Risk Assessment and Dental Management Géza T Terézhalmy DDS MA Professor and Dean Emeritus School of Dental Medicine Case Western Reserve University Cleveland Ohio gtt2caseedu The Patient With Respiratory Abnormalities ID: 914954
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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
Slide2The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
H1 receptor
antagonists
1st generationpromethazine hydrochloride2nd generationfexofenadine hydrochloride
4/1/2010
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Slide3The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, AtopyMechanisms of
action
Vascular smooth
muscle – H1 blockadeContraction of post-capillary venule and terminal arterioleReduce rubor
4/1/2010
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Slide4The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
Vascular
endothelial
cells – H1 blockadeRelaxation of endothelial cellsReduce edema, wheal response
4/1/2010
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Slide5The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, AtopyLungs – H1 blockade
Bronchodilation
Reduce asthma-like
symptoms4/1/2010
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Slide6The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
Nerves – H1 blockade
Reduce sensitivity of afferent nerve terminals to chemical mediators of inflammation
Reduce Itching, pain4/1/2010
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Slide7The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, AtopyStomach – H2 blockade
Decreased gastric acid secretion
Reduce pepsin synthesis,
heartburn4/1/2010
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Slide8The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, AtopyHeart – H2 blockade
Reduce Ca
2+
influx into myocytesDecrease in heart rate and contractility4/1/2010
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Slide9The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, AtopyCNS – H3 blockade
Block histamine-dependent neurotransmission
Modulate circadian rhythms and
wakefulness4/1/2010
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Slide10The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
ADEs
Xerostomia
4/1/2010
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Slide11The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
Risk assessment
Disease-related variables
4/1/2010
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Slide12The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
Clinical
indications
Allergic rhinitisSeasonal allergies
Perennial allergies
Urticaria
Angioedema
Atopy
4/1/2010
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Slide13The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
Treatment
strategies
First generation H1 receptor antagonists may produce sedationAdditive with other CNS depressantsAnxiolytic agentsLocal anesthetics
Opioid analgesics
4/1/2010
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Slide14The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
Preventive strategies
Oral hygiene
Conventional vs. electromechanical toothbrushesAntibacterial mouthwashesTopical fluoridesSialagogues
Pilocarpine (Salagen)Cevimeline (Evoxac)
4/1/2010
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Slide15The Patient With Respiratory AbnormalitiesAllergic Rhinitis, Urticaria, Atopy
Medical emergencies
To be anticipated based on the patient’s medical history and vital signs
4/1/2010
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Slide16The Patient With Respiratory AbnormalitiesASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
4/1/2010
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Slide17The Patient With Respiratory Abnormalities(Asthma and COPD)
2
-receptor agonists and anticholinergic agentsAdvair
Diskus (fluticasone propionate w/ salmeterol)
Proventil
HFA (
albuterol)
Albuterol
ProAir
HFA (
albuterol)
Combivent
(ipratropium
w/albuterol)
Spiriva
HandHaler (tiotropium bromide)
4/1/2010
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Slide18The 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
4/1/2010
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Slide19The Patient With Respiratory Abnormalities(Asthma and COPD)
Risk assessment
Disease-related variables
4/1/2010
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Slide20The Patient With Respiratory Abnormalities(Asthma and COPD)
Asthma
Often begins in childhood
CoughingWheezingShortness of breath
4/1/2010
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Slide21The Patient With Respiratory Abnormalities(Asthma and COPD)
10
% of asthmatics have a triad of
ASA intoleranceNasal polypsChronic sinusitis4/1/2010
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Slide22The Patient With Respiratory Abnormalities(Asthma and COPD)
Chronic bronchitis
Usually smokers 35 years or older
Recurrent respiratory infectionsProductive coughHypoxic hypoxemia
PolycythemiaRight sided heart failure
Cyanosis
4/1/2010
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Slide23The 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
4/1/2010
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Slide24The Patient With Respiratory Abnormalities(Asthma and COPD)
Treatment strategies
Physiological stress (physical, emotional) may lead to respiratory distress
Reduce anxietyEnsure profound anesthesiaPost operative pain management
Avoid opioids
4/1/2010
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Slide25The Patient With Respiratory Abnormalities(Asthma and COPD)
Preventive strategies
Oral hygiene
Conventional vs. electromechanical toothbrushesAntibacterial mouthwashesTopical fluoridesSialagoguesPilocarpine (Salagen)Cevimeline (Evoxac)
4/1/2010
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