Presentation (17).pptx respiratory tract disease

Oral manifestation of respiratory diseases

1. School Of Dental Sciences, CMCTH (Department of oral medicine and radiology) Oral manifestation and Dental management of respiratory tract disease Guided by: Dr Abhishek Gupta Presented by: Ramkrishna kushwaha Roll no. 23 BDS 9 th Batch

2. Contents Upper respiratory diseases Viral upper respiratory tract infection Allergic rhinitis and conjunctivitis Otitis media Sinusitis Laryngitis and laryngotracheobronchitis Pharyngitis and tonsillitis

3. Lower respiratory diseases Acute bronchitis Pneumonia Bronchitis Asthma COPD Cystic fibrosis Pulmonary embolism Pulmonary neoplasm

4. Anatomy of respiratory system

5. Viral upper respiratory infections Most common cause of acute respiratory illness. More common in children than in adults. At least 100 antigenically distinct subtypes have been isolated. It is most commonly during the winter months in temperate climates. They are most commonly transmitted by close person to person contact and respiratory droplets. They can occur from nasopharyngeal secretions for up to three weeks, but seven days or less is more typical.

6. Etiology Rhino virus Influenza virus Parainfluenza virus Adenovirus Enterovirus Coxsackie virus Respiratory syncytial virus Corona virus

7. Pathophysiology Lodgement of virus in upper respiratory tract Invade the respiratory epithelium and viral replication occurs Clinical sign and symptoms appeared

8. Signs and symptoms Rhinorrhea Nasal congestion Oropharyngeal irritation Nasal secretions can be serious or purulent Others Symptoms Cough Fever Malaise Fatigue Headache Myalgia

9. Laboratory findings Complete blood count Differential leukocyte count Culture Rapid diagnostic assay

10. Diagnosis Based on medical history and physical examination Exclude acute bacterial rhino sinusitis, allergic rhinitis , Group A streptococcal pharyngitis

11. Management Symptomatic treatment Sore throat and myalgia (analgesic) Antipyretic for febrile patients Anticholinergic for rhinorrhea Topical decongestant for nasal congestion Adequate hydration for febrile illness

12. Prognosis Excellent As most patient recover in 5 to 10 days

13. Oral health consideration Small round erythematous macular lesions on soft palate Oral dryness(due to decongestant) Lymph node enlargement on lateral border of tongue at the base of tongue Lingual tonsillar mass

14. Allergic rhinitis and conjunctivitis Recurrent inflammatory disorder of nasal mucosa Type 1 hypersensitivity reaction It can be seasonal or perennial Typical seasonal triggers include grass, tree and weed pollens Common perennial triggers includes dust mites, animal danger and mold spores

15. Oral health consideration Oral dryness(due to use of decongestant and antihistaminics drugs Oral candidiasis (due to long term use of corticosteroids) Allergic respiratory hypersensitivity reaction (Exposure to dental materials such as methacrylate)

16. Management Allergen avoidance, Pharmacotherapy and immunotherapy Prominent sneezing ,pruritus and rhinitis (fexofenadine, loratidine)

17. Otitis media Inflammation of middle ear space and tissues It is the most common illness occur in children It is the dysfunction of eustachian tube

18. Oral health consideration Oral candidiasis (due to use of antibiotics)

19. Management Common choices of drug is Amoxicillin

20. Sinusitis It is the inflammation of epithelial lining of paranasal sinuses

21. Oral health consideration Occasionally toothache Facial fullness Erythema and swelling of overlying skin

22. Management Comprehensive treatment include adequate hydration, steam inhalation and pharmacological measure intended to underlying causes Nasal glucosteroids Amoxicillin, Azithromycin also can be used

23. Laryngitis and laryngotracheobronchitis The upper airway is the site of infection and inflammation during the course of a common cold, but respiratory viruses can attack any portion of the respiratory tree. The viruses most commonly implicated in laryngitis are parainfluenza virus, coxsackieviruses, adenoviruses, and herpes simplex virus. The viruses most commonly associated with laryngotracheo­bronchitis are parainfluenza virus, RSV, influenza virus, and adenovirus.

24. Oral health consideration Toothache Gingivitis The use of decongestants may be associated with oral dry­ness

25. Management Self-limited Airway maintenance The standard therapy includes mist therapy, corticosteroids, and racemic epinephrine

26. Pharyngitis and tonsillitis Inflammation of the tonsils and pharynx is almost always asso­ciated with infection, either viral or bacterial These infections can be associated with fever, rhinorrhea, and cough

27. Oral health consideration Interestingly, when toothbrushes were rinsed with sterile water, organisms could not be cul­tured beyond 3 days, whereas nonrinsed toothbrushes har­bored GABHS for up to 15 days. Thus, patients with GABHS infections should be instructed to thoroughly clean their toothbrushes and removable acrylic appliances daily. It is also advisable to change to a new toothbrush after the acute stage of any oropharyngeal infection.

28. Management Gargle solutions, analgesics, and antipyretics are often helpful. The course is always self-limited. Acute streptococcal pharyngitis is treated with oral penicillin V, cephalosporin, macrolides, clindamycin, or an intramuscular injection of benzathine penicillin G.

