This lecture present to you the very basics of dental management of asthmatic patient in dental clinics. I kept it short and comprehensive as I can, for more info please refer to the reference mentioned in the lecture

1. Signs And Symptoms
Dental Management
Asthmatic Attack
Oral Manifestations
SIGNS AND SYMPTOMS
Attacks usually occur at night, but may also follow
exposure to allergen, exercise, respiratory infection, or
emotional upset or excitement.
Asthma attack characterized by airway
hyper-responsiveness (hyper-sensitivity). Symptoms
include: wheezing, dyspnea, coughing, chest tightness,
and flushing.
DENTAL MANAGEMENT
• Identify asthmatic patients by history. Ask the
patient about type of asthma, precipitating factors,
severity and frequency of attacks, the time of day
that attack most often occur, and whether he has
been hospitalized for acute asthmatic attack.
• Patient with unstable disease should be referred for
medical care and dental appointment is postponed.
• Patient who has night asthmatic attack should be
given late-morning appointment.
• Avoid aspirin, NSAIDs, barbiturates, and narcotics
because they may precipitate an asthmatic attack.
• Avoid macrolides antibiotics (clindamycin, azith-
romycin, etc..)and ciprofloxacin in patients taking
theophylline to avoid theophylline toxicity.
• Ask patient to bring his medication/inhalator with
him.
• Prophylactic inhalation before dental procedure is
recommended.
• Stress during dental appointment should be
avoided to avoid an asthmatic attack.
• Nitrous oxide is a recommended sedative in
stressed asthmatic patient because it has no
respiratory-depressing properties.
• If oral sedative required, low-dose short acting
benzodiazepines (e.g, diazepam) may be used.
• Local anesthesia containing epinephrine or
levonordefrin also contain sulfite component
which may precipitate asthmatic attack. Therefore
plain local anesthesia is recommended, especially
in moderate to severe asthmatic patients.
• Asthmatic patient taking long-term systemic
steroids may require supplemental dose of his
medication in major surgeries (not required in
routine dental treatment). However, long-term
inhalation of steroids require no supplemental dos-
es, unless daily inhalation dose is very high.
ASTHMATIC ATTACK
An acute asthmatic attack require immediate therapy.
Fast acting bronchodialtor (Ventolin, Proventil) should
be provided immediately and it is most effective. In
severe asthmatic attack that not responsive to previ-
ous treatment, subcutaneous epinephrine(0.3-0.5 mL,
1:1000) injections are helpful. Other supportive mea-
sures include providing oxygen and repeating inhala-
tion every 20 minutes. Call ambulance if the situation
required.
Dental Management of asthmatic patient
Osama Asadi, B.D.S, Published for Iraqi Dental Academy Blog
Asthma is inflammatory disease of the airway that lead to bronchospasm and overproduction of thick mucus
in the airway. This lead to symptoms of coughing, dyspnea and wheezing. Every 250 death in the world, 1
death is due to asthma, however, it is a benign reversible disease that can be managed with proper care and
most deaths are due to lack of treatment. Types of asthma includes: allergic (extrinsic), non-allergic (intrin-
sic), drug-induced and exercise-induced.
LECTURE OUTLINE
CHAPTER
1

2. 2
ORAL MANIFESTATIONS
Nasal symptoms, allergic rhinitis, and mouth
breathing are common with allergic-type
asthmatic patient. Asthmatic patient who are
mouth-breather has increased height of palatal vault,
greater overjet and higher prevalence of crossbite.
Gastroesophageal reflux is common in asthmatic
patient which may cause teeth erosion. Some
asthmatic medication may affect oral
environment such as decreasing salivary flow, and
increased prevalence of gingivitis and caries. Rarely,
asthmatic patient develop oral candidiasis due to
steroid inhalation without a spacer. It is very
responsive to antifungal treatment.
REFERENCE
Little and Falace’s Dental Management of
Medically Compromised Patient.