Chronic Obstructive Pulmonary Disease

COPD : Dental Hygiene Perspective

 

Definition:

 

COPD is general term for pulmonary disorders characterized by obstruction of airflow during respiration. It consists of two or more disease processes that may coexist, most of the times Chronic Obstructive Bronchitis and Emphysema.

Chronic Obstructive Bronchitis: inflammation of the lining of bronchi and their obstruction caused by excessive mucus production, (cough at least 3 months for two or more years) difficulty upon inspiration and expiration. Wet cough. Overweight. Cyanotic, bluish skin

Emphysema: distension of alveoli due to destruction of alveolar walls. Difficulty only upon expiration. Minimal, dry cough. Weight loss.

 


Advanced complications: heart failure and pulmonary failure

 

Most important risk factor is: smoking.  Second important risk factor is: air pollution

 

Text Box: Oral manifestations of COPD no associated oral manifestations unless a side effect of a medication. Chronic smokers with COPD have increased risk of developing: halitosis, nicotine stomatitis, periodontal disease, oral cancer and extrinsic tooth stains Treatment:

  1. Change of lifestyle: quit smoking and avoid air pollutants
  2. Home oxygen therapy (supplemental oxygen to correct hypoxemia)
  3. Pulmonary rehabilitation ( 6-10 weeks rehab program)
  4. Surgery: lung transplant or lung volume reduction surgery (LVRS)
  5. Medications:                                   Side effects

-        B-adrenergic agonists                     xerostomia

-        Antiholinergics                                xerostomia

-        Bronchodilators:Theophylline         xerostomia and bad taste

-        Corticosteroids                               xerostomia and candidiasis

 

Procedures contraindicated in clients with COPD

 

1.

Supine chair position

Place client in upright chair position for Tx. to avoid orthopnea and respiratory discomfort

2.

Avoid use of ultrasonic debridement

Pathogens found in bacterial plaque and periodontal pockets may be aspirated into the lungs

3.

Avoid use of rubber cup and air polishing  

Polisher can exacerbate existing breathing problems

 

4.

Avoid use of rubber dam

 

May produce problems with respiration

5.

Avoid use of Nitrous oxide-oxygen analgesia in clients with Emphysema  

May produce cessation of respiration (apnea)

 

6.

Avoid use of barbiturates and narcotics because of their respiratory depressant properties

 

7.

If client is on Theophylline (bronchodilator) avoid use of erythromycin, macrolide antibiotics and ciprofloxacine- it will increase levels of Theophylline

 

 

Procedures indicated in clients with COPD

 

  1. Nitrous oxide-oxygen analgesia for clients with chronic bronchitis
  2. Use of local anesthesia
  3. Low-flow supplemental oxygen is helpful
  4. Low dose of oral diazepam if needed to reduce stress

Author: Boban Fidanoski
CCDH – November, 2007