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THE PATIENT WITH RESPIRATORY ABNORMALITIS Risk Assessment and Dental Management. Géza T. Terézhalmy, D.D.S., M.A. Professor and Dean Emeritus School of Dental Medicine Case Western Reserve University Cleveland, Ohio [email protected]

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the patient with respiratory abnormalitis risk assessment and dental management

THE PATIENT WITH RESPIRATORY ABNORMALITISRisk Assessment and Dental Management

Géza T. Terézhalmy, D.D.S., M.A.

Professor and Dean Emeritus

School of Dental Medicine

Case Western Reserve University

Cleveland, Ohio

[email protected]

the patient with respiratory abnormalities allergic rhinitis urticaria atopy
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
  • H1 receptor antagonists
    • 1st generation
      • promethazine hydrochloride
    • 2nd generation
      • fexofenadine hydrochloride
the patient with respiratory abnormalities allergic rhinitis urticaria atopy1
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
  • Mechanisms of action
    • Vascular smooth muscle – H1 blockade
      • Contraction of post-capillary venule and terminal arteriole
        • Reduce rubor
the patient with respiratory abnormalities allergic rhinitis urticaria atopy2
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
  • Vascular endothelial cells – H1 blockade
    • Relaxation of endothelial cells
      • Reduce edema, wheal response
the patient with respiratory abnormalities allergic rhinitis urticaria atopy3
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
  • Lungs – H1 blockade
    • Bronchodilation
      • Reduce asthma-like symptoms
the patient with respiratory abnormalities allergic rhinitis urticaria atopy4
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
  • Nerves – H1 blockade
    • Reduce sensitivity of afferent nerve terminals to chemical mediators of inflammation
      • Reduce Itching, pain
the patient with respiratory abnormalities allergic rhinitis urticaria atopy5
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
  • Stomach – H2 blockade
    • Decreased gastric acid secretion
      • Reduce pepsin synthesis, heartburn
the patient with respiratory abnormalities allergic rhinitis urticaria atopy6
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
  • Heart – H2 blockade
    • Reduce Ca2+ influx into myocytes
      • Decrease in heart rate and contractility
the patient with respiratory abnormalities allergic rhinitis urticaria atopy7
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
  • CNS – H3 blockade
    • Block histamine-dependent neurotransmission
      • Modulate circadian rhythms and wakefulness
the patient with respiratory abnormalities allergic rhinitis urticaria atopy9
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
  • Risk assessment
    • Disease-related variables
the patient with respiratory abnormalities allergic rhinitis urticaria atopy10
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
  • Clinical indications
    • Allergic rhinitis
      • Seasonal allergies
      • Perennial allergies
    • Urticaria
    • Angioedema
    • Atopy
the patient with respiratory abnormalities allergic rhinitis urticaria atopy11
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
  • Treatment strategies
    • First generation H1 receptor antagonists may produce sedation
      • Additive with other CNS depressants
        • Anxiolytic agents
        • Local anesthetics
        • Opioid analgesics
the patient with respiratory abnormalities allergic rhinitis urticaria atopy12
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
  • Preventive strategies
    • Oral hygiene
      • Conventional vs. electromechanical toothbrushes
    • Antibacterial mouthwashes
    • Topical fluorides
    • Sialagogues
      • Pilocarpine (Salagen)
      • Cevimeline (Evoxac)
the patient with respiratory abnormalities allergic rhinitis urticaria atopy13
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
  • Medical emergencies
    • To be anticipated based on the patient’s medical history and vital signs
the patient with respiratory abnormalities
The Patient With Respiratory Abnormalities

ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

the patient with respiratory abnormalities asthma and copd
The Patient With Respiratory Abnormalities(Asthma and COPD)
  • 2-receptor agonists and anticholinergic agents
    • Advair Diskus (fluticasone propionate w/ salmeterol)
    • Proventil HFA (albuterol)
    • Albuterol
    • ProAir HFA (albuterol)
    • Combivent (ipratropium w/albuterol)
    • Spiriva HandHaler (tiotropium bromide)
the patient with respiratory abnormalities asthma and copd1
The Patient With Respiratory Abnormalities(Asthma and COPD)
  • Mechanisms of action
    • Albuterol is a short-acting 2-receptor agonist
    • Salmeterol is a long-acting 2-receptor agonist
    • Ipratropium and tiotropium block the action of acetylcholine
the patient with respiratory abnormalities asthma and copd2
The Patient With Respiratory Abnormalities(Asthma and COPD)
  • Risk assessment
    • Disease-related variables
the patient with respiratory abnormalities asthma and copd3
The Patient With Respiratory Abnormalities(Asthma and COPD)
  • Asthma
    • Often begins in childhood
      • Coughing
      • Wheezing
      • Shortness of breath
the patient with respiratory abnormalities asthma and copd4
The Patient With Respiratory Abnormalities(Asthma and COPD)
  • 10% of asthmatics have a triad of
    • ASA intolerance
    • Nasal polyps
    • Chronic sinusitis
the patient with respiratory abnormalities asthma and copd5
The Patient With Respiratory Abnormalities(Asthma and COPD)
  • Chronic bronchitis
    • Usually smokers 35 years or older
    • Recurrent respiratory infections
    • Productive cough
    • Hypoxic hypoxemia
      • Polycythemia
    • Right sided heart failure
      • Cyanosis
the patient with respiratory abnormalities asthma and copd6
The Patient With Respiratory Abnormalities(Asthma and COPD)
  • Emphysema
    • Usually preceded by chronic bronchitis
      • Smoking
        • Stimulates proteases
        •  protease inhibitor activity
    • May be hereditary
      • Lack of protease inhibitor
    • Right sided heart failure
    • Peripheral edema
    • Hepatomegaly
the patient with respiratory abnormalities asthma and copd7
The Patient With Respiratory Abnormalities(Asthma and COPD)
  • Treatment strategies
    • Physiological stress (physical, emotional) may lead to respiratory distress
      • Reduce anxiety
      • Ensure profound anesthesia
      • Post operative pain management
        • Avoid opioids
the patient with respiratory abnormalities asthma and copd8
The Patient With Respiratory Abnormalities(Asthma and COPD)
  • Preventive strategies
    • Oral hygiene
      • Conventional vs. electromechanical toothbrushes
    • Antibacterial mouthwashes
    • Topical fluorides
    • Sialagogues
      • Pilocarpine (Salagen)
      • Cevimeline (Evoxac)
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