Hygienist Essay

From pediatric patients to geriatric patients, respiratory diseases and disorders can affect a variety of patients. Many of which cause lower respiratory rates and drug interactions that can compromise routine dental treatment and even elicit medical emergencies. A hygienist should not only have the knowledge to treat a respiratory emergency but also how to prevent one. Respiratory diseases can be divided into upper and lower respiratory diseases, some requiring more precautions than others. It is important to know the general characteristics of both types and the problems they present to receiving dental treatment. This paper is indicated to discuss the identification, precaution, and treatment of patients with respiratory diseases most commonly seen in a dental setting.
Upper respiratory diseases are typically caused by infections to the sinuses, nasal passages, pharynx, and larynx. Named specifically by their location, the most common are sinusitis, rhinitis, pharyngitis, tonsillitis, and influenza. They can be transmitted airborne or contact with infected persons or objects that have been newly infected by the discharge of the infected person. Therefore, hygienist should know the signs and symptoms in case a patient should be
deferred to a later appointment when infection has ceased. Additional ways to prevent infection between hygienist and patient are using tissues to contain sneezes and coughs, frequent handwashing, and using masks (Wilkins 993). Also, getting a flu vaccination is a prevention strategy.
Influenza and rhinitis are the most common viral infections in children. A patient with the flu shows signs and symptoms of chills, sore throat, and dry cough. A less severe viral infection is rhinitis, also known as the common cold, involving nasal congestion, watering of the eyes, sneezing, and headaches. The most common clinical manifestations are small round erythematous lesions on the soft palate and enlargement of the lingual tonsils (Wilkins 992). Treatment would be antihistamines for sneezing, analgesic for pain and headaches, and decongestants. Although, the decongestants used in upper respiratory infections cause decreased saliva flow, leading to xerostomia.
Moving down in location, pharyngitis and tonsillitis is the mucosal inflammation of the pharynx and tonsils; due to either viral or bacterial infections. Symptoms include sore throat, fever, and enlarged tonsils ( ). Another common upper respiratory infection is sinusitis. When a patient has sinusitis there is an excess of mucosal secretions, tenderness, and facial swelling. In addition, patients may complain of a toothache when it is actually pain from pressure on the maxillary sinus. More severe cases include nasal obstruction and mouth breathing, which causes the patient to have xerostomia. Between the mouth breathing and decongestants, patients with upper respiratory infections have a greater risk for caries due to the significant decrease in saliva. To help xerostomia, the hygienist can inform the patient to keep the mouth moist with frequent sips of water, ice chips, or popsicles. Lower respiratory diseases and disorders involve the lower respiratory tract: trachea, bronchioles, and lungs. Pneumonia is an infection of the lungs, single or both, caused by microorganisms such as viruses, bacteria, and fungi. Patients with weakened immune systems, for instance AIDS, infants, and geriatrics, are more prone to pneumonia than a healthy individual. This infection can be divided into community-acquired and healthcare-associated, or nosocomial, pneumonia. According to Ester Wilkins, the difference is that healthcare-associated is “infection occurring forty-eight to seventy-two hours after admission to a healthcare facility,” whereas community-acquired is any person infected outside of a healthcare facility (993).
Additionally, if a patient aspirates materials such as bacteria, food, or liquid, they can have aspiration pneumonia. The oral cavity normally contains bacteria in the dental biofilm and gingival tissues; when they are aspirated along with saliva, they can grow and fester in the lungs. In a nursing home, typically the patient is unable to facilitate proper oral hygiene care, thus resulting in a greater accumulation of plaque, which also presents a risk for aspiration pneumonia. This shows the great importance for the hygienist to address constant oral homecare instructions not only to patients with periodontal disease and weakened immune systems, but also to caregivers since they would be the ones providing the oral homecare for the patient.
Asthma is chronic respiratory disorder of the lower respiratory system, resulting in wheezing, chest tightness, and breathlessness. During an asthma attack, the “bronchi contract into spasm,” causing dyspnea, and the airways tighten, causing the “coughing and wheezing” (Grimes 134).For an asthma attack to occur, a trigger, or stimuli, must be exposed to the person in order to stimulate the immune response. The type of asthma can be subdivided into one of five categories based on the trigger: intrinsic, extrinsic, drug induced, exercise induced, and infectious.