29. Acute bronchitis Acute bronchitis is an acute respiratory infection involving the large airways (trachea and bronchi) that is manifested predominantly by cough with or without phlegm production that lasts up to 3 weeks

30. Oral health consideration Odontogenic infection

31. Management Bronchodilator Cough suppressant The treatment of bacterial bronchitis includes amoxicillin, amoxicillin-clavulanate, macrolides, and cephalosporin

32. Pneumonia Pneumonia is defined pathologically as an infection and a sub­sequent inflammation involving the lung parenchyma. Both viruses and bacteria are causes, and the presentation is depen­dent on the causative organism

33. Oral health consideration The connection of oral health to pneumonia involves aspiration of a pathogen from a proximal site, for example, the oral-pharyngeal cavity, into the lower airway

34. Management Treatment options for outpatients with community-acquired pneumonia include b-lactams (e.g., amoxicillin-clavulanate), macrolides, and fluoroquinolones

35. Bronchiolitis It is characterized by infection of the lower respiratory tract, with the bronchioles being most affected.

36. Oral health consideration

37. Management Infants may be placed in cool-mist oxygen tents, where continuous oxygen administration can be given

38. Asthma Asthma is a chronic inflammatory disorder of the airways. It is characterized by recurrent and often reversible airflow limitation due to an underlying inflammatory process

39. Oral health consideration Numerous dental products and materials, including toothpaste, fissure sealants, tooth enamel dust, and methyl methacrylate, have been associated with the exacerbation of asthma, whereas other items (such as fluoride trays and cotton rolls) have been suggested as being so associated. Oral manifestations include candidiasis, decreased salivary flow, increased calculus, increased gingivitis, increased periodontal disease, increased incidence of caries, and adverse effects of orthodontic therapy

40. The following are considerations and recommendations for administering dental care to patients who have asthma: 1. Fluoride supplements should be instituted for all asthmatic patients, particular those taking R2-agonists. 2. The patient should be instructed to rinse his or her mouth with water after using inhalers. 3. Oral hygiene should be reinforced to reduce the inci­dence of gingivitis and periodontitis. 4.Antifungal medications should be administered as needed, particularly in patients who are taking inhaled corticosteroids.

41. 5. Steroid prophylaxis needs to be used with patients who are taking long-term systemic corticosteroids (see Chapter 10) 6. Use stress-reducing techniques. Conscious sedation should be performed with agents that are not associated with bronchoconstriction, such as hydroxyzine. Barbiturates and narcotics should be avoided due to their potential to cause bronchospasm and reduce respiratory functions. Nitrous oxide can be used for all but patients with severe asthma as it may irritate the airways. 7. Avoid dental materials that may precipitate an attack.
Acrylic appliances should be cured prior to insertion. Dental materials without methyl methacrylate should be considered. 8. Schedule these patients’ appointments for late morning or later in the day to minimize the risk of an asthmatic attack

42. 9. Have oxygen and bronchodilators available in case of an exacerbation of asthma. 10. There are no contraindications to the use of local anesthetics containing epinephrine, but preservatives such as sodium metabisulfite may contribute to asthma exacerbation in susceptible patients. Nevertheless, interactions between epinephrine and R2-agonists may result in a synergistic effect, producing increased blood pressure and arrhythmias. 11. Judicious use of rubber dams will prevent reduced breathing capability.12. Care should be used in the positioning of suction tips as they may elicit a cough reflex.

43. 13. Up to 10D of adult asthmatic patients have an allergy to aspirin and other nonsteroidal anti-inflammatory agents.130 A careful history concerning the use of these types of drugs needs to be elicited. Although the use of acetaminophen has been proposed as an alternative to the use of aspirin, recent data suggest caution because these types of drugs have also been associated with more severe asthma. 14. Drug interactions with theophylline are common. Macrolide antibiotics may increase the level of theo­phylline, whereas phenobarbital's may reduce the level. Furthermore, drugs such as tetracycline have been asso­ciated with more accentuated side effects when given together with theophylline.

44. 15. During an acute asthmatic attack, discontinue the den­tal procedure, remove all intraoral devices, place the patient in a comfortable position, make sure the airway is opened, and administer a R2-agonist and oxygen. If no improvement is noted, administer epinephrine subcutaneously (1:1,000 concentration, 0.01 mg/kg of body weight, up to a maximum of 0.3 mg) and alert emergency medical assistance.

45. Chronic obstructive pulmonary disease COPD is a disease state characterized by airflow limitation. The airflow is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases.

46. Oral health consideration Individuals with a confirmed chronic respiratory disease had a significantly greater oral hygiene index than subjects without a respiratory disease.

47. Management Smoking cessation is the single most important intervention to stop the progression of COPD. Bronchodilator Theophylline Antibiotics Oxygen administration with ventilator support

48. Cystic fibrosis CF is a multisystem genetic disorder that is characterized chiefly by chronic airways obstruction and infection and by exocrine pancreatic insufficiency,withitseffectsongastrointestinalfunction,nutrition,growth, and maturation

49. Oral health consideration It has also been reported that the tongue, buccal mucosa, dental plaque, and saliva serve as a reservoir of colonization by both mucoid and nonmucoid strains of P. aeruginosa, an important bacterial pathogen for CF patients

50. Management Treatment of CF includes antibiotics, bronchodilators,anti-inflammatory agents, chest physio­therapy with postural drainage, and mucolytic agents

51. References Burkets Oral medicine Eleventh Edition