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List the 8 anatomical structures that make up the respiratory system.
- Upper respiratory tract:
- nasal cavity
- Lower respiratory tract:
the respiratory tract from nasal cavity to lungs serves as a passageway for what?
_____________: warm and filtered in the nasal cavity, and enters the lungs
_____________: with carbon dioxide, leaves the body
- inhaled fresh air
- exhaled air
___________: at the cellular level, occurs in the alveoli at the ends of the bronchioles
functions with the respiratory system to pump oxygenated blood from the lungs to every cell in the body and deoxygenated blood back to the lungs
What part of the lungs functions to moisten inspired air, and prevents delicate alveolar walls from becoming dry? Where does this come from?
- secreted from goblet cells
What part of the lungs functions to assist in removing foreign material and contaminated mucus by a constant beating and wavelike motion that propels this material back into the larger bronchi and trachea where it can be coughed up and expectorated or swallowed?
What happens when the inflammatory process (of asthma and chronic bronchitis) initiates an overabundance of mucus in the lungs?
- lack of function
- congestion is created: preventing cilia from assisting with normal breathing
What are structured communities of bacteria bound together by a carbohydrate matrix and interwoven with water channels that deliver nutrients from saliva?
What are 3 characteristics of biofilm described in chapter 62?
- biofilm adheres to inanimate objects or living surfaces: contact lenses, mechanical heart valves, catheters; or oral mucosa and gingiva
- Bacteria in biofilm: are more difficult to kill with antibiotics than their 'planktonic (free floating) counter-parts
- dental biofilm: is complex and may serve as a reservoir of infection, esp. in hospital pts
What type of objects/surfaces can biofilm adhere to?
- inanimate: contact lenses, mechanical heart valves, catheters
- living: oral mucosa and gingiva
Is bacteria harder to kill with antibiotics if it is in biofilm, or in its planktonic (free floating) form?
if it is in BIOFILM
true or false. Dental biofilm may serve as a reservoir of infection.
What are 8 examples of diseases/devices involving biofilms?
- contact lenses
- cystic fibrosis pneumonia
- dental caries
- intrauterine device (IUD)
- mechanical heart valve
- unit water lines
- nocosomial infections: intensive care unit pneumonia, endotracheal tubes, ventilator-assisted pneumonia (VAP)
Are each of the following conditions upper or lower respiratory tract diseases?
allergic rhinitis (hay fever)
upper respiratory tract
Are each of the following conditions upper respiratory or lower respiratory tract disease?
chronic abstructive pulmonary disease (COPD)
lower respiratory tract
list 3 modes of transmission of upper respiratory tract infections:
- direct oral contact
- inhalation of airborne droplets
- indirectly by hands or articles freshly soiled with discharge of nose and throat of infected person
true or false. It is best to delay dental and dental hygiene tx until pt is well or no longer contagious w/ the upper respiratory tract disease
What are 2 ways that noninfectivity of upper respiratory tract infections can be determined?
- temperature returning to normal
- regression of oral lesions such as erythematous lesions of the soft palate and erythema multiforme
Is pneumonia an acute LRT disease, or chronic?
are TB, asthma, COPD, and cystic fibrosis, acute or chronic LRT diseases?
What condition is an inflammation of the lungs, can be caused by viruses, bacteria, and rarely, fungi. Normally, host defense mechanisms eliminate these pathogens, but if the body fails to clear the contamination, this may result
pneumonia: LRT disease
Is pneumonia more often caused by viral or bacterial?
Name a bacteria nosocimial gram-negative type that can be responsible for pneumonia.
Name a community acquired gram-positive bacteria that can be responible for pneumonia.
Are the following symptoms thos of viral or bacterial pneumonia?
Are the following symptoms that of viral or bacterial pneumonia?
coughing purulent sputum
pleuritic chest pain
What are 4 ways that one might make a diagnosis of pneumonia?
- pt history
- physical findings
- chest radiographs
- sputum sample: for bacterial caused only
differentiate between treatment for viral and bacterial caused pneumonia.
- bacterial: antibiotics
- viral: supportive bed rest, drink fluids
What is a fungal etiologic agent of pneumocystis pneumonia (PCP)?
susceptibility for pneumonia to be caused by what type of etiologic factor is enhanced by chronic debilitating diseases in which immunimechanisms are impaired, such as AIDS/HIV?
fungal (pneumocystis jirovecci)
What are 2 general types of pneumonia?
- community-acquired pneumonia (CAP)
- nosocomial pneumonia
which general type of pneumonia (community or nosocomial) does no one know the predisposing factors; it is transmitted person to person?