Intrinsic asthma occurs in adults and is triggered by a source from within the body. These include physiologic stress, emotional stress, and gastric reflux. Whether it is surgery or a simple cleaning, having a dental appointment is a stressful situation among many, and at times an asthmatic trigger. The dental professional should take precautions before the patient arrives and while the patient is in the dental chair to make for a calm, stress-free environment. Morning appointments are best for these patients since there is less time to be anxious. Also, the dental hygienist, or assistant, should make sure to cover any sharp instruments or needles in the room. Additionally, using a calm tone when speaking helps the patient feel more relaxed and at ease.
In contrast, extrinsic asthma is caused by an allergic trigger from the outside of the body.
This type of asthma accounts for half of all asthmatics. Allergens included, but are not limited to, are pollen, dust, and furry animals. Some dental materials such as resins, eugenol, impression materials, and latex can trigger an asthma attack (Grimes 135). Once the allergen is exposed, the allergen binds to the IgE, resulting in the mast cell releasing asthma mediators that cause “bronchoconstriction, vasodilation, and mucous production” (Wilkins 997). The best way to prevent an event from occurring in the dental chair is to review the patient’s medical history to identify the dental triggers and not incorporate them in the
appointment.
Some patients may have drug induced asthma, which can be activated by NSAIDs such as aspirin and ibuprofen. Also, metabisulfate, which is a preservative in foods and dugs like local anesthetics containing epinephrine, can be a trigger. Another type of asthma is exercised-induced, which usually affects children and young adults due to their increased level of physical activity (Grimes 135). Finally, a viral, bacterial, or fungal infection to the lungs is the most common cause of infectious asthma. Furthermore, treatment of the infection will subside the asthmatic symptoms and restore normal breathing. Patients that require an inhaler should be reminded to bring the inhaler with them to their appointment. More severe or uncontrolled patients should use their inhaler in advance. Similarly, the dental office’s emergency kit should always be equipped and up to date with an inhaler.
In patients with asthma, there are long-term control medications and short-term, or quick relief, medications. The most preferred and most effective long-term use treatment is an inhaled corticosteroid at a low dose; examples include Prednisone, Flovent, and Qvar. As a result of long-term use of a corticosteroid, there is an increased risk for dry mouth and oral candidiasis. For that reason, patients using this type of treatment should rinse mouth out with water after use to minimize the risk (Haveles 225). Patient may need a medical consult if uncontrolled or using a corticosteroid to determine whether or not they need a premedication before dental treatment. For short-term or emergency relief, a patient will more than likely have their own prescribed inhaler with them. Some examples include: Albuterol, Metaproterenol, and Levalbuterol (Haveles 222). A bronchodilator, usually Albuterol, is the preferred relief to acute symptoms and to relax the smooth muscles; this is the type that is contained in the dental office emergency kit. General oral manifestations are xerostomia, increased risk for caries, and gingivitis in patients with poor oral hygiene (Wilkins 999).
Patients with asthma should avoid sulfating agents in local anesthetics that have a vasoconstrictor if they are using Albuterol. The two conflict because the vasoconstrictor causes bronchoconstriction, whereas Albuterol causes bronchodilation (Haveles 227). It is extremely important for the dental professional to be prepared for a medical emergency. In the event of an asthma attack, cease treatment and raise dental chair to its upright position. Next, loosen any tight clothing and give the patient their bronchodilator if they do not already have it. The dental professional can supply oxygen with a non-breather bag at four to six liters per minute. Monitor vitals, and if attack does not cease, then additional doses should be taken every fifteen minutes; maximum dosage of Albuterol is twelve inhalations a day (Grimes 137). Emergency services should be contacted when attack does not subside to prevent status asthmaticus.
