|J Am Dent Assoc, Vol 132, No 9, 1229-1239.
© 2001 American Dental Association
DENTISTRY & MEDICINE
The dental patient with asthma
DEREK M. STEINBACHER, D.M.D. and MICHAEL GLICK, D.M.D.
An update and oral health considerations
Overview. Asthma is a serious global health problem that has steadily increased in prevalence during the past two decades. New classification and treatment guidelines have been published, and dental providers need to be aware of these changes. Literature Reviewed. The authors searched textbooks and MEDLINE, looking for the most updated medical information on asthma, as well as for previous publications on treatment of asthmatic patients in a dental setting.
Results. More than 9,000 articles on asthma were published in English between 1997 and 2000. From 1960 until 2000, approximately 40 articles specifically addressed asthma and dental care. The authors reviewed more than 300 articles from the medical literature and all articles after 1980 that directly focused on oral health issues for importance and relevance.
Conclusions. Recent information regarding the etiology, pathogenesis and treatment of asthma had not been adequately addressed in the dental literature. Dental care of asthmatic patients may necessitate considerations beyond what has previously been published in the dental literature.
Clinical Implications. In the treatment of asthma, as with treatment of most medical conditions, oral health care providers play a role that is important in terms of both the patient’s overall health and the systemic condition’s effect on oral health. This article provides dentists with a timely update on asthma and the relationship between asthma and oral health, and it offers suggestions for safe and appropriate dental care.
Asthma is a serious global health problem, affecting more than 100 million people worldwide. The prevalence of asthma in the United States has increased steadily for the past two decades with no end in sight.1 It is estimated that more than 17 million Americans are affected, with a projected increase to as many as 22 million cases by 2010 and 29 million cases by 2020. Although asthma is viewed by many as a fairly benign disorder, the mortality rate for this disease has almost tripled in the past 20 years, reaching a peak of more than 5,000 annual deaths.2 This somber number is projected to double within the next two decades.
In the treatment of asthma, oral health care providers play a role that is important in terms of both the patient’s overall health and the systemic condition’s effect on oral health.
Children, young adults and racial and ethnic minorities living in urban areas compose the group of people at highest risk. This is not surprising, as health disparities play a significant role in putting people at risk of developing this disease. However, other, less understood factors also contribute to the noted increased prevalence.3–6 Poverty-stricken inhabitants of the inner city have a greater chance of developing the disease, and their disease often has a more severe progression. Many different factors have been put forth as explanations of this phenomenon—crowded living conditions with poor ventilation, lack of access to quality health care, reduced long-term adherence to and maintenance of therapeutic regimens, family dysfunction, weak social supports and paucity of education.7–9
Asthma care represents a significant economic and social burden, accounting for numerous hospitalization stays and missed days of school and work.
With increasing numbers of affected patients, oral health care workers need to be adept at recognizing the signs and symptoms of asthma. Modifications to dental treatment may be indicated, and practitioners need to be capable of handling acute exacerbations. To that end, this article provides a review of asthma pathogenesis, diagnosis and classification, treatment and pertinent oral health considerations.
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