulizer.
-
Administer oxygen 6-10 liters via face mask, nasal hood or cannula. If
no improvement is observed and symptoms are worsening,
administer epinephrine subcutaneously (1:1,000 solution, 0.01
milligram/ kilogram of body weight to a maximum dose of 0.3
mg).
-
Document in time form the beginning of
the event.
-
Alert emergency medical services-911.
-
Maintain a good oxygen level until the patient stops
wheezing and/or medical assistance arrives.
-
Begin diligent basic life support A,
B,C,Ds activity as needed.
-
Escort patient to hospital as needed.
Up
To Top
|
General Oral Health Care
Instructions
|
Prescribe fluoride supplements
for all asthmatic patients, but especially for those taking b2
agonists |
|
Instruct patients to rinse their
mouths after using an inhaler |
|
Reinforce oral hygiene
instructions to help minimize gingivitis |
|
Be aware of possible need to
prescribe antifungal agents for patients who chronically use
nebulized corticosteroids |
Up To Top
Summary
of Recommendations:
Before Treatment
-
Schedule appointments for late
morning or afternoon.
Assess severity of asthmatic
condition.
Consider antibiotic prophylaxis
for immunosuppressed patients
Consider corticosteroid
replacement for adrenally suppressed patients
Avoid using dental materials
that may elicit an asthmatic attack
Have supplemental oxygen and
bronchodilators available in case of acute asthmatic exacerbation
Up To Top
During Treatment
|
Use vasoconstrictors judiciously |
|
Avoid using local anesthetics
containing sodium metabisulfite |
|
Use rubber dams cautiously |
|
Avoid eliciting a coughing
reflex |
|
Use techniques to reduce the
patient’s stress:
 |
Avoid using barbiturates
|
|
Avoid using nitrous oxide in
people with severe asthma
|
Up To
Top
|
After Treatment
-
Be aware that some patients may
have an adverse reaction to nonsteroidal anti-inflammatory drugs.
-
Use tetracycline cautiously.
-
Avoid use of erythromycin in
patients taking theophylline.
-
Avoid use of phenobarbitals in
patients taking theophylline.
-
Analgesic of choice for these patients is acetaminophen.
Oral
health care providers play a role that is important in terms of
both the patient's overall health and the systemic condition's
effect on oral health.
Up To Top
News Updates
Dentists and dental
hygienist should be attuned to adult patients who have asthma and
exhibit signs of anxiety and/or other physical symptoms, or indicators
of stress that can exacerbate asthma during or prior to dental treatment
Dental Anxiety, Dental Health
Attitudes, and Bodily Symptoms as Correlates of Asthma Symptoms in Adult
Dental Patients with Asthma Author(s): Linda Russell RDH, PhD, CHES
Source: Journal of Dental Hygiene 2004;78(3):3
Publisher: American Dental Hygienists' Association
February 27, 2007
The Dental Patient With Asthma: An Update and
Oral Health Considerations
Steinbacher D.M.[1], Glick M.[2] JADA The Journal of
the American Dental Association - September 2001
Asthma, Dr. Smith, pg 6 Nebraska Dental Association, November
2002.
| Back | Home | Our
Office |
Services | Patient
Education | Site Map |
|
