Managing Chronic Disease in the Dental Office - COPD and RA
- ALeeRDH
- Jun 27, 2019
- 3 min read
Updated: Aug 1, 2019
There are many chronic diseases that impact oral health. Heart disease and diabetes have been discussed in this forum before, therefore I chose to take a look at a two alternative chronic diseases that impact oral health and management in the dental setting.
COPD - chronic obstructive lung disease including chronic bronchitis and emphysema
COPD is typically diagnosed in people over 40 years of age.
In 2013, over 13% of Canadians 35 and over reported having COPD.
Approximately 80-90% of cases are caused by smoking.
o Alternative causes include: genetics, occupational dusts and chemicals, second
hand smoke, frequent lung infections as a child, wood smoke and other biomass
(animal dung, crop residues) fuel used for cooking.
(Canadian Lung Association, 2014; Statistics Canada, 2019)
COPD and Oral Health
Medications used to manage COPD can cause such as inhaled corticosteroids can cause:
o oral candidiasis
o gingivitis and/or periodontitis
o dry mouth
o If associated with smoking, the patient may also experience halitosis, tooth
staining, nicotine stomatitis, periodontal disease, premalignant lesions, and oral
cancer.
(College of Dental Hygienists of Ontario, 2015)
Management of COPD during Dental Hygiene Procedures
Be aware of the patient’s requirements for supplemental oxygen – patients should be informed to bring a full oxygen tank to their appointment.
Dental chair adjustments may be necessary to facilitate ease of breathing.
Shorter appointments may be necessary.
Powder components or those that create aerosols such as power-driven polishers should be avoided.
If using an ultrasonic scaler, pre-procedural rinse and high-volume suction must be used to decrease contaminated aerosols.
Patients should be given instructions about oral health and their condition. These may include:
o links between COPD and oral health
o rinsing after use of inhaled corticosteroids
o keeping oral tissues hydrated
o tobacco cessation recommendation and resources
(College of Dental Hygienists of Ontario, 2015)
Rheumatoid Arthritis (RA)
This is an inflammatory disease that can impact multiple joints in the body.
In 2017, approximately 300,000 Canadians reported having RA.
It can occur at any age, but risk increases with age and RA commonly develops between 40 and 60 years of age.
The exact cause is unknown, though factors that have been researched include:
o genetics, sex (women are at increased risk), hormonal changes, and smoking
(Arthritis Society, 2017)
RA and Oral Health
Medications used to manage COPD can cause oral manifestations.These medications include:
o Corticosteroids - can cause oral candidiasis
o Disease-modifying anti-rheumatic drugs (DMARDs) - can cause bleeding,
ulceration and stomatitis
RA is also associated with dry mouth and higher risk of dental decay.
Involvement of the Temporomandibular joint (TMJ) can cause pain and stiffness.
(College of Dental Hygienists of Ontario, 2013)
Management of RA during Dental Hygiene Procedures
Be aware of the patient’s mobility and positioning for comfort during treatment:
o Adjust treatment position as needed.
o Rolled towels or pillow may be required for support.
Patients with RA often take Aspirin or NSAIDs increasing risk for bleeding.
Patients with TMJ involvement should have regular panoramic images to assess joint health – frequency of dental radiographic images should follow the ALARA (As Low As Reasonable Achievable) concept.
Introduce oral hygiene aidd and alterations to these aids for patients as needed such as:
o Toothbrushes with larger handles or modification to handle for better grip (i.e.
tennis ball grip, bike handle grip etc.)
o Floss handles or sticks as an alternative to string or water flosser.
(College of Dental Hygienists of Ontario, 2013)
References:
Arthritis Society. (2017, September). Rheumatoid Arthritis. Retrieved June 27, 2019, from https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/rheumatoid-arthritis
Canadian Lung Association. (2014, August 12). Chronic Obstructive Pulmonary Disease (COPD). Retrieved June 27, 2019, from https://www.lung.ca/copd
College of Dental Hygienists of Ontario. (2013, June 14). Disease/Medical Condition Rheumatoid Arthritis. Retrieved June 27, 2019, from http://www.cdho.org/Advisories/CDHO_Factsheet_Rheumatoid_Arthritis.pdf
College of Dental Hygienists of Ontario. (2015, August 27). Disease/Medical Condition Chronic Obstructive Pulmonary Disease. Retrieved June 27, 2019, from http://www.cdho.org/Advisories/CDHO_Factsheet_COPD.pdf
Statistics Canada. (2019, June 27). Chronic obstructive pulmonary disease (COPD), 35 years and over. Retrieved June 27, 2019, from https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009619
Wilkins, E.M. (2013) Clinical practice of the dental hygienist. (11th Ed.) Philadelphia, PA; Lippincott Williams & Wilkins.
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