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Chronic Bronchitis And Emphysema
Special Needs Patient
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What Is COPD? The term chronic obstructive pulmonary disease (COPD) is generally used to describe pulmonary diseases characterized by prolonged airflow limitation from the lungs; is not entirely reversible. COPD involves two main diseases: Chronic bronchitis and emphysema. COPD affects about 8% of adults and 14% of elderly people in the United States (Little, 2013).
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Description of disease manifestation
Chronic Bronchitis Emphysema increased amount of mucus is produced in the respiratory tract causing airways to be swollen and irritated obstruction of the small airways, coughing up mucus or phlegm ***NDHBE Coughing attacks ***NDHBE difficulty breathing in and out due to swollen airways***NDHBE (Wilkins & Wyche, 2013). major lung disease which affects about two million people in the United States (National Institutes of Health, 1997). progressive disease; gets worse over time Chronic coughing with exporant, Wheezing and barrel chest***NDHBE widening or stretching of air spaces in the lungs due to the damage of alveolar walls, making one hard to exhale***NDHBE (Little, 2013).
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What happens in the Lungs?
Chronic Bronchitis Thickened bronchial walls, narrowing of small airways (Little, 2013). Emphysema damages the inner walls of the lungs' air sacs (alveoli), causing them to eventually rupture. This creates one larger air space instead of many small ones and reduces the surface area available for gas exchange” (Mayo Clinic Staff, 2014).
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Signs & Symptoms Develops slowly, most people are unaware of the emerging diseases.
Chronic Bronchitis Emphysema Chronic cough with mucus for at least three months for two consecutive years shortness of breath which can become worse with daily exercises known as blue bloaters***NDHBE tend to be inactive, overweight, edematous, hypoxic, and short of breath Chest radiograph will show prominent blood vessels and large heart. Can have for number of years without any signs or symptoms Traditionally known as pink puffers***NDHBE as difficulty when exhaling widened chest walls “Barrel Chest”, weight loss as the disease gets worse minimal or dry cough, and having to forcibly exhale by pursing their lips together Shortness of breath is the major symptom Chest radiograph will show hyperinflation and small heart (Little, 2013).
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Blue Bloaters Pink Puffers
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Causes & Ages Both Chronic Bronchitis & Emphysema Are Progressive Diseases
onset is approximately age fifty; prevalent in females***NDHBE Cigarette smoking is the main cause; smokers cough***NDHBE can have a chance to improve their lives if they are diagnosed and treated earlier Avoiding secondhand smoke and complete cessation of smoking can also improve their lives low chance of complete recovery for those who have the serious form of this disease. onset approximately age 60; prevalent in older males***NDHBE Smoking is the main cause of this disease Quitting smoking can help keep it from getting worse can have emphysema for number of years without seeing any signs or symptoms (Little, 2013).
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Chronic Bronchitis And Emphysema
Risk Factors Other Causes Tobacco Smoker ***NDHBE Frequent exposures to Environmental Pollutants, Chemical Fumes, & Dusts, etc. Secondhand Smoker genetics***NDHBE Severe respiratory infections in childhood***NDHBE Inhaling irritants or pollutants such as sulfur dioxide, bromine, hydrogen sulfide, strong acids, ammonia, chlorine dusts, and some organic solvents (Little, 2013).
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Everyday Life Breathing difficulty
Chronic Bronchitis Emphysema Breathing difficulty Difficulty with daily life activities or chores. Daily coughing with mucus Daily oxygen therapy 'mild' emphysema have symptoms only during exertion, such as long walks, exercise, etc. moderate or severe may have difficulty with little exertion (such as walking around the house) or during daily living activities or even resting
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Normal Chest Radiograph
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Chest Radiographs with COPD
Chronic Bronchitis Emphysema prominent vascular markings Hyper-inflated lungs with reduced vascular markings
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Chronic Bronchitis and Emphysema
Oral Manifestations Chronic Bronchitis and Emphysema Halitosis, Nicotine stomatitis Extrinsic tooth stains Periodontal disease Premalignant mucosal lesions Oral cancer Xerostomia (Little, 2013).
