-
Serves as the passage for air exchange (2)
nasal cavity and lungs
-
Loss of fxn results in Respiratory system when?
Inflammation causes an overabundance of mucus
-
structured communities of bacteria bound together by a carb. matrix and surrounded by water channels that deliver nutrients and remove waste
biofilm
-
3 characteristics of biofilm
- adheres to inanimate objects or living surfaces
- difficult to kill with antibiotics
- Complex and may serve as a reservoir of infection
-
Upper respiratory tract infections involve what anatomical structures (4)
-
Lower respiratory tract infections involve what anatomical structures (4)
- Trachea
- Lungs
- Bronchi
- Bronchioles
-
Upper Respiratory Tract Diseases (5)
- Upper Respiratory tract infection (common cold)
- Allergic Rhinitis (hay fever)
- Influenza (flu)
- sinusitis
- Tonsilitis/Pharyngitis
-
Modes of transmission for Upper Respiratory tract diseases
- Direct oral contact
- Inhalation of Air born dropplets
- Indirect contact of hands or articles freshly soilded with discharge of nose or throat of infected person
-
DH tx for Upper Respiratory tract disease
- Practice standard precautions
- delay tx until no longer infected
-
Lower Respiratory Tract Diseases
- Pneumonia
- TB
- COPD (emphasema, chronic bronchitis)
- Asthma
- Cystic fibrosis
-
Acute Lower Respiratory Tract Disease
Pneumonia
-
Chronic Lower Respiratory Tract disease
- TB
- Asthma
- COPD
- Cystic Fibrosis
-
Which upper Respiratory diseases are mostly viral?
- Influenza (flu)
- Upper respiratory tract infection (cold)
- Pharyngitis/tonsilitis
-
Which upper respiratory disease is bacterial
sinusitis
-
Etiology of Pneumonia
- Viral
- Bacterial (Staphylococcus aureus, streptococcus pneumoniae)
- Fungal (pneumocystis jirovecii)
-
Most prevelent pneumonia caused by
virus
-
nosocomial bacterial penumonia caused by
staphylococcus aureus
-
community bacterial pneumonia caused by
streptococcus pneumoniae
-
tx for virus
supportive bed rest and fluids
-
tx for bacteria
antibiotics
-
tx for fungus
sulfa drugs
-
What is CAP
Community Aquired Pneumonia (obtained from person to person)
-
Role of oral bacteria in Pneumonia
serve as a resevoir for lung infections
-
DH Care for Pneumonia
- Control Oral Disease (daily biofilm removal +on prosthetic appliances)
- Educate Healthcare Personnel
- Maintain standard precautions
- Teach use of antimicrobial mouthrinses
-
Etiology of TB
microbacterium tuberculosis
-
-
Symptoms of Clinically Active TB
- Low grade fever
- night sweats
- fatigue
- weight loss
- persistant cough
- chest pain
- hoarsness
- hemoptysis
-
Signs of LTI (latent Tuberulosis infection)
- ususally none
- detected by mantoux (tuberculin skin test)
-
TB risk factors (7)
- HIV patients
- IV drug abusers
- Residents/employees of shared habitations
- Healthcare workers
- Immigrants
- Medically underserved
- Ethnic background
-
Drug therapy for TB
- 6 month min
- 2 drug regimen of isoniazid, rifampin, rifapentine, pyazinamide
-
Latent TB drug therapy
Isoniazid for 9 months
-
Incubation period of TB
2-10 weeks
-
Oral manifestations of TB
Classic Lesion-painful, deep irregualr ulcer on dorsum of the tongue
-
DH Care for TB
- Patient history prep (ask about history and symptoms, meds, and length of tx)
- medical consulatation
- standard procedures (min. aerosols, use rubber dam, avoid ultrasonic scaler and air polisher)
-
tx for clinically active sputum-positive tb
- do not treat in dental office
- urgent care must be performed in a hospital setting
- after several weeks on prescribed meds, with physician clearance, patient may be treated as a healthy person
-
tx for past hx of tb
consult w physician
-
tx of positive tb skin test
- consult with physician
- continue w/ tx if disease is absent
- may be placed on prophylactic isoniazid for 6-12 months
-
tx for signs and symptoms of tb
- do not treat
- refer to a physician
-
dyspnea
difficulty breathing
-
A chronic inflammatory, respiratory disease consisting of recurrent episodes fo dyspnea, coughing, wheezing and is related to bronchial inflammation and muscle constriction
Asthma
-
Asthma is classified according to
- Symptoms
- severity
- frequency
- lung capacity
-
Average dental practice will see how many asthma patients?
