1. Chronic Bronchitis And Emphysema
Special Needs Patient

2. 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).

3. 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).

4. 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).

5. 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).

6. Blue Bloaters Pink Puffers

8. 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).

9. 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).

10. 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

11. Normal Chest Radiograph

12. Chest Radiographs with COPD
Chronic Bronchitis
Emphysema
prominent vascular markings
Hyper-inflated lungs with reduced vascular markings

13. 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).

14. Treatment Chronic Bronchitis & Emphysema
Smoking Cessation
Bronchodilators
Antibiotics
Oxygen Therapy
Lung Reduction Surgery
Lung Transplant

15. Barriers to Care Short Appointments Difficulty Breathing Cost of Care
Debilitating nature of the diseases

16. Patient Education Smoking Cessation Xerostomia Oral Cancer
Extrinsic Stain
Caries Process
Periodontal Disease Process

17. 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

18. Videos https://www.youtube.co m/watch?v=B5e7RMaz4I Q
Chronic Bronchitis
Emphysema
m/watch?v=B5e7RMaz4I Q
m/watch?v=l_xZrdyK1-s

19. ***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

20. 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

21. 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

22. 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

23. 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

24. 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