Dental Care for COPD Patients

Assessment and Management of COPD

• Patients with signs and symptoms of COPD (shortness of breath, respiratory tract infection, or reduced oxygen saturation <91%) should be referred for medical evaluation and treatment, and dental treatment should be deferred.
• Stable patients should be treated in upright or semisupine position to avoid further depressing respiration.
• Local anesthesia is satisfactory, but bilateral inferior dental nerve or palatal nerve block should be avoided.
• Avoid rubber dam application.
• Low flow oxygen (2-3 L/min) should be considered when oxygen saturation is reduced below 95%.
• Avoid nitrous oxide (N2O) in severe COPD.
• Avoid barbiturates, narcotics, anticholinergic, and antihistamine drugs due to respiratory depression and drying of the mucous membrane.
• Patients treated with corticosteroids may need supplementation.
• Patients may have hypertension and coronary heart disease and must be managed accordingly.

Oral Complications and Manifestations

• Chronic smokers may exhibit increased likelihood of halitosis, extrinsic tooth stains, nicotine stomatitis, periodontal diseases, premalignant oral lesions, and oral cancer.
• Obstruction is caused by the collapse of unsupported and enlarged air spaces on expiration.

Etiology

• Genetic susceptibility
• Smoking
• Pollution
• Absence of alpha-1-antitrypsin

Clinical Presentation

• Chronic bronchitis: chronic cough with copious sputum, patients are usually overweight, cyanotic, edematous, and breathless (blue bloaters).
• Emphysema: dyspnea on exertion, non-productive cough, patients are barrel-chested, with weight loss, and expiration with pursing lips to forcibly exhale air (pink puffers).

Diagnosis

• Measuring forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) by spirometry
• FEV1/FVC ratio of less than 70% indicates COPD
• Arterial blood gas measurement
• Chest radiographs (barrel shape)

Medical Management

• Smoking cessation and elimination of exposure to pollutants
• Exercise and good nutrition
• Prevention of infection
• Low flow supplemental oxygen when PO2 is 88% or less
• Medical treatment includes bronchodilators, phosphodiesterase inhibitors, and antibiotics

Dental Management

• Obtaining thorough history and examination for the presence of COPD
• Encouraging patients who smoke to quit
• Avoiding certain medications, such as macrolide antibiotics and Ciprofloxacin, in patients taking Theophylline
• Providing a stress-free environment, with options for sedation
• Using local anesthesia in dental treatment

This quiz assesses the knowledge of dentists in managing patients with Chronic Obstructive Pulmonary Disease (COPD). It covers the evaluation of disease severity, treatment, and dental care considerations.