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Questions and Answers
Which of the following symptoms is NOT associated with cystic fibrosis?
What clinical finding may indicate the progression of cystic fibrosis?
What is one recommended oral health consideration for patients with respiratory conditions?
Which of the following is a common pulmonary manifestation of cystic fibrosis?
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What is the primary cause of tuberculosis?
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What should be avoided in the dental management of patients with emphysema?
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Which characteristic is NOT associated with emphysema?
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In dental management for patients with mild to moderate emphysema, what is the primary concern?
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Which oral manifestation is commonly associated with smoking?
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What is a significant factor affecting life expectancy in patients with cystic fibrosis?
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What should be the chair position for a patient with respiratory issues during dental treatment?
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Which drug should be avoided in patients with severe emphysema during dental procedures?
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Cystic fibrosis is primarily characterized by which type of secretions in the body?
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What is the preferred drug for pain relief in patients with asthma?
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Which of the following is NOT a common symptom of chronic bronchitis?
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What should be done if an asthma attack occurs during dental treatment?
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Which of these factors is a major cause of chronic bronchitis?
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What is the recommended method to prevent triggering a hypersensitive airway during dental hygiene care?
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Which oral manifestation can be associated with chronic smoking habits?
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Which of the following is NOT a characteristic of chronic bronchitis?
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What is a common risk factor for exacerbations in chronic bronchitis patients?
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Which of the following is NOT a clinical finding associated with tuberculosis?
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What is a characteristic feature of TB ulcers in the oral cavity?
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Which of the following is a common oral manifestation of tuberculosis?
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Which of the following statements about managing dental treatment in TB patients is true?
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What effect can rifampin have when combined with acetaminophen?
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What is the primary cause of tonsillitis?
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What is a notable sign of a TB infection in the lungs?
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Which type of oral lesion is NOT associated with tuberculosis?
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What is the primary cause of radiation caries?
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Which of the following is NOT recommended for managing xerostomia post-radiation therapy?
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What is the preferred delivery method for fluoride gel in patients undergoing radiation therapy?
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Which of the following is the most effective rinse for managing oral mucositis?
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What type of diet change may occur due to radiation-induced complications?
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Which microbial shift is commonly observed in patients with xerostomia?
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How often should gentle water lavage be used to manage oral hygiene after radiation therapy?
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What is a key preventive measure against radiation caries?
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Study Notes
Asthma and Dental Hygiene
- Schedule late morning or late afternoon appointments for asthmatic patients.
- Have bronchodilator and oxygen available during appointments.
- Obtain a medical consultation for patients with severe acute asthma or those on corticosteroids to determine the need for steroid replacement and/or antibiotics.
- Use bronchodilator as a preventative measure before the appointment.
- Provide a stress-free environment for patients.
- Prevent triggering a hypersensitive airway by properly placing cotton rolls, fluoride trays, and suction tips.
- Use local anesthetic without sulfites.
- Give fluoride treatment to patients with asthma.
- If an asthma attack occurs, stop treatment, rule out foreign body obstruction, and initiate emergency procedures.
- Advise patients to rinse their mouth with water after using an inhaler to reduce oral candidiasis.
- Acetaminophen is the preferred analgesic drug as aspirin and NSAIDs may trigger an attack.
Chronic Obstructive Pulmonary Disease (COPD)
- COPD consists of two major diseases: chronic bronchitis and emphysema.
- Both are characterized by chronic airflow obstruction during normal ventilatory efforts.
Chronic Bronchitis
- Chronic inflammatory condition of the bronchoalveolar epithelium, lasting at least 3 months for more than 2 consecutive years.
- Characterized by:
- Productive cough
- Reduced forced rate of expiration
- Wheezing
- Shortness of breath
- Exertional dyspnea
- 7:1 male predominance.
- Cigarette smoking is the main etiologic factor.
- Environmental pollution and dust are secondary causes.
Clinical and Pathologic Features of Chronic Bronchitis
- Increased mucous secretion and plugging.
- Edema and fibrosis.
- Hypertrophy of bronchial mucosa.
- Hyperplasia of mucous cells and goblet cells.
