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Health and Dental Care Consideration 
for Patients with Asthma

In the treatment of asthma, oral health care providers play a role that is important in terms of both the patientís overall health and the systemic conditionís effect on oral health

 

If you use medications to control your asthma, you may need your dentist to  monitor your dental health more aggressively+.

The prevalence of asthma in the United States has increased steadily for the past two decades Mortality rate for this disease has almost tripled in the past 20 years, reaching a peak of more than 5,000 annual deaths. This  number is projected to double within the next two decades.

Asthma is:

bullet a chronic inflammatory disorder involving many cell types
bullet manifesting with episodes of chest tightness
bulletcoughing
bullet labored breathing and wheezing
bullet all of which are related to bronchiole inflammation

This child demonstrates "air hunger" that occurs in asthma...Medscape picture

Asthmatics  may have increased cavities, bad breath and gum problems.

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Symptoms may include:

bulletcoughing  
bullet wheezing 
bullet respiratory distress 
bullet muscle retractions
bullet nasal flaring  
bulletcyanosis
bullet breathlessness 

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*

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Factors That Produce Airway Obstruction in asthma:

-Modification in respiratory secretions with mucous plugging of smaller airways
-Airway smooth muscle spasm

-Inflammation of:

bullet

Eosinophil and lymphocyte infiltration and activation

bullet

Mast cell activation

bullet

Subepithelial collagen deposition

bullet

Denudation of airway epithelium

bullet

Edema of airway mucosa

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Common precipitating allergens that lead to the development asthma:
bullet tobacco smoke
bullet dust mites
bullet animal fur
bulletcockroaches
bulletpollens
bullet molds 
bullet other airborne irritants including acrylic and other aerosolized dental materials

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These things can also contribute to the development of asthma:

bulletviral respiratory infections
bulletsmall birth size 
bulletdiet 

Source of asthma can be:

  1. Intrinsic-asthma tends to be be patients older than 35 and is often chronic in nature
  2. Extrinsic-precipitated by allergens, viral infections, stress, cold, medication, emotional upset, physical activity
  3. Mixed

These above factors can also aggravate asthmatic attacks. 

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Additional triggers leading to asthma developing include:

  1. wood smoke
  2. physical activity
  3. emotional upset
  4. cold air 
  5. food additives 
  6. aspirin.
  7. dental precipitants: tooth dust, dental materials, dental odors (acrylic)*

  People with asthma vary widely in their response to triggering factors.

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Type of Asthma Medications and frequency of use Symptoms before treatment
Step 4
Severe Persistent
-Inhaled Corticosteriods or 
- inhaled b2 agonist or     -Ipratropium bromide or
-b2 agonist tablets/ syrup 
-or oral Corticosteriods (all used daily)
Continuous symptoms

Frequent worsening symptoms

Frequent nighttime symptoms

Limited physical activity
Step 3:
Moderate Persistent
-Inhaled Corticosteriods or
-Inhaled b2 agonist or       -Ipratropium bromide or
-b2 agonist tablets/syrup
(all used daily)
Daily symptoms

Worsening symptoms that affect activity

Nighttime asthma symptoms about one time per week

Daily use of  short acting inhaler 
Step 2:
Mild Persistent
-Inhaled Corticosteriods or
-Cromolyn or       
-Inhaled b2 agonist or           -Ipratropium bromide or
-b2 agonist tablets/syrup
(all used daily)
Symptoms are about two times per week but more often than one time per day

Symptoms  may affect activity

Nighttime asthma symptoms are about two times per month
Step 1:
Mild Intermittent
-Inhaled b2 agonist or         -Ipratropium bromide, but not more than three times per week (both used as needed) Symptoms about two times per week

Brief symptoms (from a few hours to a few days)

Nighttime asthma symptoms about two times per month

No symptoms and normal lung function between asthma "attacks"

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Treatment of Asthma.

Treatment of asthma begins with patient education, particularly about avoidance of precipitating factors

TREATMENT GOAL: CONTROL OF ASTHMA

Goals of Treatment:
bullet

Minimal (or no) chronic symptoms, including nighttime symptoms

bullet

Infrequent episodes

bullet

No emergency department visits

bullet

Minimal need for additional b2 agonist

bullet

No limitations on activities, including exercise

bullet

Peak expiratory flow and normal or near-normal PEF

bullet

Minimal (or no) adverse effects from medicine

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ORAL HEALTH CHANGES  AND DENTAL HOME CARE TIPS RECOMMENDATIONS FOR INDIVIDUALS WITH ASTHMA: 
                                                                   Next page>>>>>>

The Dental Patient With Asthma: An Update and Oral Health Considerations
Steinbacher D.M.[1], Glick M.[2] JADA The Journal of the American Dental Association - September 2001
+Asthma medications linked to xerostomia, caries; Medical University of South Carolina; Dr. Carlos Salinas, professor and director of the Division of Craniofacial Genetics and the Craniofacial Anomalies and Cleft Palate Team; March 2001
*Asthma, Dr. Smith, Nebraska Dental Association, pg 6, November 2002

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February 06, 2008

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