100
-
Traditional Classification of Asthma
- Extrinsic, Atopic (allergic triggers from outside the body)
- Intrinsic, Nonallergic(nonallergic triggers from within the body) ie stress
-
NAEPP classification of Asthma
- Mild intermittent
- mild persistent
- moderate persistent
- severe persistent
-
based of severity and frequency of symptoms as well as pulmonary fxn assessment
NAEPP
-
Drug or food induced (nonallergic, nonatopic)
- aspirin
- NSAIDS
- beta blockers
- foods
- tartrazine (yellow food dye)
-
other classes of asthma
- drug or food induced
- exercised induced
- infection induced
-
signs and symptoms of Asthma attack
- chest tightness, difficulty breathing, sense of suffocation
- wheezing
- cough
- flushed appearance, sweating
- confusion due to lack of oxygen
- dilated pupils
- inability to complete a sentence in one breath
-
emergency care for asthma
- stop tx
- rule out foreign body obstruction
- assist patient with inhaler
- administer supplemental oxygen
- initiate emergency procedures
-
Pathogenesis of Atopic (allergic) asthma
Immunoglobulin E mediated hypersensitivity rxn
-
local anaphylaxis: allergen binds to the mast cell in the nasal cavity and results in?
allergen binds to the mast cell in teh bronchiole: results in?
-
Systemic Anaphylaxis
allergen (penicillin, bee venom, food substance ) binds to mast cells troughout the body: results in anaphylactic shock
-
Drugs for Asthma
- Anti-inflammatory agents
- bronchodilators
- Combined anti-inlammatory and bronchodilator
-
Long term controller drugs for asthma
anti-inlammatory (systemic corticosteroids)...oral issues
-
Rescue drugs
bronchodilators
-
Drugs to avoid for asthma patients
- Aspirin containing meds
- sulfite containing local anesthetic
- NSAIDS
- Narcotics/barbituates (these decrease respiratory fxn)
- Erythromycin
-
oral manefestations of asthma
- xerostomia
- dental caries
- gingivitis
- reflux
- enamel erosion
- candidasis
-
What meds are contraindiated for asthma
What analgesic should you use
- aspirin and NSAIDS
- acetominophen
-
recomends for asthma patients
- fluouride
- wash mouth after using inhaler
-
Two types of COPD
- chronic bronchitis
- emphysema
-
Primary etiology of COPD
- smoking
- environmental work environment
-
other risk factors
- smoking
- envirnmnetal pllutants
- viral infections
- allergy
- genetic factors
- periodontal disease
-
excessive respiratory tract mucus production sufficient to cause a cough with expectoration fro at least 3 month of the year for 2 or more years
chronic bronchitis
-
distension of teh air spaces distal to terminal bronchioles due to destruction of alveolar walls (difficulty breathing only upon expiration)
emphysema
-
signs and symptoms of bronchitis
- chronic cough
- copious sputum
- sedentary, overweight, cyanotic, edematous, breathless
- blue bloater
-
signs and symptoms of emphysema
- difficulty in breathing upon exertion
- minimal, nonproductive cough (dry, no mucus)
- barrel chest
- weight loss
- puses lips forcibly expel air
- pink puffer
-
-
medical tx
- adequate nutrition
- plenty of water
- exercise regularly
- decrease exposure to pollutants
- have pneumonia and influenza vaccines
- bronchodilators and other asthma meds
-
Oral Manifestations (4)
- halitosis
- nicotine stomatitis
- periodontal infections oral cancer
- extrinsic tooth stains
-
Before Tx of COPD patient
- review history
- avoid tx if infection os present
- adequate breathing
- identify symptoms of exacerbation
-
Clinical Adaptaion
- shorter appt length
- adjust chair up
- no sulfites or nitrous oxide
-
Patient instruction
encourage smoking cessation
-
complex, genetic, life-limiting disorder that involves the pancreas, liver and lungs
Cystic fibrosis
-
characteristics of cystic fibrosis
- mucous secretions of the lungs and digestive tisssus (obstructs the pancreas, liver, and lungs)
- Pulmonary impairment leading to restrictive lung disease (RLD)
- Respiratory Failure
-
pneumothorax
collapsed lung
-
pseudomonas aeruginosa
bacterial infection in patients with cystic fibrosis
-
Medical tx for cystic fibrosis
- regular physical activity
- diet should include enzyme supplements and liquds with high salt intake
- antibiotics for infections
- PULMOZYME (mucus thinning soln)
- NSAIDS
- Mucus secretion removal
-
Oral manefestations of Cystic Fibrosis
- gingivitis with dry mouth
- diffuse erythema
- thickinging and elargement of salivary glands
- lower lip enlarged (swollen and dry)
- halitosis
-
adaptations for DH care
- adjust the chair
- don't use a rubber dam
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