RESPIRATORY DISEASES STUDY NOTE - Alma Fuentes

Primary Functions​:
- Air distributor for the body
- Gas exchanger for the body

Other Functions​:
- Humidifies air
- Filters air
- Warms air

Honorable Mentions​:
- Helps with speech
- Helps with sense of smell

Structures:
- Sinuses
- Nasal cavity
- Larynx
- Trachea
- Bronchi
- Lungs
- Pleura

Respiratory Tracts
- Upper:
- Outside of the thorax
- Nose
- Sinuses
- Pharynx,
- Larynx
- Lower:
- Inside of the thorax
- Trachea
- Bronchial tree (bronchi, bronchioles, alveoli)
 RESPIRATORY DISEASES STUDY NOTE - Alma Fuentes

- Lungs
- Pleura
Functions:
- Facilitate movement of air into alveoli (O​2​ and CO​2​ exchange via diffusion aka
passive transport)
- Fxns w/ cardiovascular system

Respiratory membrane and mucosa:

Respiratory Diseases
- Common amongst general population
- Common nature makes them important to understand for RDH
- Restrictive vs obstructive
- Divided into:
- Acute and chronic
- Upper and lower respiratory
- Lower resp tract diseases considered more serious
- Most common resp. Diseases:
- Asthma
- Chronic obstructive pulmonary disease (COPD)
- Emphysema
- Chronic bronchitis
- TB remains a worldwide problem
 RESPIRATORY DISEASES STUDY NOTE - Alma Fuentes

Respiratory Diseases
Location Acute Chronic

Upper Infective Rhinitis Allergic Rhinitis

Respiratory Sinusitis
Tract Pharyngitis/tonsillitis
Laryngitis
seasonal/viral flu

Lower Acute bronchitis TB

Respiratory Pneumonia Asthma
Tract COPD

Upper Respiratory Tract Diseases

- Nose
- Rhinitis
- Infective
- Viral
- Sneezing, nasal congestion and discharge
- Headache
- Watery eyes
- Small red erythematous lesions on soft palate, enlarged
tonsils, dry mouth due to medications or mouth breathing
- Runs course with or without treatment in 7-10 days
- Analgesics for pain, decongestants, antihistamines
- Allergic
- Aka hay fever
- Seasonal or year round triggers result in
- IgE-mediated hypersensitivity reactions
- Watery burning eyes
- Sneezing
- Nasal congestion
- Dry mouth and oral candidiasis
- Antihistamines, decongestants and immunotherapy
- Nasal Polyps
- Non-cancerous growths on nasal mucosa that may partially obstruct
air passage
- Associated with chronic hay fever
- Sinuses
- Sinusitis
- Inflammation of the mucosa that lines the sinuses
- Continuation of respiratory mucosa
- Often results from cold in which the nasal mucosa is inflamed
- Pharynx
- Pharyngitis
- Inflammation of pharynx
- AKA sore throat
 RESPIRATORY DISEASES STUDY NOTE - Alma Fuentes

- Painful to swallow
- Enlarged tonsils and erythematous tissues
- Many causes-mostly viral
- Inflammation of mucus membrane of pharynx can continue in to
Eustachian tube-ear ache
- Tonsils
- Masses of lymphatic tissue that provide immune protection at this critical
boundary with internal environment
- Tonsillitis=swelling or inflammation of tonsils due to infection
- Swelling of pharyngeal tonsils can make breathing difficult through nose and
force through mouth
- Laryngitis
- Inflammation and edema of the mucous lining of the larynx
- If swelling of vocal cords occurs then voice may be lost or hoarse
- Virus, bacteria, smoking, allergies
- Croup-type of laryngitis in children under 3
- Epiglottitis-life threatening condition caused by H influenza B (Hib)

RDH Considerations:

- Postpone treatment until not infectious (reduction in temperature and regression of

oral erythematous lesions)
- Post visual alerts of respiratory infections, hand hygiene and cough and sneeze
etiquette for workers and clients
- Hand hygiene
- Hand sanitizer for staff and clients
- Routine practices/universal precautions/standard precautions
- Keep up to date on immunizations-staff and clients
- Possible need for medical consult if unsure of medical status, or severity of
condition or level of control
- Dry mouth due to mouth breathing
- Difficulty with water due to mouth breathing
- Difficulty breathing due to obstructions such as enlarged tonsils, nose polyps, or
inflammation of affected mucous membrane
- Dry mouth due to medications-antihistamines, analgesics, decongestants,
anticholinergic
- Encourage client to avoid allergens if allergic rhinitis and remove from office (fresh
flowers, plants, dust, mold, etc…)
- Rinse after corticosteroid use to avoid candidiasis- Puffers
- Sinusitis may result in pain in maxillary molar teeth due to proximity

