2. Asthma
Asthma vs respiratory problem such as allergic rhinitis
True asthma: episodic narrowing of inflamed small airways wheezing and dyspnea
chemical, infectious,immunologic, or emotional stimulation
Check:
Precipitating factors
frequency and severity of attacks: emergency room visits and hospital admissions
Medications &response to medications
Fateme Ameri,Dentistry student,SEMums
3. Aspirin allergy: high frequency of generalized (NSAID) allergy
severe asthma xanthine-derived bronchodilators such as theophylline
corticosteroids.
Cromolyn protect against acute attacks but ineffective once bronchospasm occurs
sympathomimetic amines such as epinephrine or metaproterenol in an aerosol
if wheezing occurs.
Fateme Ameri,Dentistry student,SEMums
4. Samter’s triade (2019)
NSAID allergy
asthma, chronic rhinitis, or sinusitis
presence of nasal polyps
Fateme Ameri,Dentistry student,SEMums
7. Oral surgical management
role of anxiety in bronchospasm initiation
potential adrenal suppression in patients receiving corticosteroid
Elective oral surgery should be deferred respiratory tract infection
wheezing is present
Fateme Ameri,Dentistry student,SEMums
9. COPD
COPD Obstructive
restrictive pulmonary diseases
spectrum of pathologic pulmonary problems
long-term exposure to pulmonary irritants such as tobacco metaplasia of pulmonary airway
airways inflammation and disruption loss their elastic properties
Fateme Ameri,Dentistry student,SEMums
11. symptoms
Dyspnea mild to moderate exertion
chronic cough
large amounts of thick secretions
frequent respiratory tract infections
barrel shaped chests
purse their lips to breathe
audible wheezing during breathing
Fateme Ameri,Dentistry student,SEMums
12. Bronchodilators such as theophylline significant COPD
in more severe cases corticosteroids
Only in the most severe chronic cases supplemental portable oxygen
Fateme Ameri,Dentistry student,SEMums
15. What is Hyperventilation?
Hyperventilation is defined as ventilation in excess of
that required to maintain normal blood PaO2 (arterial
oxygen [O2] tension) and PaCO2 (arterial carbon
dioxide [CO2] tension.
Fateme Ameri,Dentistry student,SEMums
18. Tberculosis
An Old Disease – New Twists
A Continuing Public Health
Challenge
Fateme Ameri,Dentistry student,SEMums
19. Robert Koch
1882 – Robert Koch – “one seventh of all
human beings die of tuberculosis and… if
one considers only the productive middle-
age groups, tuberculosis carries away one-
third and often more of these…”
Fateme Ameri,Dentistry student,SEMums
20. M tuberculosis as causative
agent for tuberculosis
1886
Robert Koch
Fateme Ameri,Dentistry student,SEMums
21. MBT is carried in
airborne
particles called droplet nuclei
that are generated when
persons with infectious TB
disease coughs, sneezes,
shouts, sings, or talks.Fateme Ameri,Dentistry student,SEMums
22. TB – A Multi-system Infection
Fateme Ameri,Dentistry student,SEMums
23. Natural History
of TB Infection
Exposure to TB
No infection
(70-90%)
Infection
(10-30%)
Latent TB
(90%)
Active TB
(10%)
Untreated
Die within 2 years Survive Die Cured
Never develop
Active disease
Treated
Fateme Ameri,Dentistry student,SEMums
24. Latent TB vs. Active TB
Latent TB (LTBI) (Goal = prevent future active
disease)
= TB Infection
= No Disease
= NOT SICK
= NOT INFECTIOUS
= INFECTIOUS if PULMONARY (usually)
= NOT INFECTIOUS if not PULMONARY
(usually)
Active TB (Goal = treat to cure, prevent
transmission)
= TB Infection which has
progressed to TB Disease
= SICK (usually)
Fateme Ameri,Dentistry student,SEMums
25. Symptoms of TB in the lungs may include
A bad cough that lasts 3 weeks or longer
Weight loss
Loss of appetite
Coughing up blood or mucus
Weakness or fatigue
Fever
Night sweats
Fateme Ameri,Dentistry student,SEMums
27. lesion of the dorsum
of the tongue in a
patient with both TB
disease and HIV
infection.
Oral tuberculous
Fateme Ameri,Dentistry student,SEMums
28. While high-speed and ultrasonic dental
instrumentation clearly generate droplet
nuclei, there is a paucity of data
linking dental instrumentation to the
generation of droplet nuclei containing
MBT.
Fateme Ameri,Dentistry student,SEMums
29. Dentist should be perform 1 time a year
Fateme Ameri,Dentistry student,SEMums
Tuberculosis
Jane L. Moore, RN, MHSA, Virginia Department of Health
Review the slide show presentation on Tuberculosis: Part 1, Slides,. Then look at the example of goal setting to reduce TB incidence and be prepared to discuss the epidemiological basis for such goal setting. Even though this slide is more than 30 years old there are still lessons to be learned today. Although increasing, there are still few only a few instances of community analysis and results oriented programming and evaluation on the web. Also, review at the CDC web pages devoted to TB, HIV & STDs and click on Dr Fenton's blog. Finally look at a discussion of a recent TB outbreak in New York compared to one in London, UK (Second item under Perspective). Where was the information published? Why do you think I selected this topic? Consider why TB persists today with all our antibiotics. Take a look at the Global Issues defined by the WHO (look at some of the publications on the right side of the screen). Scan at the WHO global plan to STOP TB and the reprint from the NEJM of global TB. You may wish to visit the PBS Deadly Diseases - TB site All of you should watch the 4 minute video (part III). Also students from outside the US who have seen the effectiveness of BCG in TB prevention, look at this article from the Lancet (April 2006) and try to determine why BCG is not used in the US. A recent article on the planned use of BCG in London is worth reviewing,as is this report in the Guardian. Also look at this editorial on BCG use in Developing Countries (the second editorial). The latest informationon a new test for TB The [WHO] has endorsed a new rapid test for tuberculosis use worldwide. Review the articles on the [WHO] website. How will this new test be a game changer for TB diagnosis and morbidity? Blood testing for TB infection - http://www.medscape.com/viewarticle/738519 Pros and cons of available blood tests over tuberculin skin test Do you agree with the current CDC recommendations – if you were making policy what would you change? Program evaluation for TB Control – are we evaluating the right indicators? Review the 15 national TB Program indicators. How will improvement on these indicators improve TB Control in the United States? http://www.cdc.gov/tb/publications/factsheets/statistics/NTIP.htm. Look at this short editorial from the Lancet. Finally a recent report on TB Trends in the USA from the MMWR.
References: The BCG Quandary (pdf) BCG Effectiveness (pdf) Stopping BCG in the UK TB & AIDS, Recent JAMA Article TB among Foreign Born in US, JAMA, July 08 What is Thwarting Tb Prevention - Editorial NEJM, July 2011
