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

2. 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

3. 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.

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

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

6. 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

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

8. 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

9. 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

10. 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.

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

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

13. 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

14. 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

15. 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

16. 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.

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

18. References
Wilkins, E.M. (2009). Clinical Practice of Dental Hygiene 10th edition. Baltimore, MD
Online