Which general type of pneumonia (community or nosocomial) usually affects debilitated or chronically ill pts in hospital intensive care units or nursing homes and is the leading cause of death there? Most cases are due to aspiration of oropharungeal secretions into the lungs. Oral bacteria can be released from biofilm into salivary secretions that are then aspirated into the LRT to cause pneumonia. Most frequently bacteria cultured from the lungs are gram-negative bacilli and oral bacteria consistent with varieties often found in perio pockets
true or false. The oral cavity may serve as a reservoir for lung infections, especially for those in institutional settings. Improved oral hygiene can reduce the incidence of pneumonia
both are TRUE
What is the main medical treatment for pneumonia caused by each of the following agents:
- viral: supportive tx of bed rest and fluids
- bacterial: antibiotic therapy
- fungal: sulfa drugs
dental hygienists can educate other healthcare personnel to reduce risk of nosocomial pneumonia from infecting pts by informing them of what 3 things?
- maintainings standard precautions
- performing daily biofilm control measures on natural teeth and dentures
- teaching the use of an antimicrobial mouth rinse
What is a chronic infectious, and communicable disease with worldwide public health significance? It is a serious disease that can involve many months and years of lost time during the active state of illness and following convalescence? The incidence of this disease has increased in population groups with a high prevalence of HIV infections.
tuberculosis (TB): a LRT disease
true or false. TB is an AIDS defining illness
What agent is responsible for the etiology of TB?
What disease travels in airborne droplet nuclei from infected saliva or sputum carried during coughing, singing, or sneezing from individuals with pulmonary or laryngeal types?
What are 3 ways tubercle vacilli travel in airborne droplet nuclei?
The followin symptoms are signs of what LRT disease?
early: low-grade fever, weight loss, fatigue, night sweats
later: persistent cough, chest pain, hoarseness, hemoptysis (coughing up blood)
The diagnosis for what LRT disease includes a chest x-ray, sputum sample culture for acid-fast bacilli, and a physical examination?
What is the incubation period for TB?
What are 4 risk factors for getting TB?
- degree of exposure: prolonged close exposure can lead to infection by contact
- the homeless and those living in dense, over-crowded conditions
- employees or residents in tight living settings such as: prisons, shelters, nursing homes
- Immunosuppressed persons: HIV/AIDS, and other medical risk conditions
What are the signs and symptoms for latent TB infection?
What test is done to determine latent infection of TB? Does it determine clinically active TB as well?
What is the incubation period for latent TB?
What are 3 risk factors for LATENT TB?
- prolonged contat with an individual with active TB
- HIV or other medical risk conditions
- recent immigrant from a country with high incidence of TB
For clinically active TB drug therapy, multiple antituberculosis drugs are taken __________ for a minimum of ______ months
List 5 drugs commonly taken to medically treat clinically active TB.
What type of TB is being treated by taking Isoniazid for 9 months?
providing medications directly and observing the pt swallow the TB drugs is recommended for all TB pts and will result in what 3 things?
- high medication compliance
- prevention of multidrug-resistant bacterial development
- prevention of multi-drug resistant TB, which is more sever and difficult to treat
What infrequently appears in the oral cavity from pulmonary organisms brought to the mouth by coughing; most frequently seen in older individuals after the disease is far advanced or younger persons with lowered immunity from other diseases?
oral manifestations of TB
Describe the classic oral lesion seen in TB pts.
- painful, deep, irregular ulder on the dorsum of the tongue
- (it may also occur on palate, lips, buccal mucosa, and gingiva)
What will a biopsy of a TB oral lesion reveal for diagnosis?
acid-bast tubercle bacilli
List and describe 3 factors Dental Hygiene care that are affected by TB.
- pt history preparation: questions for history and symptoms of TB; medications and length of treatment
- medical consultation: to determine potential for communicability
- treatment protocol: it is imperative to recognize signs and symptoms of active disease and determine wether to treat or refer to a clinic where transmission based precautions can be followed
The following signs and symptoms are seen in pts with what URT disease?
nasal discharge (coryza)
common cold: infectious rhinitis
What is the etiology of the common cold?
The following drugs can be used to medically treat the common cold; since it is a virus they are all used to reduce symptoms, list the function of each:
- analgesic: sore throat, muscle ache
- anticholinergic: decrease nasa discharge
- oral decongestant: decrease nasal congestion
- antihistamine: for ithching, sneezing, or runny nose
The following are oral findings that may be seen in pts with which URT disease?
small round erythematous lesions on soft palate, enlarged tonsils, erythema multiforme, acute ulcerative gingivitis; decongestants and mouth breathing may cause dry mouth
common cold: infectious rhinitis
The following are signs and symptoms of what URT disease?
watering, burning eyes
allergic rhinitis: hay fever
seasonal triggers (grass, trees, pollen, mold spores), or perennial triggers (dust mites, animal dander) result in IgE-mediated hypersensitivity reactions; is the etiology for what URT disease?
allergic rhinitis: hay fever
What are 3 ways to medically treat hay fever (allergic rhinitis)?