Lower Respiratory Tract Diseases

- Acute Bronchitis
- Infection involving large airways
- Trachea, bronchi
RESPIRATORY DISEASES STUDY NOTE - Alma Fuentes

- Cough lasts 3 weeks-with or without phlegm

- Wheezing, shortness of breath, chest tightness
- Clear x-ray
- Viral - most common, rest, fluids and possible bronchodilators and or cough
suppressant
- Bacterial - antibiotics required
- Pneumonia
- Inflammation of lungs in bronchioles, interstitial lung tissue or alveoli
- Pathogens trapped by defenses (cough reflex, mucociliary/mucus blanket,
macrophages in alveoli) in nasopharynx, oropharynx and upper respiratory
tract
- When defense mechanisms are inadequate the inflammatory and immune
response occurs in interstitial tissue and alveoli
- Alveoli fill with RBC, WBC and fibrin and cause consolidation/solid mass in
the lung tissues
- Consolidation areas are evident on x-rays
- Alters ventilation resulting in impaired oxygen diffusion, hypoxia, metabolic
acidosis, and dehydration
- Runs course in approximately 2 weeks
- Elderly, very young, smokers, immunosuppressed have increased risk
- People with decreased salivary flow, inability to perform OH, problems with
swallowing, physical disabilities have an increased risk
-
Viral Pneumonia tx Bacterial Pneumonia tx Fungal Pneumonia tx

- Mild cough, - Sudden onset - Sulfa drugs

fever, dyspnea, - Cough, purulent
mild symptoms sputum
- Diagnosis with - High fever
signs and - Dyspnea
symptoms and tachypnea
chest x-ray - Pleuritic chest
- Rest, fluids pain
- Diagnosis with
signs and
symptoms and
chest x-ray and
sputum sample,
blood test
(WBC)
- Antibiotics
- Legionnaires Disease:
- Type of pneumonia that is a bacterial (legionella) that is inhaled
through air condition units or other non person to person contact
(whirlpools, potable water supply)
- Nosocomial infection from hospitals or other institutions
- Legionella has been detected in dental unit waterlines
RESPIRATORY DISEASES STUDY NOTE - Alma Fuentes

- RDH Considerations:
- Postpone treatment until recovered
- Control of oral diseases including periodontal disease in LTC and
hospital settings to prevent aspiration pneumonia
- 0.12% chlorhexidine gluconate rinse as PPR
- Avoid ultrasonic, and air polisher use due to aerosols and potential for
aspiration of pathogens
- Possible need for medical consult if unsure of medical status, or
severity of condition or level of control
- Asthma
- CHRONIC respiratory disease consisting of recurrent episodes of:
- Dyspnea
- Wheezing
- Increased responsiveness/over-reaction of bronchioles to stimuli/triggers
- Leads to bronchial inflammation and muscle contraction
- Stimuli and Triggers:
- Extrinsic /Allergic/Atopic (inhaled antigen)
- Intrinsic/Non-allergic (pollen, ragweed, moulds, foods, cockroaches,
animal hair, house dust mites, methacrylates in dental materials,
smoke, scents, sprays)
- Drug or food Induced (Non-allergenic, Non-atopic) (ASA, NSAIDS,
Beta Blockers, nuts, shellfish, milk, strawberries, yellow food dye
(tartrazine), metabisulphate preservatives in wine, beer, shrimp, dried
food, and metabisulphate preservatives in drugs (local anesthetics
with epinephrine)
- Exercise Induced (common in younger people)
- Infection Induced (viral, fungal, bacterial lung infection)
- Status Asthmaticus (sever and does not respond to tx by
bronchodilators, requires hospitalization)
- Signs and Symptoms:
- Tight chest, pressure in chest
- Sense of suffocation
- Wheezing, cough
- Nasal flaring
- Dyspnea
- Ineffectiveness of bronchodilator
- Increased BP
- Confusion
- Tachycardia
- Flushed appearance
- Anxiety
- Need to stand up
- Tuberculosis
- Most commonly caused by Mycobacterium tuberculosis (rod shaped tubercle
bacillus)
- Highly contagious infectious disease
RESPIRATORY DISEASES STUDY NOTE - Alma Fuentes