Chronic obstructive pulmonary disease, abbreviated as COPD, is an “irreversible airway obstruction,” that occurs with chronic bronchitis and emphysema (Haveles 221). Emphysema causes destruction of the walls and elastic fibers of the alveoli; so when exhaling, the airways collapse, impairing airflow out of your lungs. Chronic bronchitis cause inflammation and narrowing of the bronchial tubes, and it present with more mucous production, which further obstructs the narrowed airways. The majority of COPD cases result from long term exposure to lung irritants that attack the lungs and airways. Cigarette smoking is the leading cause of COPD, accounting for eighty-seven to ninety-one percent of development. Additionally, breathing in polluted air, chemical fumes, and even secondhand smoke can contribute to COPD (Rahman, et al. 1).
A patient with COPD will show signs and symptoms of a persistent cough that may produce large amounts of mucous. Furthermore, they will have a chest tightness, wheezing, and shortness of breath, especially with physical activity. Severe COPD can result in cor pulmonale, which is when the right side of the heart fails; thus, leading to swelling in the lower extremities, blue lips due to low blood oxygen levels, and shortness of breath. It is important for the dental professional to not assume that the patient has COPD based on symptoms because the symptoms can encompass other conditions and respiratory diseases (Rahman, et al. 2). As recently discussed, asthmatic patients also have wheezing, tightness in chest, and shortness of breath. Likewise, pulmonary hypertension is the most common cause of cor pulmonale and it is not limited to COPD as the only cause. Therefore, it is the role of the patient’s physician to diagnosed and determine management of COPD.
Hygienists have an easy gateway to conversing with their patient about smoking cessation when they have COPD because smoking only exacerbates the condition. More severe symptoms may require the patient to seek emergency care, for instance difficulty catching breath, and if lips or fingernails turn blue or gray. Orally, the clinical observation will be similar to asthmatic patients, and patients that use tobacco will have an increased risk for halitosis, staining, oral cancer, periodontal infections, and nicotine stomatitis (Wilkins 1001). These patients are also prone to secondary respiratory infections. COPD symptoms gradually worsen overtime and the severity of symptoms depends on how much lung damage has occurred. There is no cure for COPD, but medications and therapies can be used to manage symptoms. Medications used are similar to the ones used to treat asthma. Patients may need oxygen therapy via oxygen tank: continuous flow or by demand. Ones using this therapy should be advised to cease smoking and avoid high heats, or flames, due to its capability of combustion. Severe emphysema may require a lung transplant if part of one lung or both have to be surgically removed.
During the dental appointment, the hygienist needs to take special precautions. This includes being aware of the level of severity; the more moderate or severe they are, the more obstruction in the lungs. A comprehensive medical history is the “foundation of the risk assessment process” (Rahman, et al. 2). It is important that the hygienist or dental professional use stress reducing techniques, and avoid procedures that may depress the patient's respiratory capability, such as power-driven scalers and air polishers. Also, the patient may require an upright or semi-supine position during dental treatment (Wilkins 1002). They may require short, focused dental appointments in the morning. Nitrous oxide is a contraindication for patients with COPD due to their decreased lung capacity. Medications used for COPD are inhaled anticholinergic drugs (Haveles 226). Vasoconstrictors should be avoided with these medications since they have the opposite effect, causing bronchoconstriction instead of bronchodilation. When severe cases are unaffected by the bronchodilators, the use of sustained release theophylline may be considered (Rahman, et al 2). Theophylline has proven to increase respiratory muscle function, but patients using this medication should not should not be given erythromycin, ciprofloxin, or clindamycin because they affect the metabolism of theophylline, causing toxicity.
In conclusion, there are multiple respiratory diseases that present complications when providing dental treatment. Pertaining to the ones mentioned in this paper, the hygienist or dental professional should be able to recognize these diseases in order to provide an effective and safe dental treatment. He or she must also be able to recognize the oral manifestations that might arise from the condition or the medications used to treat or manage the symptoms. Any medical alerts should be documented in the patient’s records for current and future appointments. Additionally, there are many factors a hygienist can teach the patient whether it be oral hygiene or common precautions to take before dental treatment or during. Patients with respiratory diseases can be easily treated as long as the dental professional has an established knowledge on the precautions, identifications, and treatments of the more commonly seen cases in the dental setting.