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Oral Medicine > Caring for the patient with pulmonary disease > Flashcards

Caring for the patient with pulmonary disease Flashcards

1
Q

Congenital Pulmonary Disease
vs
Acquired Pulmonary Disease
Congenital
(3)

A
  • Cystic fibrosis
  • Bronchitis
  • Emphysema
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2
Q

Congenital Pulmonary Disease
vs
Acquired Pulmonary Disease
Acquired
(2)

A
  • Industrial
  • Recreational
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3
Q

Acquired Pulmonary Disease
(5)

A

Industrial
* Recreational
* Tobacco
* Cannabis (Marie Juana)
* Cannabidol

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4
Q

Industrial
(4)

A
  • Black Lung (coal miners)
  • Asbestosis (miners)
  • Bronchitis (Steel mills,
    smog)
  • COPD
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5
Q
  • Tobacco
    (3)
A
  • Cigarettes, cigars, pipes
  • Vaping ( )
  • Chew (Snus, chaw, dip, etc.)_
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6
Q
  • Cannabis (Marie Juana)
A
  • Cigarettes (joint)
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7
Q
  • Cannabidol
A
  • Topical (oils, creams)
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8
Q

Focal Problems
aggravated by
Smoke and Smoking
(2)

A
  • Periodontal Disease
  • Asthma
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9
Q

the negative of cigarette smoking on the periodontium is cumulative and dose dependent

the severity of attachment loss is directly related to the amt of smoking measured either as

A

pack years or number of cugs per day

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10
Q

the more cigs smoked per day and the longer the individual has smoked,

A

the more severe the level of attachment loss

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11
Q

cig smoking significantly increases the risk for tooth loss by

A

70%

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12
Q
  • Smoking has detrimental effects on the Periodontium.
    Although the exact mechanisms are not known, it appears that (2) are significantly affected.
A

the host response to bacterial plaque and the ability of the wound healing response in the host

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13
Q
  • Much of the impairment centers on —
    and the
    functions of vascularity ie ability to provide (4) to the tissues.
  • Even slight alteration in the — can have significant effects on the tissues.
A

vacularity
02, nutrients, cells and growth stimulants
vascularity

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14
Q

Smoking and Periodontal Disease
— alterations
Altered — function
Decreased — production
Decreased — proliferation
Increased prevalence of —
Altered — attachment and function
Difficulty in eliminating pathogens by — therapy
Negative local effects on (2) products

A

Vascular
neutrophil
IgG
lymphocyte
periopathogens
fibroblast
mechanical
cytokine and growth factor

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15
Q

REFRACTORY PERIODONTITS

A
  • As it is difficult to control the disease in smokers, the smokers become refractory to the traditional periodontal treatment and tend to show more periodontal breakdown than non* smokers after therapy.
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16
Q

in sturdies of pt who failed to respond to the conventional therapy, including different combos of OHI, SRP, surgery and abx, approx –% were smokers

A

90

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17
Q

Chronic inflammatory airway disorder
(3)

A
  • Airway hyper-responsiveness to stimuli
  • Bronchial edema
  • Narrowing of the airways i.e., obstruction
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18
Q

Smoking and Asthma
Signs and Symptoms
Recurrent, reversible episodes of:
(4)

A

*Dyspnea (shortness of breath)
*Wheezing
*Coughing
*Tightness of chest

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19
Q

Which of the following is a “true”
asthma symptom?

A
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20
Q

Aggravating/Complicating Factors
(2)

A

● Smoking
● Air pollutants (quality)
- urban
- industrial

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21
Q

Staging Asthma
(3)

A
  1. Controlled
  2. Partially Controlled
  3. Uncontrolled
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22
Q

Types of Asthma
(4)

A
  1. Extrinsic (Allergic)
  2. Exercise Induced
  3. Intrinsic
  4. Drug Induced
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23
Q
  1. Intrinsic (idiosyncratic, nonallergic, nonatopic)
    (5)
A
  • Second most common
  • Middle-aged individuals
  • Triggered by respiratory irritants (tobacco, air
    pollution, emotional stress, gastroesophageal reflux
    disease (GERD)
  • Infrequently associated with family history
  • Normal IgE levels
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24
Q