- Irreversible narrowing of the bronchial airway.
- Decrease in ciliary and macrophage activity.
- Diminished gaseous air exchange.
- Increased risk for secondary bacterial infections, primarily Haemophilus influenzae, Streptococcus pneumoniae.
- Increased risk for pulmonary hypertension and respiratory failure.
Oral Manifestations of Chronic Bronchitis
- Smoke-related oral lesions:
- Melanosis
- Nicotine stomatitis
- Dysplastic changes of oral mucosa
- Leukoplakic or erythroplakic lesions.
Dental Management of Chronic Bronchitis
- The primary concern is preserving the patient's respiratory capacity during treatment.
- Maintain a more upright chair position.
- Avoid CNS depressing drugs like narcotics and barbiturates.
- Avoid xerostomic medications like antihistamines, which dry the respiratory mucosa.
- Use rubber dam with caution.
- Nitrous oxide and other anesthetic gases are contraindicated.
Emphysema
- Irreversible lower airway obstructive lung disease.
- Alveolar wall destruction.
- Enlargement and dilatation of alveolar acini and collapse of terminal bronchioles.
- Diminished surface for gas exchange.
- Loss of elastic recoil.
- Long-term air entrapment.
Characteristics of Emphysema
- Occurs at 50-70 years of age.
- History of heavy smoking.
- Thin patient (asthenic).
- Exertional dyspnea.
- Tachypnea.
Other Features of Emphysema
- Pink face (pink puffer).
- Barrel-chested.
- Holds shoulders high, slightly forward; struggles to catch breath.
- Nonproductive cough.
- Wheezing on expiration.
- Distended neck veins.
Oral Manifestations of Emphysema
- Smoke-related oral lesions:
- Melanosis
- Nicotine stomatitis
- Dysplastic changes of oral mucosa
- Leukoplakic or erythroplakic lesions.
- Pursed lip expirations, resulting in xerostomia.
Dental Management of Emphysema
- Patients with mild to moderate disease can safely receive dental treatment if their respiratory capacity is adequate.
- Patients with severe disease are NOT recommended for stressful dental treatment.
- Avoid sedation, general anesthesia, bilateral mandibular block, and antihistaminic medications.
- Adjust chair position to a more upright posture.
Cystic Fibrosis
- Inherited genetic disorder characterized by hyperviscous secretions in the respiratory and gastrointestinal tracts.
- Viscid mucus in the lungs leads to airway obstruction, infection, and bronchiectasis.
- Pulmonary complications significantly impact life expectancy in patients with CF.
Symptoms of Cystic Fibrosis
- Salty-tasting skin (when newborns are kissed).
- Steatorrhea (greasy, bulky, and foul-smelling stools).
- Poor growth and weight gain despite good appetite.
- Chronic coughing, sometimes with phlegm.
- Frequent lung infections.
Clinical Findings in Cystic Fibrosis
- Pulmonary manifestations include coughing, recurrent lower respiratory tract infections, and bronchospasm.
- Tachypnea and crackles may be present on physical examination.
- Digital clubbing and bronchiectasis may become apparent as the disease progresses.
- Airway obstruction worsens with disease progression, although some patients have mild pulmonary disease.
Oral Health Considerations for Cystic Fibrosis
- Treat patients in a semisupine or upright chair position to promote breathing and comfort.
- Take measures to prevent or treat gingivitis and periodontal diseases.
- Recommend patients rinse with sodium bicarbonate or use xylitol after sugary drinks or snacks, and after using their inhaler/nebulizer.
- Recommend home fluoride treatment based on caries risk.
Tuberculosis
- Systemic infectious disease with worldwide prevalence and variable clinical manifestations.
- Infectious granulomatous disease caused by Mycobacterium tuberculosis.
Clinical Findings in Tuberculosis
- Episodic fever and chills.
- Dyspnea.
- Fatigue.
- Anorexia.
- Weight loss.
- Sputum production: green, yellow, or purulent.
- Persistent cough with hemoptysis (expectoration of blood or blood-tinged sputum), typically in the morning.
- Chest pain due to pleural involvement.
