Respiratory System - Dental Aspects

• Respiratory history:

  • Ask about respiratory disorders in history
  • If a pt has a respiratory disorder, ask about the effectiveness of treatment (eg inhalers) and what is required to precipitate problems
• General points:

  • Shortage of breath - at rest, on exertion (SOBAR [shortness of breath at rest], SOBOE [shortness of breath on exertion])
  • Cough - possible production of sputum - colour - if so, wait until infection has cleared up before treating them
  • Necessity or otherwise for hospital in-patient treatment
  • Use of steroids - if they do then it's quite a serious respiratory problem
• Inhaler use:

  • Commonest - Salbutamol - beta-2-agonist
  • Terbutaline - same mechanism
  • Ipratropium bromide - antimuscarinic
  • Beclometasone - steroid
  • Salbutamol = "ventolin" = blue
  • Beclometasone = "becotide" = brown
• Steroid inhalers:

  • Predispose to oral candidosis - because aerosol from inhaler has hit soft palate instead of going down airway
  • Rinse with water after inhaler use
  • Consider other oral causes of candidosis
• Oral candidosis:

  • Consider diabetes mellitus
  • Immunosuppression (inherent or induced)
  • Denture-related issues
• Examination:

  • Colour
  • Signs of anaemia
  • Finger clubbing
  • Radial pulse - bounding in COPD
  • Use of accessory muscles of respiration
  • Respiratory rate
  • Trachea position
  • Symmetry of chest movements
• Respiratory system conclusions:

  • Most information is gained from the HISTORY
  • A dental clinician should be able to make an informed assessment of the status of a patient's respiratory system and be able to make relevant basic clinical observations in a clothed patient
  • Know how to manage acute exacerbations