It is critical for the oral healthcare professional to be aware of the xerostomic effects of many of the medications used to treat asthma and to be diligent in maintaining protective oral factors and decreasing exposures to risk factors such as additional fluoride exposure or at-home diet modifications. Patients who regularly use inhaled medications should be instructed to bring them to their dental appointments and have them readily available. Short-acting bronchodilators such as albuterol or metaproterenol sulfate (Alupent) are useful for emergent treatment of sudden asthma symptoms. Candida infections are common and should be treated quickly and appropriately to minimize patient discomfort using antifungal medications such as fluconazole or clotrimazole. Nystatin is a commonly prescribed antifungal, although its formulation may prove cariogenic in the pediatric population. obstructs the alveoli, causing an increase in bacterial colonization. Inflammatory response of the respiratory system causes excessive connective tissue in the lungs, which furthers mucus development and recurrent infections. As the disease progresses, the pancreas becomes unable to release digestive enzymes when the ducts leading to the stomach become clogged with mucus. The liver is similarly affected, and it can become difficult for the liver to function properly. The results are frequent lung infections and malnutrition of the patient. an increase in oral opportunistic infections, such as thrush caused by Candida albicans . Patient-to-patient transmission of harmful bacteria is becoming more problematic in the CF population. Bacteria such as Pseudomonas aeruginosa, Staphylococcus aureu s, and Burkholderia cepacia can readily spread between CF patients if they are not at least 3 feet from one another. Universal infection control procedures should be in place to help prevent the potentially fatal result of bacterial transmission. risk assessment. Liver cirrhosis occurs in 27% to 41% of children with CF (Yamaguchi et al., 2023). Because the liver is responsible for drug metabolism and the formation of coagulation factors, review of the patient’s latest complete blood count (CBC) with platelets, INR, and liver proteins should be done prior to treatment. If liver enzymes are found to be abnormally high, it is best to limit the amount of local anesthetic to lessen the chances of toxic levels. If the patient’s INR is 3.5 or greater, typical procedures have a greater chance of producing prolonged bleeding. Since the patient with CF is usually diagnosed in infancy, early dental intervention can greatly lessen the effects of oral disease in this patient population. A multidisciplinary team approach will optimize treatment options for long- term health. Primary care physicians, respiratory therapists, endocrinologists, dieticians, and oral health providers should all work together to intervene as early as possible to facilitate the long-term health of the patient with CF (Coffey et al., 2023).
The use of nitrous oxide/oxygen, which does not irritate the airway, is one option. Another option is the use of an antihistamine such as diphenhydramine (Benadryl, Aventyl), which has anticholinergic properties that can dry secretions as well as prevent histaminic bronchiolar constriction. The asthmatic patient or their caregivers need to identify the triggers that initiate an attack. This information is important for members of the dental team to have in advance of the patient’s first visit and in anticipation of ongoing care. The team may have to put special precautions in place in the office in preparation for a severely asthmatic patient. These precautions might include minimizing the use of cleaning solutions and aerosols, as well as limiting the use of dental medicaments that may be harmful to this type of patient. Cystic fibrosis Cystic fibrosis (CF) is an autosomal recessive disease that primarily affects the respiratory system. Affecting roughly 35,000 people in the U.S., CF is the most frequently inherited fatal disorder among Caucasians (CDC, 2023c). The gene for CF is carried on chromosome 7, and roughly 1 out of 20 people carry one copy of the recessive gene. CF typically affects the respiratory system and the pancreas, although the reproductive organs, digestive tract, and liver may also be affected (Wei et al., 2020). In the patient with CF, the lungs are typically normal at birth. As the infant develops, thick viscous mucus production Medical considerations/current medical therapies Since no cure for CF is available, treatment involves the use of medications aimed at symptomatic relief. Beta-2 agonist bronchodilators such as albuterol (Proventil, Ventolin) are used to decrease the resistance of airflow to the lungs. These medications frequently dry out the oral cavity and decrease salivary secretions, leading to xerostomia. Corticosteroid inhalers such as budesonide (Pulmicort, Rhinocort) are used to suppress the immune response in the airway. Side effects include drying of the oral cavity and Dental treatment implications In addition to its effects on the respiratory and digestive systems, CF also affects oral health. The epithelial response to CF can occur in the salivary glands as well. Saliva has components that aid in the digestive process and immune response. Through production of lactoferrin, lysozyme, and immunoglobulin A in the salivary glands, saliva plays an antimicrobial role against bacteria and viruses in the oral cavity. Saliva also acts to establish a favorable oral biofilm on teeth that provides protection against cariogenic activity. Oral pH and the buffering capacity of saliva can be altered in the patient with CF. In the acidic xerostomic environment, the cariogenicity of oral bacteria can rapidly damage teeth. Dental treatment planning in the patient with CF should include an assessment of the metabolic effects of the disease. Gastroesophageal reflux occurs in 20% of children with CF (Maqbool, 2017). Steps should be taken to modulate the deleterious effects of acid upon the tooth enamel. This is an opportunity for the dentist to evaluate the balance of protective versus risk factors in the caries
METABOLIC AND ENDOCRINE DISORDERS
Diabetes mellitus Metabolism refers to the complex conversion of food into usable energy. There are many metabolic disorders that are classified according to the cell type involved, the
biochemical pathway, and the enzyme affected. Because of the increase in the numbers of pediatric patients presenting with diabetes mellitus (DM) type 1 (Los & Wilt, 2023), this
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