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