- Transmitted through inhalation or swallowing of contaminated droplets with

TB bacillus
- One of oldest disease – world widespread
- Once thought under control
- Decrease in Americans while increase worldwide due to social & economic
conditions, international travel, TB persons migration & HIV
- Immunosuppressed = more susceptible
- Affects lungs, but can attack other organs & tissues
- Difficult to treat due to compliance, groups affected, length of time needed to
treat
- Drug resistance
- Signs and symptoms
- Later Stages
- Fever
- Chills
- Persistent cough with purulent sputum
- Hemoptysis
- Chest pain
- Dyspnea
- RDH Considerations:
- eed to address major concern – risk of disease transmission to
prevent disease transmission
- Always use universal infection control as TB clients may not be
identified
- Recognize signs & symptoms of TB during med history assessment –
refer to MD
- Question client with TB history or positive results from TB skin test =
dates and results of chest radiographs, sputum cultures, physical
exam, treatment regimen, compliance, follow-ups evaluations
- COPD
- Blanket Condition that describes a number of obstructive conditions
- Most common COPD:
- Chronic Bronchitis
- Emphysema
- Often occur together
- Progressive non-reversible diseases
- Preventable
- Tobacco use accounts for 80-90% of COPD related mortality in men and
women
- Second hand smoke and other environmental and occupational contributing
factors
- Risk Factors:
- Cigarette smoking – major risk factor
- Air pollutants
- Industrial dust & fumes
- Underlying respiratory disease
RESPIRATORY DISEASES STUDY NOTE - Alma Fuentes

- Severe respiratory infection

- Underdeveloped lungs (childhood, gestation)
- Genetic predisposition known as alpha-1 antitrypsin deficiency blood
protein that protects lungs
- Oral Manifestations:
- Similar to asthma
- Meds cause xerostomia
- Increased risk of caries
- Potential for increase in GERD
- Candidiasis
- RDH Considerations
- PPR
- Tobacco cessation-are increased risk of perio, oral cancer, stomatitis,
bad breath, stain
- Comorbidities
- Postpone if in exacerbation until stable
- Determine severity-stability
- Manage stress-may exacerbate
- Shorter appointments
- Have client upright
- Avoid any power driven scaler or air polisher
- No epinephrine in anesthetic
- No nitrous oxide sedation
- Chronic Bronchitis​ aka “​blue bloater”​
- Excessive respiratory tract mucus production resulting in narrowing of small
airways
- Enough to cause a cough with expectoration
- Last 3 months of the last 2 years
- Difficulty on inspiration and expiration
- Clients often have other significant non-pulmonary conditions
- Weight loss, skeletal muscle wasting, CVD, anemia, osteoporosis,
depression
- Because of progressive nature of COPD = quality of life compromised
greatly in severe cases
- More prevalent among women
- Affect all ages but higher in 45+
- Spirometry – test used to measure lung function - helps to classify COPD
- Stage I – mild
- Stage II - moderate
- Stage III – severe
- Stage VI – very severe
- Signs and Symptoms:
- Chronic cough
- Large amounts of sputum
- Abnormalities on chest x-ray
- Overweight, sedentary lifestyle, edematous
RESPIRATORY DISEASES STUDY NOTE - Alma Fuentes

- Breathless-prolonged expiration and wheezing

- Dyspnea (difficulty breathing)
- Acute attacks of breathing distress with rapid labored breathing,
- intensive coughing, & bluish skin (blue bloater)
- Emphysema
- Understood as the widening of the air spaces distal to terminal bronchioles
due to destruction of alveolar walls
- Smoking injures alveolar epithelium destroying walls and creating large air
spaces
- Difficulty only upon expiration
- Signs and Symptoms:
- Barrel chest
- Minimal nonproductive cough
- Difficulty breathing on exertion
- Weight loss
- Tri-pod positioning
- Purses lips to help expel air-pink puffer
- Cystic Fibrosis
- Autosomal recessive gene disorder that affects movement of salt and water
transfer in respiratory tract and exocrine glands resulting in excess phlegm,
and mucus
- Both parents
- Fatal
- Progressive disease
- Excess mucus leads to:
- Chronic sinusitis
- Opportunistic lung infections
- Mucus affects pancreas by clogging ducts and enzymes unable to reach
digestive tract resulting in undigested food
- RDH Considerations:
- Rubber dam contraindicated
- Avoid aerosol producing equipment-motor driven scalers, polishers, air
polish
- Possible need for medical consult if unsure of medical status, or
severity of condition or level of control
- Sleep Apnea
- Xerostomia (usually with halitosis) on waking
- Daytime sleepiness exhaustion
- Memory lapses and/or learning difficulty
- Mood changes
- Morning headaches
- Erectile dysfunction