Self-Assessment Quiz Question #1 As a dentist, it is highly likely that you will treat patients with a history of heart conditions, including infective endocarditis. According to the latest AHA recommendations, which of the following statements is true? a. Clindamycin is currently recommended for antibiotic prophylaxis. b. Patients unable to take oral antibiotics should be given IM azithromycin. c. A 2022 Cochrane review of antibiotic use in dentistry to prevent IE concluded that at this time, the benefits conclusively outweigh the risks of administering antibiotic premedication. d. According to a study by Lockhart and colleagues (2023), there is a significantly greater risk of developing measurable bacteremia after daily brushing in the presence of poor oral hygiene and gingival disease than in a healthy environment. DISORDERS OF THE RESPIRATORY SYSTEM
Respiratory disorders include a variety of conditions— including acquired viral, bacterial, and developmental conditions of the breathing passages and lungs—that are frequently encountered in the pediatric patient. Some Asthma Asthma is a reactive airway disease. It is a common childhood condition that is likely to be found in the medical histories of many patients in the dental office. According to recent data from the CDC, asthma affects more than 25 million people in the U.S., with about 6.5% of those under the age of 18. As of 2021, 10.4% of those living below the poverty line were affected by asthma (CDC, 2021). Because of the increasing numbers of asthma patients within the population, it is highly likely that dental providers will treat a greater number of patients with this illness in the future. It has been suggested that the trend of increasing asthma rates may, paradoxically, be related to improved public health programs such as increased immunizations, improved community sanitary conditions, and reduced microbial exposure. This idea is called the hygiene hypothesis Medical considerations/current medical therapies There are three main medical considerations for the asthmatic patient: 1. Monitoring peak expiratory flow. 2. Avoiding triggers. 3. Treating with medications. Using a peak flow meter, the patient regularly measures the rate at which air moves out of the lungs. As asthma worsens, the peak flow expiratory rate will decrease. This gives the patient’s physician insight into the condition of the patient. Patients with asthma may be taking any of a number of medications, based on the frequency and degree of respiratory symptoms. There are two general classes of drugs: 1. Short-acting, quick relief medications. 2. Long-term control medications. Quick-relief bronchodilators relax smooth muscles of the bronchiole by activating the beta-2 receptor specifically found in respiratory tissues. The most commonly used short- acting bronchodilator today is albuterol (Ventolin, Proventil). Although albuterol is selective for beta-2 receptors found in respiratory tissue, it is possible that albuterol also stimulates beta-1 receptors, which are found in cardiac tissue. This stimulation may result in the patient feeling shaky or anxious, or the individual may develop a rapid heartbeat (tachycardia). Although these effects are generally short Dental treatment implications The dental office can prove to be a challenging environment for the severely asthmatic patient. Ambient temperature, the use of disinfection solutions, and dental materials can irritate bronchioles in hypersensitive individuals. Studies have shown that patients with asthma have poorer salivary health
patients present with more serious chronic respiratory conditions—such as asthma, tuberculosis, and cystic fibrosis—that will be discussed here.
(Fiuza et al., 2021). The reasoning is that without enough pathogens to deal with, the immune system does not get enough training and reacts by attacking dust and pollen as though they were dangerous invaders (U.S. Food and Drug Administration [FDA], 2018). In the acute phase, asthma is characterized by shortness of breath, chest tightness, coughing, and reversible attacks of wheezing. These symptoms are caused by a hypersensitive response of the bronchioles in reaction to various triggers. These triggers can include animal dander, chemicals, dust, mold, tobacco smoke, and even cold weather. It is important to note that triggers may be present within the dental environment as well. In asthma’s most severe form, bronchiolar constriction can lead to suffocation and death. lived, it is important to obtain a baseline blood pressure and pulse in order to detect any significant changes. As part of a daily regimen to control the symptoms of asthma, long-term control medications may be taken as well. The dental team should be aware of the different types of long-term control medications their patient is taking. These medications include inhaled steroids and cromolyn (Nasalcrom, Intal). Inhaled steroids act to decrease sensitivity to allergic triggers and thereby minimize inflammation. The most common side effect noted in patients using inhaled steroids is the development of thrush, or Candida albicans infection, in the mouth. These medications also tend to cause xerostomia, which can in turn exacerbate the Candida infection and increase the risk for caries long term. Again, these medications have additional cariogenic potential because of sugar added to increase compliance in the pediatric population. Cromolyn, a mast cell stabilizer, is typically used in the prophylaxis of allergic disorders such as asthma. In the pediatric patient, cromolyn is especially useful in the prevention of exercise-induced bronchospasm; therefore, this medication may be listed on a patient’s health history. Cromolyn has few dental implications, although it can produce a very unpleasant taste. and higher caries rates than nonasthmatic patients (Santhiya et al., 2020). It may be of particular concern in the dental office that anxiety and stress can exacerbate an asthmatic attack. Several stress reduction options are available to the clinician.
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