Pulmonary Disease

1. Pulmonary Disease Presented by: Bobbie Jo Bennett, Kristen Franklin, & Lacey McGallion

2. Chronic obstructive pulmonary disease (COPD) A large group of lung diseases characterized by obstruction of air flow that interferes with normal breathing. 2 common types Chronic bronchitis Emphysema

3. Etiology • The primary etiology is use of tobacco and exposure to occupational and environmental pollutants. • Dental hygienists should motivate patients with COPD using tobacco to begin a smoking cessation program.

4. Occurrence • Chronic bronchitis • 2009- estimated 9.9 million Americans • Emphysema • 2009- estimated 4.9 million Americans

5. Population • Chronic bronchitis • Race: non-hispanic white • Age: 45-64 years old • Sex: women almost 2x likely • Location: South of the United States • Emphysema • Race: non-hispanic white • Age: 65+ years old • Sex: men

6. Treatment • No cure • Medication intervention • Home oxygen therapy • Pulmonary rehabilitation • Surgery (lung transplant & LVRS)–severe cases only • Patients are encouraged to… • Stop smoking • Adequate nutrition • Drink plenty of water • Exercise regularly • Decrease exposure to pollutants

7. Medications • Pneumonia and influenza vaccines • Bronchodilators and other medications similar to those used for asthma • Beta-agonists • Anticholinergics • Systemic or inhaled corticosteroids • Antibiotics

8. Dental Concerns Indications Contraindications • Nitrous oxide-oxygen analgesia for clients with chronic bronchitis • Use of local anesthesia: without epinephrine • Low-flow supplemental oxygen is helpful • Low dose of oral diazepam if needed to reduce stress • Semiupright/upright chair position to facilitate breathing • Diazepam/Lorazepam • Supine chair position • Avoid use of ultrasonic debridement • Avoid use of rubber cup and air polishing • Avoid use of rubber dam • Avoid use of Nitrous oxide-oxygen analgesia in clients with Emphysema • Avoid use of barbiturates and narcotics because of their respiratory depressant properties • If client is on Theophylline (bronchodilator) avoid use of erythromycin, macrolide antibiotics and ciprofloxacine- it will increase levels of Theophylline

9. How will oral health be impacted? • Chronic smokers with COPD have a higher risk of developing: • Halitosis • Nicotine stomatitis • Periodontal infections • Oral cancer • Extrinsic tooth stains

10. Medical Treatments impact on oral health • There is no cure for COPD. • Encourage patients to: • stop smoking • have adequate nutrition • drink plenty of water • exercise regularly • decrease exposure to pollutants. • Medical interventions strategies include: • Pneumonia and influenza vaccines. • Bronchodilators and other medications similar to those used for asthma.

11. Medications impact on oral health Medications: Side effects -        B-adrenergic agonists xerostomia -        Antiholinergicsxerostomia -        Bronchodilators:Theophyllinexerostomia and bad taste -        Corticosteroids xerostomia and candidiasis

12. Periodontal Management • Interventions that improve oral hygiene and possibly lower oral inflammation may prove to lower risk of lung infection in susceptible populations.

13. Expected/Accepted Treatment Options • Pre-med • No- controversial • Patient positioning • Semi-supine or upright chair position to facilitate breathing • Appointment length • Shorter appointments • Ultrasonic use • Avoid use- Pathogens may be aspirated into the lungs • Recall intervals • Semi-annual appointments- unless other medical/dental issues involved

14. Dental Hygiene Care • Before you begin… • Review medical history • Avoid treating if upper respiratory infection is present • Treatment may be performed on stable patients with adequate breathing. • Identify patients who may experience exacerbation of symptoms under emotional stress • May use local anesthesia without epinephrine • Nitrous oxide-oxygen inhalation sedation should be avoided with severe COPD and emphysema

15. Question #1 • Dental hygienist should motivate patients with COPD to… A. Stop smoking B. Drink plenty of water C. Exercise daily D. All of the above

16. Question #2 Chronic smokers with COPD have a higher risk for developing oral cancer. Chronic smokers with COPD have a higher risk for developing periodontal infections. • Both statements are true. • Both statements are false. • The first statement is true, and the second statement is false. • The first statement is false, and the second statement is true.

17. Question #3 Chronic bronchitis is most commonly seen in which race? A. Hispanics B. Non-hispanic- white C. African Americans D. Asians

18. References • Wilkins, E.M. (2009). Clinical Practice of Dental Hygiene 10th edition. Baltimore, MD • Online • http://www.lung.org/finding-cures/our-research/trend-reports/copd-trend-report.pdf • http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/chronic-obstructive-pulmonary-disease/ • http://www.fidanoski.ca/dentalhygiene/2011/COPD.htm