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  • Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation from the lungs that is not fully reversible and encompasses two diseases, chronic bronchitis and emphysema.  

  • These conditions are related, often represent the progression of disease, and may have overlapping symptoms.

  • The most important cause of COPD is tobacco smoking.  Other causes are long term exposure to occupational and environmental pollutants and the absence or deficiency of alpa-1 antitrypsin.

  • Complications:

    • Progressive dyspnea and hypercapnia

    • Recurrent pulmonary infections

    • Cor pulmonale (right sided heart failure)

 

Chronic Obstructive Pulmonary Disease

Introduction

Risks to the dental patient

Management During Treatment

  • Exacerbation of symptoms - shortness of breath

Questions to Ask 

  • Cough

  • Sputum production

  • Shortness of breath, especially at rest

  • Upper respiratory infection

  • If the patient is symptomatic at rest.

Clinical Findings 

Prevention 

  • Encourage patient to stop smoking and aid with medications.

  • Avoid use of barbiturates - respiratory depressant

  • Take blood pressure

  • Semi-supine or upright chair position as needed by patient

  • Bilateral mandibular  or palatal blocks may cause unpleasant airway constriction sensation

  • Rubber dam may cause airway constriction sensation

  • Supplemental oxygen should be humidified

  • Local anesthetic with epinephrine can be used

  • Avoid nitrous oxide-oxygen inhalation sedation ONLY in patients who retain carbon dioxide (usually Stage III or IV) - gas may accumulate in the air spaces of the diseased lung

  • Use nitrous-oxide with caution in patients with mild to moderate bronchitis. Flow rates should be no greater than 3 L/minute.  Expect induction and recovery times double that of healthy patient.

  • Consider low-dose oral diazepam or other benzodiazepine for sedation

  • Outpatient general anesthesia is contraindicated

Post-Operative Care

  • Avoid narcotic analgesics - respiratory depressant

  • Avoid erythromycin, macrolide antibiotics, ciprofloxacin if patient is taking theophylline

References

Dental Management of the Medically Compromised Patient.  Little, Falace, Miller and Rhodus. 8th Edition

Medical Consultation Recommended 

  • Do you retain carbon dioxide?

  • Can you walk two blocks without shortness of breath?

  • How do you feel about dental treatment? Do you feel anxious or fearful?

  • Do you have any heart problems?

  • Do you currently have a respiratory infection?

  • Are you taking your medication as directed?  Did you take it today?

  • How many pillows do you need to sleep with?

  • What do you do for exercise?

  • How are you being treated?

  • Did you take your medications today?  Do you take your medications as directed by your physician?

  • How often do you see your physician?

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