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Dental Management Of
Medically Compromised
Patients

Respiratory System

The definition of a “medically
compromised” patient is not precise
and in this context, it is interpreted
as the presence of a medical factor
which may have implications for the
provision of dental care.

The Respiratory System
The tube which carries the air from the mouth is called the Trachea or
Windpipe, this later divides into two at which point it becomes the
Bronchi and divides the air equally to each lung. Once the air enters the
lungs it passes through a fine spongy structure which contains an
extensive network of blood vessels, these vessels bring carbon dioxide
into the lungs for removal, and take oxygen from the lungs to the body.

This is collectively known as the respiratory system.

It deals with the exchange of gases (i.e oxygen & carbon dioxide) in
and out of our bodies.

Respiratory Diseases
Categorized into:

1. Upper Airway Diseases

2. Lower Airway Diseases

Upper Airway Diseases
• Sinusitis
• Viral Upper Respiratory Infections
• Allergic Rhinitis & Conjunctivitis
• Laryngitis & Laryngotracheobronchitis
• Pharyngitis & Tonsillitis

Sinusitis

 inflammation of the epithelial lining of the
paranasal sinuses.

 causes mucosal edema and increase in
mucosal secretions.

Relations To Dentistry

→ Patients complain of tooth ache when they have sinus infections
therefore it is important to differentiate between a odontogenic
infection and a sinus pain.
→ Chronic sinus infections causes a patient to breath through the
mouth leading to dry mouth and is susceptible to gingivitis.
→ Use of decongestants causes dry mouth.
→ Use of antibiotics that patients has been used for another
condition, even in increased dosage will not work because the body
has gained resistance to it.

Viral Upper Respiratory Infections
 Viral infections are the most common
cause of acute respiratory illness in
children.

 It is transmitted by person-to-person
contact through respiratory droplets

Relation To Dentistry
→The most common oral manifestations of this is the
presence of small round erythematous macular lesions
on the soft palate and the enlargement of lingual
tonsillar tissue at the lateral borders of the tongue.

→Treatment for upper respiratory infections are
decongestants which causes a decrease in saliva flow
leading to xerostomia.

Allergic Rhinitis & Conjunctivitis

 Is a chronic recurrent inflammatory disorder
of the nasal mucosa and an inflammatory
disorder involving the conjunctiva.

 When they occur together it is called
rhinoconjunctivitis, which is an allergic
hypersensitivity.

→The use of decongestants and first generation
antihistamines in treatments leads to xerostomia.
→Exposure to dental materials such as
methacrylates and natural rubber latex increases
the risk for allergic respiratory hypersensitivity.

Laryngitis &
Laryngotracheobronchitis

 Laryngitis is the inflammation of the larynx
caused by viral infections.
 Laryngotracheobronchitis is an
inflammation involving the larynx, trachea
& lungs also due to viral infections.
 Patients with laryngitis often complain of
fever and sore throat and later coughing.

→ Medications used such as Corticosteroids
for reducing vocal cord inflammation, used
over a period of time causes candidosis.

→ Antibiotics used for the bacterial infections
would not be able to be used when antibiotic
armamemtarium is given. And anitbiotics
used over a period of time causes
candidosis.

Pharyngitis & Tonsillitis
 It is the inflammation of the pharynx & the
tonsils which is due to either viral or bacterial
infections.
 Caused by the group A β-hemolytic Streptococcus
(GABHS) infections.


→ Patients with GABHS infections should
thoroughly clean their tooth brushes or
removable orthodontic appliances or rinse it
with sterile water.

Lower Airway Diseases
• Acute Bronchitis
• Pneumonia
• Asthma
• Chronic Obstructive Pulmonary Disease
• Cystic Fibrosis

Acute Bronchitis
 is an acute respiratory infection involving the
trachea and bronchi (large airways).

 Caused by either viral or bacterial infection.

• Patients who take amoxicillin should be
prescribed another type of antibiotic when it
is needed for an odontogenic infection.

Pneumonia
• Is an infection or inflammatory illness of the
lung.
• Caused by viruses, bacteria and fungi (rarely).
• Signs and symptoms include, cough, sputum and
fever

o Aspirations of oral cavity secretions which contains oral bacteria &
pneumonia causing pathogens into the respiratory tract, could cause
pneumonia.
o Inflammatory products from the gingival tissue and pathogenic bacteria can
be aspirated into the lower airway promoting lung infection.

Asthma
• Chronic inflammatory disorder of the airways in
which it is reversibly narrow.
• Narrowing of the airways obstructs airflow and
breathing becomes difficult to the patient.
• Asthma could be developed from factors such
as a family history of asthma, respiratory
infections and inhaled pollutants.

Relations To Dentistry
• Dental products and materials such as
toothpastes, fissure sealants, tooth enamel dust
and methylmetacrylate is associated with asthma.
• Oral manifestations include candidiasis, decrease
in salivary flow and increase in calculus and
gingivitis.

Chronic Obstructive Pulmonary
Disease
• COPD refers to chronic bronchitis and emphysema, a
pair of two commonly co-existing diseases of the lungs
in which the airways become narrowed.
• This limits airflow causing shortness of breath.
• COPD is caused by noxious particles or gas, most
commonly from tobacco smoking, which trigger an
abnormal inflammatory response in the lung.

• Oral manifestations of COPD are halitosis, Oral
cancer, periodontal infections and tooth stains.

Cystic Fibrosis
• It is a rare disease but the most widespread life-
shortening genetic diseases .
• is a genetic disorder known to be an inherited
disease of the secretory glands, including the
glands that make mucous and sweat.
• Mucous secretions obstructs ducts & passages in
the pancreas, liver & lungs.

Relation to Dentistry
• Oral manifestations are enlargement of the
salivary , xerostomia, gingivitis and halitosis.

Dental Management For Patients
With Respiratory Disease.
 Consultation with patient’s physician before any
treatment.
 Review the patient’s medical history to see if:
- severity of the disease
- if they have taken corticosteriods
- the medications taken by the patient
 For asthmatic patients, remind them to bring
their inhalers.

When Performing Treatments:
 Chair to be in position where patient can breath
easily.
 Perform daily bio-film control measures on
teeth and dentures.
 For local anesthesia, avoid using epinephrine
for asthmatic patients.
 Availability of nitrous oxide or oxygen for
patients with upper respiratory infection.

 Allergy to antibiotics.
 Avoid aspirin or aspirin containing analgesics
for patients who have aspirin-induced asthma.
 Advice on using antimicrobial mouth rinse.
 Avoid triggering a hypersensitive airway by
placing cotton rolls and suction tips.

 Follow standard precautions for infection
control.
 Do NOT use equipments that produce aerosols.
Eg. Ultrasonic scalers and polishing because of
aspiration risks.

Reference
• Greenberg, MS et al. 2008, “Oral Medicine”.
• Willikins, E, “ Clinical
• http://mayoclinic.com/health/laryngitis/DS003
66/DSECTION=treatments-and-drugs

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Dental management 1 respiratory

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