Oral Manifestations of Tuberculosis
- Dissemination of Mycobacterium from the lungs to the oral cavity can cause secondary infection.
- Oral ulcers are common, often found in the posterior oral cavity, dorsum or lateral margin of the tongue, labial mucosa (commissures), but can appear elsewhere.
Characteristics of Oral Ulcers in Tuberculosis
- May be painful or less painful.
- Slowly increase in size.
- Grayish center with lumpy (cobblestone) and undermined margins.
- Purulent base containing active organisms.
- Cervical lymphadenopathy is common.
Non-typical Oral Lesions in Tuberculosis
- Fissures.
- Granulomas.
- Osteomyelitis of the jaws.
- Sialadenitis of major salivary glands, particularly the parotid.
- Calcified lymph nodes in arrested disease may be visible on X-rays.
- Anti-TB drugs can cause adverse effects like excessive salivation and metallic taste, as well as gingival bleeding.
Oral Considerations for Tuberculosis
- Consult with a physician to determine the patient's infectious status.
- Patients on anti-TB therapy can be safely treated after 2-3 weeks of antibiotic treatment.
- Manage emergency situations during the infectious period with palliative treatment (antibiotics and analgesics).
- Dental personnel should be aware that cold sterilization or chemical sterilization solutions are ineffective for TB.
- If clinical signs suggestive of TB are present, do NOT treat.
- Evaluate patients' pulmonary capacity before any sedation or narcotic administration.
- Acetaminophen can interact with the hepatotoxic effect of rifampin.
Tonsillitis
- Inflammation of the pharyngeal tonsils.
- Predominantly caused by viral or bacterial infection.
- Uncomplicated cases present as a sore throat.
- Acute tonsillitis is a clinical diagnosis.
- It can be challenging to differentiate between bacterial and viral causes, but this is crucial to avoid antibiotic overuse.
- Can lead to:
- Dysphagia (difficulty swallowing).
- Mucositis.
Sequelae of Radiation-Induced Xerostomia
- Decreased retention of removable prostheses due to increased sore spots.
- Adherence of food and cellular debris to oral structures.
- Shift in diet to softer foods, often carbohydrates.
- Shift in microflora, leading to an increase in Lactobacilli, cariogenic Streptococci, and Candida.
Patient Instructions for Radiation-Induced Xerostomia
- Rinse frequently with sterile water or saline.
- Use commercially available artificial saliva substitutes.
- Use salivary stimulants like sugarless gum or candy, or consider drug therapy.
- Apply lubricating agents to the lips to prevent cracking.
Radiation Caries
- Rampant form of dental caries induced by xerostomia.
- Primarily localized in cervical regions.
- Dental team should focus on prevention.
Prevention of Radiation Caries
- Educate the patient about the role of dental plaque in caries and periodontal disease.
- Perform a complete prophylaxis, including scaling if necessary, 10-14 days before radiation therapy.
- Teach and reinforce proper brushing and flossing techniques.
- Implement and maintain a fluoride program. Neutral fluoride is best tolerated by patients with oral mucositis.
- Deliver fluoride gel using custom trays. Recommend daily 5-minute application during therapy with weekly office visits.
Additional Mouth Rinse Options for Radiation-Induced Xerostomia
- Baking soda: ½ teaspoon in 8 ounces of warm water.
- Milk of magnesia mixed with equal parts warm water.
- Three percent hydrogen peroxide mixed with equal parts warm water.
- If oral infections occur, antibiotic/antifungal mouth rinses may be prescribed.
Other Considerations for Radiation-Induced Xerostomia
- Gentle water lavage can remove thick, ropy saliva and debris.
- If tooth brushing is intolerable, single-use toothettes, gauze squares, and cotton-tipped applicators may be used.
- Some saliva substitutes not only lubricate the mucosa but also contain chemicals that promote remineralization and inhibit decay.
- A successful recall program is crucial for maintaining optimal oral health.
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Description
This quiz covers essential practices for managing asthma in dental settings. It includes strategies for patient appointments, emergency procedures, and advice on medications. Test your knowledge about how dental hygiene can accommodate the needs of asthmatic patients.
