This lecture discuss an important subject in dental clinic. COPD is the third leading cause of death in united state. this lecture is oriented to the level of mind of undergraduate students.

1. COPD
Clinical Signs And Symptoms
Medical Management
Dental Management
Oral Complications
COPD
Chronic bronchitis characterized by overproduction of
mucus in the airway (trachea and bronchi)which lead
to cough and difficulty breathing.
Emphysema is caused by years of smoking which
irritate the alveolar wall and stimulate macrophages
to destroy inflamed alveolar wall which lead to
over-inflated alveoli (large alveoli). These alveoli are
non-functional, meaning they do not exchange O2 and
Co2 with the body. This make muscle of breathing
works harder to compensate and eventually they get
tired and resign.
CLINICAL SIGNS AND SYMPTOMS
The onset of symptoms take years to develop and
usually start after age of 40. Symptoms includes
chronic cough with sputum production, and dyspnea
(difficulty breathing) especially with exercise.
MEDICAL MANAGEMENT
Management of COPD includes smoking
cessation, influenza and pneumococcal vaccinations,
anduseofshort-andlong-actingbronchodilators.Other
recommended measures include regular exercise, good
nutrition, and adequate hydration.
DENTAL MANAGEMENT
Most these patients are smokers, therefore it’s dentist
responsibility to encourage them to quit smoking.
Patients who display: shortness of breath at rest, a
productive cough, upper respiratory infection or an
oxygen saturation level less than 91% are unstable and
contraindicated for routine dental treatment.
Patients who are stable with adequate breathing
capacity are allowed to be treated, unless there is
respiratory infection.
Oxygen saturation in the blood should be monitored
throughout the procedure with pulse oximetry device.
Use of humidified low-flow O2 at rate of 2-3 L/minute
is recommended.
• No contraindication to the use of local anesthetic
has been identified. However, it’s recommended
to avoid bilateral mandibular block or bilateral
palatal block because it cause unpleasant airway
constriction is some patients.
• Avoid rubber dam in patient with severe COPD.
• If sedative medication is required, low-dose
diazepam may be used.
• Avoid narcotics and barbiturates because they
cause respiratory depression.
• Anticholinergics and antihistamines should be
used with caution because they cause dryness and
mucus density.
• There is no need to adjust systemic steroid dose
on the day of treatment in routine dental
procedures. However, major surgical procedures
require supplemental doses.
• Use nitrous oxide with caustion in patient with
mild to moderate COPD. Avoid in sever COPD.
• Avoid prescribing macrolides (erythromycin,
clindamycin, azitrhomycin, clarithrmycin) in
patients taking theophylline to avoid theophylline
toxicity.
Dental Management of Chronic
obstructive pulmonary disease (copd)
Osama Asadi, B.D.S, Published for Iraqi Dental Academy Blog
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in united state. Cigarette
smoking is the most important etiological factor in this disease. COPD is a diagnostic term used to describe
both Chronic bronchitis and emphysema. Their differentiation is difficult clinically and they overlap in
symptoms so that most clinicians prefer to use the term COPD or chronic obstructive pulmonary disease.
LECTURE OUTLINE
CHAPTER
1

2. 2
• Avoid supine position for the patient during
treatment. Use semisupine or upright position.
• Patient with COPD may have hypertension or
other systemic diseases which require specific
management.Patient with COPD may have
hypertension or other systemic diseases which
require specific management.
ORAL COMPLICATIONS
Patients with COPD who are chronic smokers
have an increased likelihood of developing hal-
itosis, extrinsic tooth stains, nicotine stomatitis,
periodontal disease, premalignant mucosal lesions,
and oral cancer.
REFERENCE
Little and Falace’s Dental Management of Medical-
ly Compromised Patients