The patient with respiratory abnormalitis risk assessment and dental management
This presentation is the property of its rightful owner.
Sponsored Links
1 / 25

THE PATIENT WITH RESPIRATORY ABNORMALITIS Risk Assessment and Dental Management PowerPoint PPT Presentation


  • 97 Views
  • Uploaded on
  • Presentation posted in: General

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]

Download Presentation

THE PATIENT WITH RESPIRATORY ABNORMALITIS Risk Assessment and Dental Management

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


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 atopy8

The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy

  • ADEs

    • Xerostomia


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)


  • Login