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THE PATIENT WITH RESPIRATORY ABNORMALITIS Risk Assessment and Dental Management. Géza T. Terézhalmy, D.D.S., M.A. Professor and Dean Emeritus School of Dental Medicine Case Western Reserve University Cleveland, Ohio gtt2@case.edu.
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THE PATIENT WITH RESPIRATORY ABNORMALITISRisk Assessment and Dental Management Géza T. Terézhalmy, D.D.S., M.A. Professor and Dean Emeritus School of Dental Medicine Case Western Reserve University Cleveland, Ohio gtt2@case.edu
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy • H1 receptor antagonists • 1st generation • promethazine hydrochloride • 2nd generation • fexofenadine hydrochloride
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy • Mechanisms of action • Vascular smooth muscle – H1 blockade • Contraction of post-capillary venule and terminal arteriole • Reduce rubor
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy • Vascular endothelial cells – H1 blockade • Relaxation of endothelial cells • Reduce edema, wheal response
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy • Lungs – H1 blockade • Bronchodilation • Reduce asthma-like symptoms
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy • Nerves – H1 blockade • Reduce sensitivity of afferent nerve terminals to chemical mediators of inflammation • Reduce Itching, pain
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy • Stomach – H2 blockade • Decreased gastric acid secretion • Reduce pepsin synthesis, heartburn
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy • Heart – H2 blockade • Reduce Ca2+ influx into myocytes • Decrease in heart rate and contractility
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy • CNS – H3 blockade • Block histamine-dependent neurotransmission • Modulate circadian rhythms and wakefulness
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy • ADEs • Xerostomia
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy • Risk assessment • Disease-related variables
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy • Clinical indications • Allergic rhinitis • Seasonal allergies • Perennial allergies • Urticaria • Angioedema • Atopy
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy • Treatment strategies • First generation H1 receptor antagonists may produce sedation • Additive with other CNS depressants • Anxiolytic agents • Local anesthetics • Opioid analgesics
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy • Preventive strategies • Oral hygiene • Conventional vs. electromechanical toothbrushes • Antibacterial mouthwashes • Topical fluorides • Sialagogues • Pilocarpine (Salagen) • Cevimeline (Evoxac)
The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy • Medical emergencies • To be anticipated based on the patient’s medical history and vital signs
The Patient With Respiratory Abnormalities ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
The Patient With Respiratory Abnormalities(Asthma and COPD) • 2-receptor agonists and anticholinergic agents • Advair Diskus (fluticasone propionate w/ salmeterol) • Proventil HFA (albuterol) • Albuterol • ProAir HFA (albuterol) • Combivent (ipratropium w/albuterol) • Spiriva HandHaler (tiotropium bromide)
The Patient With Respiratory Abnormalities(Asthma and COPD) • Mechanisms of action • Albuterol is a short-acting 2-receptor agonist • Salmeterol is a long-acting 2-receptor agonist • Ipratropium and tiotropium block the action of acetylcholine
The Patient With Respiratory Abnormalities(Asthma and COPD) • Risk assessment • Disease-related variables
The Patient With Respiratory Abnormalities(Asthma and COPD) • Asthma • Often begins in childhood • Coughing • Wheezing • Shortness of breath
The Patient With Respiratory Abnormalities(Asthma and COPD) • 10% of asthmatics have a triad of • ASA intolerance • Nasal polyps • Chronic sinusitis
The Patient With Respiratory Abnormalities(Asthma and COPD) • Chronic bronchitis • Usually smokers 35 years or older • Recurrent respiratory infections • Productive cough • Hypoxic hypoxemia • Polycythemia • Right sided heart failure • Cyanosis
The Patient With Respiratory Abnormalities(Asthma and COPD) • Emphysema • Usually preceded by chronic bronchitis • Smoking • Stimulates proteases • protease inhibitor activity • May be hereditary • Lack of protease inhibitor • Right sided heart failure • Peripheral edema • Hepatomegaly
The Patient With Respiratory Abnormalities(Asthma and COPD) • Treatment strategies • Physiological stress (physical, emotional) may lead to respiratory distress • Reduce anxiety • Ensure profound anesthesia • Post operative pain management • Avoid opioids
The Patient With Respiratory Abnormalities(Asthma and COPD) • Preventive strategies • Oral hygiene • Conventional vs. electromechanical toothbrushes • Antibacterial mouthwashes • Topical fluorides • Sialagogues • Pilocarpine (Salagen) • Cevimeline (Evoxac)