Monday, 28 November 2011

How to manage Asthematic patients in dental clinics & hospitals

TO BE FOLLOWED BY DENTIST BEFORE TREATMENT:-1.Patients appointment should be late morning or afternoon.
2.Assess severity of ASTHAMATIC condition.
3.Consider antibiotic prophylaxis for immuno-suppressed patients.
4.Consider corticosteriod replacement for adrenally suppressed patients.
5.Avoid using dental materials that may elicit an ASTHMATIC ATTACK ie ,DENTIFRICES ,FISSURE SEALANTS ,METHYL METHA ACRYLATE ,FLOURIDE TRAYS & COTTON ROLLS can trigger asthmatic events.6.If asthmatic patients does not use a broncodilator ,make sure the emergency kits has both a bronchodilator & oxygen.
TO BE FOLLOWED BY DENTISTS DURING TREATMENT:-1.Rubber dams should be used cautiously.
2.Use technique to reduce patient stress:

  • Avoid prolonged supine positioning
  • Avoid nitrous oxide in people with severe ASTHMA.
  • Avoid using BARBITURATES.
3.Avoid using LA containing SODIUM METABISULFIDE.
4.Use vasoconstrictor judiciously.
TO BE FOLLOWED BY DENTISTS AFTER TREATMENT:-1. Be cautious while prescribing NSAID to ASTHMATIC patient.
2.TETRACYCLINE should be used cautiously.
3.Avoid use of ERTHROMYCIN in patients taking THEOPHYLLINE.
4.Avoid use of PHENOBARBITALS in patients taking THEOPHYLLINE.

5.Analgesic of choice for these patients is ACETAMINOPHEN.WHAT TO DO DURING ACUTE ASTHMATIC ATTACK IN DENTAL CLINIC OR HOSPITAL :-
1. Allow patient to assume a comfortable position & discontinue the dental procedure.
2.Establish & maintain patient airway & administor beta2 agonists VIA inhaler or nebulizer.
3.
Administer oxygen 6-10 liters VIA facemask, nasal hood or cannula.
if no signs of improvement is absorbed & systoms are worsening ,administer EPINEPHRINE subcutaneously (1:1,000 solution ,0.01 milligram/kg of body weight to a maximum dose of 0.3mg)
4.Alert medical emergency service.
5.Maintain a good oxygen level until the patient stops,wheezing /or medical assistance arrives.
6.Begin basic life support A,B,C & D 's activity as needed.

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