Presented by: Bobbie Jo Bennett, Kristen Franklin, & Lacey McGallion Pulmonary Disease Presented by: Bobbie Jo Bennett, Kristen Franklin, & Lacey McGallion

Chronic obstructive pulmonary disease (COPD) A large group of lung diseases characterized by obstruction of air flow that interferes with normal breathing. 2 common types Chronic bronchitis Emphysema

Etiology The primary etiology is use of tobacco and exposure to occupational and environmental pollutants. Dental hygienists should motivate patients with COPD using tobacco to begin a smoking cessation program.

Occurrence Chronic bronchitis 2009- estimated 9.9 million Americans Emphysema 2009- estimated 4.9 million Americans

Population Chronic bronchitis Race: non-hispanic white Age: 45-64 years old Sex: women almost 2x likely Location: South of the United States Emphysema Age: 65+ years old Sex: men

Treatment No cure Medication intervention Home oxygen therapy Pulmonary rehabilitation Surgery (lung transplant & LVRS)–severe cases only Patients are encouraged to… Stop smoking Adequate nutrition Drink plenty of water Exercise regularly Decrease exposure to pollutants

Medications Pneumonia and influenza vaccines Bronchodilators and other medications similar to those used for asthma Beta-agonists Anticholinergics Systemic or inhaled corticosteroids Antibiotics

Dental Concerns Indications Contraindications Nitrous oxide-oxygen analgesia for clients with chronic bronchitis Use of local anesthesia: without epinephrine Low-flow supplemental oxygen is helpful Low dose of oral diazepam if needed to reduce stress Semiupright/upright chair position to facilitate breathing Diazepam/Lorazepam Supine chair position Avoid use of ultrasonic debridement Avoid use of rubber cup and air polishing Avoid use of rubber dam Avoid use of Nitrous oxide-oxygen analgesia in clients with Emphysema Avoid use of barbiturates and narcotics because of their respiratory depressant properties If client is on Theophylline (bronchodilator) avoid use of erythromycin, macrolide antibiotics and ciprofloxacine- it will increase levels of Theophylline

How will oral health be impacted? Chronic smokers with COPD have a higher risk of developing: Halitosis Nicotine stomatitis Periodontal infections Oral cancer Extrinsic tooth stains

Medical Treatments impact on oral health There is no cure for COPD. Encourage patients to: stop smoking have adequate nutrition drink plenty of water exercise regularly decrease exposure to pollutants. Medical interventions strategies include: Pneumonia and influenza vaccines. Bronchodilators and other medications similar to those used for asthma.

Medications impact on oral health Medications: Side effects - B-adrenergic agonists xerostomia - Antiholinergics xerostomia - Bronchodilators:Theophylline xerostomia and bad taste - Corticosteroids xerostomia and candidiasis

Periodontal Management Interventions that improve oral hygiene and possibly lower oral inflammation may prove to lower risk of lung infection in susceptible populations.

Expected/Accepted Treatment Options Pre-med No- controversial Patient positioning Semi-supine or upright chair position to facilitate breathing Appointment length Shorter appointments Ultrasonic use Avoid use- Pathogens may be aspirated into the lungs Recall intervals Semi-annual appointments- unless other medical/dental issues involved

Dental Hygiene Care Before you begin… Review medical history Avoid treating if upper respiratory infection is present Treatment may be performed on stable patients with adequate breathing. Identify patients who may experience exacerbation of symptoms under emotional stress May use local anesthesia without epinephrine Nitrous oxide-oxygen inhalation sedation should be avoided with severe COPD and emphysema

Question #1 Dental hygienist should motivate patients with COPD to… A. Stop smoking B. Drink plenty of water C. Exercise daily D. All of the above

Question #2 Chronic smokers with COPD have a higher risk for developing oral cancer. Chronic smokers with COPD have a higher risk for developing periodontal infections. Both statements are true. Both statements are false. The first statement is true, and the second statement is false. The first statement is false, and the second statement is true.

Question #3 Chronic bronchitis is most commonly seen in which race? A. Hispanics B. Non-hispanic- white C. African Americans D. Asians

References Wilkins, E.M. (2009). Clinical Practice of Dental Hygiene 10th edition. Baltimore, MD Online http://www.lung.org/finding-cures/our-research/trend-reports/copd-trend-report.pdf http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/chronic-obstructive-pulmonary-disease/ http://www.fidanoski.ca/dentalhygiene/2011/COPD.htm