- avoidance of allergen
- pharmacotherapy: antihistamines, decongestants
- immunotherapy: allergy injections increase tolerance to allergens and reduce symptoms
Dry mouth and oral candidiasis from long-term use of topical corticosteroids, are oral findings that can be found in pts with what URT disease?
allergic rhinitis: hay fever
nasal obstruction, fever, chills, constant mid-face head pain that is more severe when lying down, palpation over sinus area with tenderness and swelling, are signs and symptoms of what URT disease?
bacterial infection of the epithelial lining of the sinus, triggers include upper respiratory infections, dental infections, and direct traum, are all etiologic factors for what URT disease?
What are 2 ways to medically treat sinusitis?
dry mouth; and sinus congestion creates pressure on nearby maxillary molar roots and may cause symptoms of toothache, are oral findings of what URT disease?
What is the main sign/symptom of pharyngitis/tonsillitis? (an URT disease)
The etiology of which URT disease is mostly viral, rarely bacterial: group A beta-hemolytic stretpococcus infection
Describe how to treat viral and bacterial pharyngitis/tonsillitis.
- viral: treat symptoms
- bacterial: antibiotics - pt is no longer contagious after 1 day on antibiotics
What are 2 oral findings in pts with pharyngitis/tonsillitis?
- enlaged tonsils
- erythmatous tissues
Chills, fever, headache, coryza, nonproductive dry cough, myalgia, and malaise are all signs and symptoms of what common URT disease?
What is the etiology for the URT disease influenza?
- mode of transmission: airborne, direct contact
Bed rest, analgesics, antivirals, fluids, monitor for secondary bacteria infections, are all ways to medically treat which type of URT disease?
What is an oral finding of influenza?
What is a chronic, inflammatory, respiratory disease of the LRT, consisting of recurrent episodes of dyspnea, coughing, and wheezing and is related to bronchial inflammation and muscle constriction?
What are 2 traditional classifications of asthma?
- extrinsic atopic
- intrinsic non-allergic
Which type of traditional asthma is caused by allergic triggers from outside the body; exposure to an environmental allergen; allergic stimulus leads to activation of airway epithelial mast cells, steps in an IgE mediated hypersensitivity reaction take place
What are 5 possible environmental allergens that may cause extrinsic atopic asthma?
- animal dander
which type of traditional asthma is caused by nonallergic triggers from within the body; the specific trigger may not be identified; but is usually identified with adults, and endogenous factors such as emotional stress are significant?
What are the 4 categories of asthma as defined by the NAEPP classification based on severity and frequency of symptoms as well as pulmonary function assessment?
- mild intermittent
- mild persistant
- moderate persistant
- severe persistant
aspirin, nonsteroidal anti-inflammatory drugs (NSAIDS), beta blockers, food substances: nuts, shellfish, milk, strawberries, and tartrazine (yellow food dye); are all factors that cause what type of asthma?
drug- or food-induced (nonallergenic, nonatopic)
Which type of asthma affects adolescents and young people, and occurs from vigorous physical activity or thermal changes during inhalation of cold air may provoke mucosal irritation and airway hypersensitivity?
Which type of ashtma is caused from lung infections caused by viruses, bacteria, or fungi; and the treatment of the infection will improve the breathing?
List 7 signs and symptoms of an asthma attack.
- chest tightness
- difficulty breathing, sense of suffocating
- flushed appearance, sweating
- confusion due to lack of oxygen
- dilated pupils
- inability to complete a sentence in one breath
What are 5 steps to take in the emergency care of an asthma attack?
- stop treatment
- rule out foreign body obstruction
- assist with pts own bronchodilator or inhaler
- administer supplemental oxygen by nasal cannula
- initiate emergency procedures
Atopic asthma is one type of ________ mediated hypersensitivity reaction.
What is one of the 5 antibodies produced by the body that provides the primary defense against environmental allergens (pollen, tobacco smoke, and food substances)?
Immunoglibin E (IgE)
Describe the normal inflammatory reaction of IgE.
- IgE breaks down the allergens and removes them from the body
- normally, this activity does no produce notoceable symptoms
Describe tha sthmatic hypersensitivity reaction of IgE.
- people with asthma are believed to hyperreact, and produce more IgE antibodies than normal
- this results in symptoms of asthma: wheezing, coughing, dyspnea
What are 4 oral manifestations of asthma?
- dental caries and gingivitis
- enamel erosion: from increase in GI reflux with use of beta-2 agonists and theophylline
- Oral candidiasis: with high dosage or frequency of inhaled corticosteroids
What disease is caused most commonly by chronic bronchitis or emphysema? The primary etiology is the use of tobacco and exposure to occupational and environmental pollutants? Motivating the pt with this disease to begin a smoking cessation program can be one of the most rewarding aspects of dental hygiene practice.
chronic obstructive pulmonary disease (COPD)
What are 2 of the most common causes of COPD?
