According to the Centers for Disease Control and Prevention (CDC), approximately 25 million Americans are affected by asthma, including nearly 5 million children. Given this prevalence, it’s likely that dental professionals will regularly treat patients with asthma, which can vary from moderate to severe in nature. Managing these patients requires additional care and awareness due to the unique challenges asthma can present in the dental setting.
Medication Interactions and Considerations
Patients with asthma who use both short- and long-term maintenance medications are at increased risk for oral complications. Inhaler use can cause xerostomia (dry mouth) by reducing salivary flow, which contributes to dental caries and erosion. Additionally, changes in salivary flow and oral pH from asthma medications can increase biofilm accumulation and calculus formation, resulting in both inflammation and periodontal breakdown. Other considerations include opportunistic infections as a result of the immunosuppressive properties of inhaler corticosteroids and a potential reduction in bone mineral density which has been linked to corticosteroid use.
Because asthma and its treatments can alter oral health, preventive dental care is especially important. Fluoride treatments, scaling, and more frequent hygiene visits may be warranted. Patients may also be advised to rinse their mouth with water or fluoridated mouthwash after each inhaler use whenever possible to remove residual medication in the mouth.
Emergency Preparedness for Acute Attacks
More than half of dental professionals will face a medical emergency during their career, with respiratory distress among the most common emergencies.
Dental anxiety is common with up to 36% of people reporting a fear of going to the dentist, and the stress of a dental visit may lead to changes in respiration or panic, both of which can provoke asthma symptoms. Dentists should be able to recognize and treat a patient’s dental anxiety by modifying treatment and/or providing adequate pain control during treatment.
Reviewing the patient’s medical history carefully and creating a trigger-free environment, when possible, can improve safety and comfort. The use of air polishers, power-driven polishers, and ultrasonic scalers should be limited for patients with asthma, as these devices can aggravate respiratory issues or increase the risk of pathogen aspiration into the lungs. Efforts should also be made to minimize the production of aerosols and tooth enamel dust during procedures. Prolonged supine position should be avoided, as it may compromise breathing comfort.
Conclusion
Dental patients with asthma may require more than routine care. From preventing attacks to managing medication side effects, dental professionals can take a proactive and informed approach. Having a short-acting beta-agonist (like albuterol) readily available in a dental emergency medical kit is essential and dental teams should be trained to recognize signs of respiratory distress and respond appropriately.