Intrinsic

A

Allergen
→ lymphocytes
→ activation of mast cells,
basophils and eosinophils
→ bradykinin, histamine,
leukotrienes, interleukins
→ bronchoconstriction

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25
Q

Patient Considerations
Management

A

➢Medications
o Which medications are you taking for your asthma

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26
Q

skipped
Level of Control/Severity
(6)

A

o How often do you use your inhaler?
o Does your inhaler have a spacer?
o How many asthma attacks/week?
o Do you have any night time attacks?
o Have you ever been to the emergency room or been
hospitalized for an asthma attack?
o Do you have a spirometer to keep a record of your lung
function

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27
Q

Status Asthmaticus
(2)

A

→ Severe prolonged asthma attack (more than 24 hours)
→ life threatening

28
Q

— is the
drug of choice for an acute attack

A

Short-acting Beta2-adrenergic agonist (inhaler)

29
Q

Drugs to avoid:
(2)

A

➢Aspirin, NSAIDs, Narcotics, Macrolide antibiotics
like erythromycin.
➢Sulfite (preservative) containing local anesthetics
may need to be avoided.

30
Q

Sedation for Dental Anxiety
(2)

A

➢Nitrous (better)
➢Short-acting benzodiazepine

31
Q

— for severe persistent asthma

A

Med Consult

32
Q

SoD Asthma Emergency
Patient presentation
(3)

A
  • Respiratory rate >25 breaths/min, labored breathing
  • Tachycardia >110 beats/min
  • Flushed appearance
33
Q

Stop treatment, inform supervising faculty, administer O2, and call 4444

A

➢ Remove all items from patient’s mouth
➢ Record the time attack began
➢ Raise the dental chair
➢ Give short-acting β2-adrenergic agonist inhaler
➢ Administer oxygen
o Administer 0.3-0.5 ml of 1:1000 epinephrine –small doses are SM dilators
o Call an ambulance
o Re-administer short-acting β2-adrenergic agonist inhaler every 20
minutes until EMS arrive
o The emergency team will continue treating the patient with
bronchodilators and oral systemic corticosteroids

34
Q

Focal Problems
from
Smoke and Smoking
(2)

A
  • COPD
  • CAD (coronary artery
    disease)
35
Q
  • COPD
    (2)
A
  • Bronchitis
  • Emphysema
36
Q

. Bronchiolitis (chronic obstruction - small airways)

A
  • Excessive tracheobronchial mucus production to cause
    coughing and sputum production for >3 months for >2
    consecutive years in the absence of infection or other causes
    of chronic cough
37
Q

II. Emphysema
* Longterm Chronic obstructive bronchiolitis leads to destruction
of (2)
* Decreased —
* Difficulty in maintaining —

A

lung parenchyma and alveolar walls
elastic recoil
airway opening during expiration

38
Q

Type – is a progression of Type – leading many to just use these
as descriptive terms for COPD

A

II
I

39
Q

Chronic Obstructive Pulmonary Disease (COPD) is the — leading cause of death in USA

A

3rd

40
Q

Chronic Obstructive Pulmonary Disease (COPD)
Aggravating/Complicating Factors
(3)

A

● Smoking
● Air pollutants (quality)
- urban
- industrial
● CVD
- comorbidity

41
Q

Chronic Obstructive Pulmonary Disease (COPD)
Signs and Symptoms
(3)

A
  • Dyspnea
  • Cough
  • Sputum
42
Q

Chronic Obstructive Pulmonary Disease (COPD)
Treatment
(3)

A
  • Inhaled long-acting bronchodilators
  • Corticosteroids if asthma also present and/or more reversible
    obstruction
  • Smoking cessation is only intervention that actually lessens
    disease progression
43
Q

Chronic Obstructive Pulmonary Disease (COPD)
Oral Manifestations
(2)

A

• Dry mouth
• Steven-Johnson syndrome
with theophylline

44
Q

Exacerbates Smoking Side
Effects of:
(8)

A
  • Halitosis
  • Tooth staining
  • Nicotine stomatitis
  • Periodontal disease
  • Oral potentially malignant disorders
  • Leukoplakia
  • Erythroplakia
  • Oral squamous cell carcinoma
45
Q

