Table 3.34.
Key considerations for dental management in chronic obstructive pulmonary disease (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 1–3 | Conditioned by severity of disease |
| Pain and anxiety control | ||
| – Local anaesthesia | 1 | Reduce epinephrine dose; avoid bilateral mandibular and palatal anaesthesia |
| – Conscious sedation | 3/4 | Avoid benzodiazepines and nitrous oxide |
| – General anaesthesia | 3–5 | Stop smoking; eradicate infections; postoperative complications |
| Patient access and positioning | ||
| – Access to dental office | 0 | |
| – Timing of treatment | 1 | Short appointments |
| – Patient positioning | 1 | Upright position |
| Treatment modification | ||
| – Oral surgery | 1 | |
| – Implantology | 1 | |
| – Conservative/Endodontics | 1 | Rubber dam may not be tolerated |
| – Fixed prosthetics | 1 | |
| – Removable prosthetics | 1 | |
| – Non-surgical periodontology | 1 | |
| – Surgical periodontology | 1 | |
| Hazardous and contraindicated drugs | 2 | Antibiotic selection; avoid drugs interacting with theophylline; some patients receive corticosteroids |
*
0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.