The patient with a

Respiratory Disease
CHAPTER 65

Increased Risk

Tobacco Cessation: respiratory disease are caused or aggravated by

the use of tobacco

Emergency Treatment: know signs, symptoms and medical emergency

procedures for(Table 69-4):

Local anesthesia reactions

Respiratory failure

Airway obstruction

Asthma attack

Hyperventilation

Anaphylaxis

Allergic reactions

Scientific evidence
shows that bacteria
from periodontal
infections can
contribute/initiate
certain respiratory
infections.

The Respiratory System

Anatomy: sinuses, nasal cavity, larynx, pharynx,

trachea, bronchi, lungs, and pleura

Physiology: the respiratory tract from nasal cavity to

lungs serves as a passageway for air exchange

Functions of Respiratory Mucosa: mucus moistens

inspired air, prevents delicate alveolar walls form
becoming dry, and traps airborne particles

The Respiratory System

Respiratory Assessment

Vitals
Spirometry: medical test that measures various aspects of breathing and lung
infections
Pulse Oximetry: measures blood oxygen saturation levels
-healthy oxygen saturation is 97-100%; anything below 91% signifies poor
oxygen exchange
Chest Radiography: indicated presence of pathological density in the lungs
Blood Gas Analysis: determines acid/base balance, alveolar ventilation, arterial
oxygen saturation, and carbon dioxide
Cytology and hematology evaluation: examine cells and body fluids to
determine the presence of microorganisms that cause respiratory diseases

Classification of Respiratory Diseases

LOCATION/
STRUCTURES

ACUTE

CHRONIC

Upper Respiratory Tract:

Diseaes of the nose,
sinuses, pharynx, larynx

Rhinitis (common cold)

Sinusitis
Pharyngitis/tonsillitis
Flu (seasonal and viral)

Allergic rhinitis (hay fever)

Lower Respiratory Tract:

disease of the trachea
lungs

Acute bronchitis
pneumonia

Tuberculosis
Asthama
COPD (chronic bronchitis and
emphysema)
Cystic Fibrosis

Acute Bronchitis

An acute respiratory infection that involves large airways

(trachea, bronchi)
Primary Symptoms: cough with or without phlegm, may last up to
three weeks

Differentiated from pneumonia: no significant findings on chest

radiography

Pneumonia
Community Acquired Pneumonia
(CAP)

Infection occurring in any

individual in the community

Not in a healthcare facility

Person-to-person
transmission

Healthcare-Associated Pneumonia
(HCAP)

Infection occurring 48-72 hours

after admission to a healthcare
facility

Main cause of death in hospital

patients

Bacteria in periodontal pockets

may serve as a reservoir for lung
infections

Tuberculosis

Etiology: mycobacterium tuberculosis

Dental Hygienists are at high risk

Transmission: airborne droplet of nuclei in infected saliva or mucus (coughing,

sneezing, talking, singing)

Disease Development: inhaled tubercle bacilli travel to the lung alveoli where the
local infection begins

Diagnosis

Latent TB: skin test

Active TB: chest radiograph and physical examination

Do not treat in dental office if TB is active

Asthma

Definition: A chronic respiratory disease consisting of recurrent episodes of

dyspnea, coughing, and wheezing leading to bronchial inflammation and
muscle constriction

Etiology: no understood; but is thought to be one of the following

Extrinsic (allergic and atrophic): allergic triggers from outside the body

Intrinsic (non-allergic): emotion stress, GERD, or undefined

Drug-or Food Induced (non-allergic, non-atrophic): medicine or food

Exercised Induced

Infection Induced

Asthma (continued)

Signs of asthma attack: chest tightens, sense of suffocation,

coughing and wheezing

Oral Manifestations due to medications

Beta-2 agonists inhalers: decreased salivary flow, increase in GERD

which may contribute to enamel erosion, oral candidiasis

Dental Hygiene Care: remind patient to bring inhaler, schedule

morning appointments (symptoms worse at night)

Chronic Obstructive Pulmonary

Disease (COPD)

Used to describe pulmonary disorders that obstruct airflow

Primary Etiology: inhaling tobacco smoke with occupations and

environmental pollutants as contributing factors

Tobacco use accounts for 80-90% of COPD mortality

Chronic Bronchitis: excessive respiratory tract mucus production sufficient

to cause a cough with expectoration for at least 3 months

Emphysema: distension (widening) of the air spaces distal to terminal

bronchioles due to destruction of alveolar walls

Assess salivary flow

Cystic Fibrosis

The gene disorder affects salt and water in epithelial cells of the
respiratory tract and exocrine glands and results in thickened
secretions

Medical Management: encouraged to have regular physical

activity

Airways are filled with phlegm (similar to pus)

Postural drainage: the patient should be placed in carious body

position to allow mucus to drain from the airway

No specific oral lesions; dry mouth is associated with cystic fibrosis

Respiratory Disease

Factors to Teach the Patient

Attention to the respiratory hygiene and cough

Frequent hand washing

Thorough daily cleaning and drying of tooth brush to prevent spread of

infection

The need for pneumonia and seasonal influenza immunization

Improve compliance in taking prescriptions

Options to combat medication induced dry mouth

Ouestion #1
Chronic respiratory
diseases include all of the
following except one.
Which one is the
exception?

A. Allergic Rhinitis (hay fever)

B. Pneumonia

C. Tuberculosis

D. COPD

E. All of the following are

chronic respiratory diseases

Ouestion #2
Oral manifestations due to
asthma medications
include:

A. Decreased salivary flow

B. Enamel erosion due to

an increase in GERD

C. Oral Candidiasis

D. Both A and B

E.

All of the above

Question #3
The primary etiology of
COPD is inhaling tobacco
smoke with occupational
and environmental
pollutants as contributing
factors. Tobacco use
accounts for 40-50% of
COPD mortality in men
and women?

A. Both statements are true

B. Both statements are false

C. The first statement is true

and the second statement is
false

D. the first statement is false

and the second statement is
true

References:

Wilkins, Esther M. Clinical Practice of the Dental Hygienist. Philadelphia: Wolters

Kluwer Health/Lippincott Williams & Wilkins, 2013. Print.

Ingelheim, Boehringer. "Chronic Bronchitis." Https://www.spiriva.com/what-iscopd/treating-chronic-bronchitis.html. Boehringer Ingelheim Pharmaceuticals,

Inc., 14 Mar. 2014. Web. 28 Nov. 2014.

"Respiratory Diseases and Conditions."

Http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/Oral-andDental-Health-Basics/Medical-Conditions/Physical-Disorder-OralEffects/article/Respiratory.cvsp. Colgate-Palmolive Company, 1 Mar. 2013. Web.
28 Nov. 2014.