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In the treatment of
asthma, 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
If you use medications
to control your asthma, you may need your dentist to monitor your
dental health more aggressively+.
The prevalence of asthma in the United States has
increased steadily for the past two decades.
Mortality rate for this disease has almost tripled in
the past 20 years, reaching a peak of more than 5,000 annual deaths.
This number is projected to double within the next two decades.
Asthma is:
 | a chronic inflammatory disorder
involving many cell types |
| manifesting with episodes of chest tightness |
| coughing |
| labored breathing and wheezing |
| all of which are related to
bronchiole inflammation |
Asthmatics may
have increased cavities, bad breath and gum problems.
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Symptoms may include:
| coughing |
| wheezing |
| respiratory distress |
| muscle retractions |
| nasal flaring |
| cyanosis |
| breathlessness |
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 *
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Factors That Produce Airway Obstruction in asthma:
| -Modification in
respiratory secretions with mucous plugging of smaller airways |
| -Airway smooth muscle spasm |
|
-Inflammation of:
|
Eosinophil
and lymphocyte infiltration and activation |
|
Mast
cell activation |
|
Subepithelial
collagen deposition |
|
Denudation
of airway epithelium |
|
Edema
of airway mucosa
|
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|
| Common precipitating allergens
that lead to the development asthma: |
| tobacco smoke |
|
| dust mites |
| animal fur |
| cockroaches |
| pollens |
| molds |
| other airborne irritants including acrylic and other
aerosolized dental materials |
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These things can also
contribute to the development of asthma:
| viral respiratory infections |
| small birth size |
| diet |
Source of asthma can be:
- Intrinsic-asthma tends to be be patients older than
35 and is often chronic in nature
- Extrinsic-precipitated by allergens, viral
infections, stress, cold, medication, emotional upset, physical
activity
- Mixed
These above factors can also aggravate asthmatic attacks.
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Additional triggers
leading to asthma developing include:
- wood smoke
- physical activity
-
emotional upset
- cold air
- food additives
- aspirin.
- dental precipitants: tooth dust, dental materials,
dental odors (acrylic)*
People with asthma vary widely in their response to triggering factors.
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| Type of Asthma |
Medications and frequency of use |
Symptoms before treatment |
Step 4
Severe Persistent |
-Inhaled Corticosteriods or
-
inhaled b2 agonist
or -Ipratropium bromide or
-b2 agonist tablets/ syrup
-or
oral Corticosteriods (all used daily) |
Continuous symptoms
Frequent worsening symptoms
Frequent nighttime symptoms
Limited physical activity |
Step 3:
Moderate Persistent |
-Inhaled Corticosteriods or
-Inhaled b2
agonist or -Ipratropium bromide or
-b2
agonist tablets/syrup
(all used daily) |
Daily symptoms
Worsening symptoms that affect activity
Nighttime asthma symptoms about one time per week
Daily use of short acting inhaler |
Step 2:
Mild Persistent |
-Inhaled Corticosteriods or
-Cromolyn or
-Inhaled b2
agonist or
-Ipratropium bromide or
-b2
agonist tablets/syrup
(all used daily) |
Symptoms are about two times per week but
more often than one time
per day
Symptoms may affect activity
Nighttime asthma symptoms are about two times per month |
Step 1:
Mild Intermittent |
-Inhaled b2
agonist or -Ipratropium bromide, but not more than three times per
week (both used as needed) |
Symptoms about two times
per week
Brief symptoms (from a few hours to a few days)
Nighttime asthma symptoms about two times per month
No symptoms and normal lung function between asthma
"attacks" |
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Treatment of Asthma.
Treatment of asthma begins with patient education,
particularly about avoidance of precipitating factors
TREATMENT GOAL: CONTROL OF ASTHMA
| Goals of Treatment: |
|
Minimal (or no) chronic
symptoms, including nighttime symptoms |
|
Infrequent episodes |
|
No emergency department visits |
|
Minimal need for additional b2
agonist |
|
No limitations on activities,
including exercise |
|
Peak expiratory flow and
normal or near-normal PEF |
|
Minimal (or no) adverse effects
from medicine
|
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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 medications linked to xerostomia, caries; Medical University of
South Carolina; Dr. Carlos Salinas, professor and director of the
Division of Craniofacial Genetics and the Craniofacial Anomalies and
Cleft Palate Team; March 2001
*Asthma, Dr. Smith, Nebraska Dental Association, pg 6, November 2002
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February 06, 2008
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