About 10,000 people in the UK are newly diagnosed with a lung disease every week, and approximately one in five people in the UK has ever developed asthma, COPD, or another long-term respiratory illness.[i] This means you are likely to come across patients with a lung condition in practice on a regular basis.
Love Your Lungs Week is an initiative started by the British Lung Foundation to raise awareness and focus on lung health, but it also provides us the opportunity to improve our understanding of lung conditions – enabling us to adapt and enhance the care we provide to those affected. Never has this been more important during a year impacted by the Coronavirus pandemic, and the resulting lockdowns and shielding initiatives for those whose lung health is compromised.
What is chronic obstructive pulmonary disease (COPD)?
Chronic obstructive pulmonary disease (COPD) describes a group of lung conditions that affect an estimated 3 million people in the UK[ii] and is, therefore, likely to impact a proportion of your patient base. In general, COPD is characterised by reduced expiratory flow and two main conditions – bronchitis and emphysema[iii] – which can often occur together.
Patients with chronic bronchitis may present with a reoccurring cough of mucoid secretions, while those with emphysema can suffer from breathlessness caused by the damage and enlargement of the alveoli of the lungs.ii Other symptoms can include frequent chest infections and persistent wheezing, and it’s common for all symptoms to flare up at different points in the year – particularly during winter months.[iv]
The cause of COPD usually centres around long-term exposure to harmful substances, such as cigarette smoke, which results in the lungs and airways becoming damaged and inflamed.[v] Smoking is the main cause of COPD and is thought to be responsible for around 9 in every 10 cases.v However, exposure to certain types of dust and chemicals in the workplace, like welding fumes and coal dust, may damage the lungs and increase the risk of developing the disease.v
abstract digital grid human lungs
Dental treatment considerations
Patient experience
The nature of a lung condition can make attending a dental appointment a worrying prospect for a patient, but there are ways for the dental team to adapt their workflow to make it a positive experience for the dentist and patient alike.
As the accessory muscles of respiration are more effective with the patient positioned upright,ii it is advisable to consult with the patient as to whether adjusting the chair to work in the vertical position eases their breathing[vi] during treatment. Also, take care to monitor the usage of water spray and the application of rubber dam during restorative dentistry, as this can further inhibit the patients already compromised breathing action.ii
Dental teams should remain on high alert to some patients with COPD experiencing worsening of respiratory function during dental treatments. Some specialised clinics offer oxygen equipment and have members of the team trained and ready to administer this to patients if required.vi It can also be beneficial to establish hand signals for when the patient finds they need to cough or have a break to adjust their breathing, to give them extra peace of mind during treatments.
Patient oral health
As you may know, COPD – together with some of the treatments for the disease – can impact a patient’s oral health in several ways that they may not be aware of. It can be hugely beneficial to communicate the dental implications, while monitoring any symptoms, during appointments.
For instance, inhaled corticosteroids may be prescribed to COPD patients with severe symptoms, which can lead to an increased risk of oropharyngeal candidosis.ii The risk can increase further if the patient is elderly and wearing complete dentures, so care should be taken to monitor this patient group and advise them on the necessary preventative care measures, such as rinsing the mouth after using a steroid-containing inhaler, or using a spacer device to better control the amount of steroid entering the mouth.ii
Dental instruments or tools
Chest infections are more common for patients with COPD, with bacteria causing about 1 in 2 or 3 exacerbations of the disease,[vii] which is why it is more important than ever to control microbes in a dental environment treating patients with a lung condition. Laboratory results have shown that high concentrations of Legionella can thrive in Dental Unit Waterlines (DUWLs),[viii] which as we know causes Legionnaires’ disease.[ix] To prevent the possibility of patients consuming contaminated water, practices can adopt more intensive cleaning regimes to eliminate microbes from the waterlines, such as steam sterilisation and chemical disinfection.
Complex care
Sometimes, the oral healthcare needs of someone with a lung condition can be complex, necessitating the referral to a trusted clinic. If you have patients that have issues beyond your remit, do not hesitate to refer them to Ten Dental+Facial, whose team of highly trained dentists will be able to carry out complex treatments with care and confidence.
For more information visit www.tendental.com, email referrals@tendental.com or call on 020 8675 1798
[i] British Lung Foundation. Lung disease in the UK. Available at: https://statistics.blf.org.uk/ [Last accessed 21.04.2021]
[ii] Devlin, J. (2014). Patients with chronic obstructive pulmonary disease: management considerations for the dental team. British Dental Journal. Available at: https://www.nature.com/articles/sj.bdj.2014.756 [Last accessed 21.04.2021]
[iii] British Lung Foundation. COPD (chronic obstructive pulmonary disease). Available at: https://www.blf.org.uk/support-for-you/copd/what-is-copd [Last accessed 21.04.2021]
[iv] NHS. Chronic obstructive pulmonary disease (COPD). Available at: https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/symptoms/ [Last accessed 21.04.2021]
[v] NHS. Chronic obstructive pulmonary disease (COPD) – Causes. Available at: https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/causes/ [Last accessed 21.04.2021]
[vi] Claramunt Lozano A, Sarrión Perez MG, Gavaldá Esteve C. (2011). Dental considerations in patients with respiratory problems. J Clin Exp Dent. 2011;3(3):e222-7. doi:10.4317/jced.i.e222. Available at: http://www.medicinaoral.com/odo/volumenes/v3i3/jcedv3i3p222.pdf [Last accessed 21.04.2021]
[vii] Harding, M. Dr. (2018) Chronic Obstructive Pulmonary Disease. Patient. Available at: https://patient.info/chest-lungs/chronic-obstructive-pulmonary-disease-leaflet#:~:text=Chest%20infections%20are%20more%20common,you%20may%20cough%20more%20sputum. [Last accessed 21.04.2021]
[viii] Atlas, RM., Williams, JF., and Huntington, M K. (1995) Legionella Contamination of Dental-Unit Waters. Appl Environ Microbiol. p. 1208–1213 0099-2240/95/$04.0010 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC167375/ [Last accessed 21.04.2021]
[ix] NHS. Legionnaires’ disease. Available at: https://www.nhs.uk/conditions/legionnaires-disease/ [Last accessed 21.04.2021]
