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Asthma By Dr Haider Al shamaa
Bronchial asthma It is a syndrome consisting of dyspnia, cough, and wheezing caused by bronchospasm which results from a hyperirritability of the pes: 1 -Allergic or extrinsic asthma: usually seen in children and young adults, generally associated with family history and 50% of patients d. 2 -Idiosyncratic or intrinsic asthma: usually seen in middle aged adults and not associated with family history. Asthma may be precipitated by airborne substances (pollen, dust), aspirin, non-steroidal anti-inflammatory drugs, environmental pollutants (smoke, chemicals), respiratory infections (viruses), excersize (especially otional stress. A small percentage of patient may develop status asthmaticus which is a particularly sever asthmatic attack that is refractory to usual therapy and can lead to death in a matter of minutes, it is often associated with a respiratory infection.
Clinical Manifestations: Constriction of bronchi, coughing, wheezing, chest tightness, and shortness of breath. Oral manifestations: Increased caries risk, Increased gingivitis and periodontal disease risk, more calculus , Oral candidiasis, xerostomia, decreased salivary flow rate and salivary p. H.
Dental management : 1 -Identification and assessment of patient by history: a) Type of asthma (allergic or idiosyncratic), b) Precipitating factors. c) Age of onset. d) Frequency and severity of attack. e) How usually managed. f) Medication being taken. g) Necessity of emergency care. 2 -Avoidance of known precipitating factors. 3 -Medical consultation for sever active asthmatic patients. 4 - Reschedule symptomatic patient (coughing, wheezing, etc. ) if appropriate. 5 - Administration of a bronchodilator as premedication before dental reatment may be useful.
6 -For recent corticosteroids use consideration of need for supplementation. 7 -If patient uses metered dose inhaler, instruct him to bring it to each appointment. 8 -If possible avoidance of use of penicillin, Aspirinand others NSAIDS (due to allergies). May provoke a severe exacerbation of bronchoconstriction – use acetaminophen , antihistamines (cause thick secretion), anticholenergics (cause dryness), and narcotic drugs (cause respiratory depression). 9 -Provission of stress free environment and consideration of premedication of anxiety. Stimulating procedures (e. g. surgery, extractions, etc. ) may provoke attack. 10 - Use of Nitrous Oxide analgesia is appropriate for patients with mild to moderate asthma, but is contraindicated during episodes of wheezing. Caution is advised for patients with severe asthma – medical consult may be indicated.
11 -Have supplemental oxygen available during treatment in case of acute asthmatic exacerbation. Monitor breathing and avoid obstructing airway. 12 -Local anesthesia with adrenaline is safe but sulfide preservatives if present may precipitate an attack. 13 - If an asthmatic attack occurs in the dental chair, the aerosol inhaler of the patient is used; in severe cases an I. V injection of hydrocortisone hemisuccinate may be used. 14 -The most important side effects of ventoline(B 2 -agonists – short acting)are Oral candidiasis, xerostomia, decreased salivary flow rate, nausea. While Salmeterol (B 2 -agonists – long acting) are Xerostomia, tooth pain, sores or white in mouth. And corticosteroid inhaler are Oral candidiasis, dental caries, and hoarseness. 15 -As needed for patients with xerostomia: * Educate on proper oral hygiene (brushing, flossing) and nutrition. * Recommend brushing teeth with a fluoride containing dentifrice before bedtime. * Recommend xylitol mints, lozenges, and/or gum to stimulate saliva production and caries resistance.