Determine stage and severity of COPD
(2)

A

➢ Medical consultation for mild to moderate COPD to
determine the presence of respiratory failure right-sided
heart failure
➢ If COPD Stage III or higher or who have respiratory and
heart failure
o Consider dental treatment in a hospital setting

46
Q

If < Stage III COPD
➢ Place the patient in …
➢ Avoid using a —
➢ Avoid treating if — is present
➢ — is acceptable
o May need to limit …

A

a semi-supine position to avoid respiratory distress
rubber dam
upper respiratory infection
Local anesthetic with epi
epi if concomitant CVD

47
Q

Avoid medications that cause respiratory depression
(4)

A

➢Barbiturates
➢Narcotics
➢Nitrous oxide is contraindicated
➢Benzodiazepines (low dose may be acceptable in
certain situations)
o Consult physician

48
Q

(3) should not be prescribed to COPD
patients already taking theophylline

A

Erythromycin, macrolide antibiotics (clarithromycin, azithromycin, etc.)
and ciprofloxacin

49
Q

Low Level Intervention
(5)

A
  • Health/medical evaluation
  • Exams
  • Dental prophylaxis
  • Radiographs
  • Optical oral scans
50
Q

Moderate Intervention
(4)

A
  • SRP (scaling and root planning)
  • Simple restorative procedures; 1-2 teeth
  • Simple extractions; 1-2 teeth
  • Impressions
51
Q

High Risk Intervention
(6)

A
  • Complex restorative procedures on >2 teeth
  • Multiple extractions
  • Surgical extractions
  • Implant placement
  • Full arch impressions
  • Dental care under general anesthesia
52
Q

Vaping
(3)

A
  • Act of inhaling and exhaling the aerosol, often referred to as vapor, which is produced by an e-cigarette or similar device.
  • E-cigarettes do not produce tobacco smoke, but rather an aerosol, often mistaken for water vapor, that actually consists of fine particles.
    vapor is generated from a solid, semi solid, or liquid substance
53
Q

vaping components (5)

A

battery
heating element
atomizer
cartridge/pod
indicator light

54
Q

e liquid ingredients
(4)
other compounds/chemicals:
(2)

A

vegetable glycerin
propylene glycol
flavorings
nicotine

diacetyl
benzoic acid

55
Q

e juice
ingredients may be deemed safe for sure or ingestion but not evaluated for

A

inhalation and heat

56
Q

can remain on surfaces for

A

weeks to months
potential for 3rd hand exposure or accidental ingestion by children

57
Q

may cause adverse effects during or after

A

pregnancy
nicotine can cross the placenta

58
Q

aerosol (4)

A

volatile organic compounds
nicotine
ultrafine particles
heavy metals: nickel, tin, lead

59
Q

popularity of devices (4)

A

easy to get
flavorings make devices appealing
discreet use/sleek design
11-17 year olds think e cigs are less harmful than smoking

60
Q

cost
variety in cost based on device
single use, disposable e cigs:
rechargeable staterkits:
refill cartridges: monthly cost

A

$1-15
$25-150
$50-75

61
Q

EVALI

A

e cig/vaping product use associated lung injury
name given to vaping related lung illness
-US CDC and prevention
-as of feb 2020: 2807 cases confirmed

all 50 states have confirmed cases
-68 deaths connected to the illness in 29 states
KS and MO have confirmed cases

62
Q

other health concerns
o Increased ..
* Higher risk for –
* Increased –
o Increase in –
* Increase in –
* “popcorn lung” - –
o May cause – levels to rise

A

heart rate due to spike in adrenaline
heart attack
blood pressure
bronchitis
lung dispase
bronchiolitis obliterans
blood sugar

63
Q

EFFECTS ON ORAL HEALTH
(4)

A

o Chemical vapors produced can alter or damage epithelial cells
o Indicates an inflammatory response in the PDL
fibroblasts
o Sore throat
o Dry mouth

64
Q

o Chemical vapors produced can alter or damage epithelial cells
(2)

A
  • Oral ulcerations
  • Oral cancer may result
65
Q

o Indicates an inflammatory response in the PDL
fibroblasts

A

*May lead to greater risk for periodontal disease

Oral Medicine (13 decks)

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