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Treatment Chronic Bronchitis & Emphysema
Smoking Cessation Bronchodilators Antibiotics Oxygen Therapy Lung Reduction Surgery Lung Transplant
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Barriers to Care Short Appointments Difficulty Breathing Cost of Care
Debilitating nature of the diseases
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Patient Education Smoking Cessation Xerostomia Oral Cancer
Extrinsic Stain Caries Process Periodontal Disease Process
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Dental Treatment Considerations
Semi-Supine Position***NDHBE Basically treat patient sitting up***NDHBE Avoid N2O***NDHBE Avoid ultrasonics, power-driven polishers, and rubber dams***NDHBE May increase respiratory vital signs ***NDHBE Avoid Overdose of Anticholinergic Avoid Narcotics & Barbiturates
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Videos https://www.youtube.co m/watch?v=B5e7RMaz4I Q
Chronic Bronchitis Emphysema m/watch?v=B5e7RMaz4I Q m/watch?v=l_xZrdyK1-s
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***NDHBE Chronic Ostructive Pulmonary Disease (copd)
Group of lung diseases that block airflow and make breathing difficult. Emphysema (pink puffer) Chronic Bronchitis (blue bloater) Cystic Fibrosis Tuberculosis
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Emphysema ***NDHBE Over inflation of alveoli/air sacs which impairs airflow out of the lungs Increased respiratory rate (puffer); shallow breaths-o2 ok Dry cough-smoker hack Appointment modifications: Stress reduction Treat patient sitting up Increased risk of oral cancer if long-term smoking history May need oxygen Do NOT use: nitrous oxide, air polisher, ultrasonic scaler, or rubber dam***NDHBE
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Chronic Bronchitis ***NDHBE
Inflammation of lining of bronchial tubes which narrows airways Heavy mucous/phlegm Wet cough Cyanosis (blue) & increased lung volume (bloater) Appointment modifications: Stress reduction Treat patient sitting up Increased risk of oral cancer if long-term smoking history May need oxygen Do NOT use: nitrous oxide, air polisher, ultrasonic scaler, or rubber dam***NDHBE
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Cystic Fibrosis ***NDHBE
Inherited disorder of exocrine glands (glands that go to surfaces—tears, sweat, saliva, digestive juices) Secretions become thick and sticky Accumulation of mucous blocks oxygen exchange in the lungs Shortens life; most people die in their 40’s Appointment modifications: Chair semi-upright to facilitate breathing Do NOT use: nitrous oxide, air polisher, ultrasonic scaler
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Tuberculosis (TB) ***NDHBE
Bacteria (mycobacteria) spread through airborne transmission (cough, sneeze, spit) Drug resistant strains Appointment Modifications: Do not treat patient with active TB disease TB drugs may lead to hepatotoxicity—avoid drugs metabolized in liver (acetaminphen-tylenol) PPD (Purified protein derivative, Mantoux skin test, TB skin test, tuberculin skin test) Measure of exposure to TB Type IV hypersensitivity reaction—delayed, read hour after PPD administered Positive if area of induration (hard swelling) If positive: Means there has been exposure to TB—Does not mean active infection Follow-up is needed to assess active TB chest xray/sputum-can confirm active TB May treat prophylactically with anti-TB drugs (isoniazid) tough on liver
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References Wilkins, E. M., & Wyche, C. J. (2013). 2012). Clinical Practice of the Dental Hygienist, 11th Edition. [VitalSource Bookshelf version]. Retrieved from Mayo Clinic Staff. (2014, July 11). Emphysema - Mayo Clinic. Retrieved from /CON ?p=1 Little, J. W., Falace, D., Miller, C., & Rhodus, N. L. (2013). Little and Falace's Dental Management of the Medically Compromised Patient, 8th Edition. [VitalSource Bookshelf version]. Retrieved from /outline/7 National Institutes of Health. (2011, August 4). How Is Bronchitis Diagnosed? - NHLBI, NIH. Retrieved from topics/topics/brnchi/diagnosis 7: Pulmonary Disease | Pocket Dentistry. (n.d.). Retrieved from Hasudungan, A. (2014, January 14). Emphysema Treatment [Video file]. Retrieved from Khan Academy. (2014, July 8). What is chronic bronchitis? [Video file]. Retrieved from National Institutes of Health. (1997, June 1). NHLBI Researchers Reverse Emphysema in Lab Animals - NHLBI, NIH. Retrieved from releases/1997/nhlbi-researchers-reverse-emphysema-in-lab-animals
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