What is asthma?
Asthma is a disease of the respiratory system characterized by chronic inflammation of the airway, whose clinical manifestations are heterogeneous and variable over time and consist of wheezing, respiratory distress, chest tightness and cough.
Types of asthma
We can classify asthma into different types according to the causes that produce it, although the most common form is extrinsic or allergic asthma, typical in children and adolescents.
The asthmatic crisis
The clinic of an asthmatic crisis is the same in all types, being reversible and with self-limited episodes. Controlled patients who continue their treatment can lead a normal life as long as they carry the medication with them. The drugs to treat asthma are inhaled anti-inflammatories (corticosteroid type such as budesonide or beclomethasone) and long-acting bronchodilators (beta-adrenergic agonist type such as salbutamol). However, in the most severe cases, these drugs are insufficient and hospital admission is necessary.
How to carry out proper dental management in asthmatic patients?
One of the most important aspects that the dentist must consider is to avoid triggering an asthmatic crisis. For this, it is necessary to adopt a series of preventive measures:
- Know the patient’s medical history: type of asthma, triggers, severity and usual treatment. On the other hand, it is very important to ensure that the patient carries the medication and has taken it before beginning any dental intervention.
- Know and detect the signs and symptoms that generate a crisis and avoid precipitating factors. Anxiety can be one of these factors, therefore, it is very important to establish an honest and supportive relationship with the patient from the first moment he goes in search of help for his oral health problem. The professional should discuss with the patient his dental condition, how he will be treated, and everything related to the fears that the patient may have regarding the treatment.
The patient must be invited to ask questions and the dentist must respond openly and directly. The patient should be informed about the measures that the dentist will take to prevent the onset of pain and make the consultation more comfortable. If there is going to be some discomfort at any time during the procedure, the patient should be informed at what point it will occur.
Very anxious patients can be medicated with a small dose of anxiolytic the night before and one hour before the appointment.
If any sign or symptom such as cough, shortness of breath, wheezing or chest pressure is detected, treatment should be terminated immediately, and the usual nebulizer given.
Finally, it is important to consider drug interactions with dental practice. Drugs such as aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) can trigger the crisis.
On the other hand, macrolide antibiotics such as erythromycin should not be prescribed to patients treated with theophylline because they may increase their toxicity.
For more information on dental management in asthmatic patients, please refer to:
Silvestre Donat, F.J (2002). El paciente médicamente comprometido en la clínica dental. Valencia (España). A.S.P.,s.l