1. By::
Areej Salim Dawood
SUPERVISION BY::
Dr.Emad Hamodey Abdulla

2. Asthma is a chronic
inflammatory disorder of the
airways, causes recurrent
episodes of wheezing,
breathlessness, chest tightness,
and coughing, particularly at
night or in the early morning

3.  Narrowing of bronchial Airways
 Muscle Spasm
 Mucosal swelling
 Thick bronchial secretion
 Inflammatory Reaction
 Reversible

5. Intrinsic Asthma:
Non-Atopic/Non-Allergic
Bronchial reaction due to: cold air
 Extrinsic ASTHMA
Atopic/Allergic Asthma
Allergic Rhinitis
Urticaria
Eczema

6. Signs
&
Symptoms

7.  Feeling of chest tightness
 Dyspnea
 Tachypnea
 Cough
 Use of Accessory/Respiratory
Muscles
 Agitations
WHEEZING

8. ALL THAT WHEEZES IS NOT
ASTHMA
Differential Diagnosis:
 Pulmonary Edema
 Pulmonary Embolism
 Anaphylactic Rxn
 COPD
 Pneumonia
 Foreign Body Aspiration
 Cystic fibrosis

9.  History & Clinical
 Chest X- Ray (CXR)
 Pulmonary Function Test (PFT)
 Arterial Blood Gases (ABGs)

10. Dental treatment may lead to anxiety
of patient this lead to bronchi
construction..
And if not treated immediately it may
lead to a condition called status
asthmaticus,, it consider as sever
form of paroxysmal asthma and
consider as live threat

11.  Asymptomatic patients:
Elective dentistry
 Symptomatic patients
Reappointment

12. Dentifrices
Sulfites
Cotton rolls
Fluoride trays
Fissure sealants
Tooth Enamel dust
Methyl methacrylate

13.  Frequency of asthmatic attacks
 Precipitating agents
 Types of pharmacotherapy used
 Length of time since an emergency visit
owing to acute asthma

14. 1.Patients appointment should be late morning or
afternoon.
2.Assess severity of ASTHAMATIC condition.
3.Consider antibiotic prophylaxis for immuno-
suppressed patients
4.Consider corticosteriod replacement for adrenally
suppressed patients.

15.  Confirm that they have taken their most recent
scheduled dose of medication.
 The patient’s own metered-dose inhaler
bronchodilator should be on hand at each visit to
minimize the risk of an attack.
 Procedure should be done Late morning / afternoon.
 Emergency kit with a bronchodilator and oxygen.

16.  Avoid using dental materials that may elicit
an ASTHMATIC ATTACK ie ,DENTIFRICES
,FISSURE SEALANTS ,METHYL METHA
ACRYLATE ,FLOURIDE TRAYS & COTTON ROLLS
can trigger asthmatic events.
 Ifasthmatic patients does not use a
broncodilator ,make sure the emergency kits
has both a bronchodilator & oxygen.

17. 1.Rubber dams should be used cautiously.
2.Use technique to reduce patient stress:
 Avoid prolonged supine positioning
 Avoid nitrous oxide in people with sever ASTHMA.
 Avoid using BARBITURATES.
3.Avoid using LA containing SODIUM METABISULFIDE.
4.Use vasoconstrictor judiciously

18. 1.TETRACYCLINE should be used cautiously.
2.Avoid use of ERTHROMYCIN in patients taking
THEOPHYLLINE.
3.Avoid use of PHENOBARBITALS in patients taking
THEOPHYLLINE.
4.Analgesic of choice for these patients is
ACETAMINOPHEN.

19.  During
and immediately after local
anesthetic administration.
 Withstimulating procedures such
as extraction, surgery,pulp
extirpation

20. You gave local anesthesia to your patient & all
of a sudden patient:
 Has difficulty in breathing
 Talking in phrases
 You could hear loud wheezes
 Using accessory muscles
 Slightly Agitated

21. THE DENTAL PROCEDURE

23. DON’T
BE
AFRAID

24.  Discontinue the dental procedure and allow the
patient to assume a comfortable position.
 Establish
and maintain a patent airway and
administer b2 agonists via inhaler or nebulizer.
 Administer oxygen 6-10 liters via face mask,
nasal hood or cannula. If no improvement is
observed and symptoms are worsening,
administer epinephrine subcutaneously (1:1,000
solution, 0.01 milligram/ kilogram of body weight
to a maximum dose of 0.3 mg).

25.  Document in time form the beginning of the
event.
 Alert emergency medical services.
 Maintaina good oxygen level until the patient
stops wheezing and/or medical assistance
arrives.
 Begin diligent basic life support.
 Escort patient to hospital as needed.

26. UPRIGHT
POSITION
IS
PREFERED