- chronic bronchitis
What is the primary etiology of COPD? (2)
- exposure to occupational and environmental pollutants
What LRT disease is characterized by excessive respiratory tract mucux production sufficient to cause a cough with expectoration (coughing up mucus) for at least 3 months of the year for 2 or more years? The obstructino is caused by narrowing of airway and mucus plugging, the person has difficulty breathing present on inspiration and expiration?
what disease is characterized by distension of the air spaces distal to terminal bronchioles due to destructino of alveolar walls (septa)? alveolar epithelium is injured and alveolar walls are destroyed, creating large air spaces; there is a difficulty of breathing only upon expiration.
What are 5 risk factors for COPD that poor oral health, especially periodontal involvement, may work in concert with any of the following factors to promote COPD exacerbations?
- continuing smoking
- environmental pollutants
- viral infections
- genetic factors
The following are signs and symptoms of what LRT disease?
sedentary, overweight, cyanotic, edematous, breathing less, leading to the term "blue bloaters"
The following are signs and symptoms of what LRT disease?
difficulty in breathing upon exertion
minimal, nonproductive cough (dry, no mucus)
barrel chest due to increased use of respiratory chest muscles
purses lips to forcibly expel air, leading to the term "pink puffers"
Who does the term "blue bloaters" refer to?
Who does the term "pink puffers" refer to?
- chronic bronchitis
true or false. There is no cure for COPD. Pts are encouraged to stop smoking, have adequate nutrition, drink plenty of water, exercise regularly, and decrease exposure to pollutants.
both are true
What are 2 medical intervention strategies used to medically treat COPD?
- pneumonia and influenza vaccines
- bronchodilators and other medications similar to thos used for asthma
Chronic smokers with COPD have an increased risk of developing what 5 oral manifestations?
- nicotine stomatitis
- periodontal infections
- oral cancer
- extrinsic tooth stains
What are 4 dental hygiene interventions that can be done to help COPD pts before treatment?
- review history: for evidence of concurrent cardiovascular disease
- avoid treating if URT infection is present
- treatment may be performed on stable pts with adequate breathing
- identify pts who may experience exacerbation of symptoms under emotional stress
What are 4 clinical adaptations that may need to be made during a DH appointment for a pt with COPD?
- appointment length: modify
- chair positioning: semi supine or upright to facilitate breathing
- local anesthesia: w/out epi
- nitrous oxide-oxygen inhalation sedation: avoid with severe COPD and emphysema
Pts who use oxygen to improve breathing function may hold a portable unit during treatment. What are 2 different types of these?
- continuous flow: oxygen flows at a determined rate of liters per minute
- on demand: Oxygen flows during inhalation only, increasing time between tank refills
- Note: oxygen promotes rapid burning; keep away from heat
What is a complex, genetic, life-limiting disorder that involves the pancreas, liver, and lungs? the disease is progressive and ultimately fatal? With improved multifaceted healthcare, the average survival time has increased.
What 3 organs does the disease cystic fibrosis include?
What are 5 early-stage clinical signs and symptoms of cycstic fibrosis?
- persistant cough and wheezing
- recurrent pneumonia
- excessive appetite but poor weight gain
- salty skin or sweat
- bulky, foul-smelling stools (undigested lipids)
What are 7 late-stage clinical signs and symptoms of cystic fibrosis with pulmonary involvement?
- sustained chronic cough with mucus production and vomiting
- barrel chest
- cyanosis and digital clubbing
- exertional dyspnea with decreased exercise capacity
- right herat failure secondary to pulmonary hypertension
What are 4 oral manifestations of cystic fibrosis?
- gingivitis associated with dry mouth
- thickening and enlargement of the salivary glands with advanced disease
- lower lip may be enlarged, swollen, and dry
What is the primary cause of sleep-related breathing disorders?
obstructive resistance to airflow during respirations
True or false. Those who snore may not have OSA, but those with OSA, typically snore
The spectrum of sleep-related breathing disorders constitues a spectrum of clinical entries with variations in sleep structure, respiration, and blood oxygen saturation. What are 5 different disorders in this spectrum?
- Snoring: chronic heavy snoring
- Upper airway resistance syndrome: UARS
- Mild obstructive sleep apnea
- Moderate OSA
- Severe OSA: obesity hypoventilation
What are 6 signs and symptoms of sleep-related breathing disorders?
- excessive daytime sleepiness
What are 3 neurocognitive adverse health affects that can result from sleep-related breathing disorders?
- sleepiness, decreased alertness, irritability
- poor concentration, memory loss
- lack of libido
What are 5 Cardiovascular adverse affects that can result from sleep-related breathing disorders?
- CV disease, cardiac arrhythmia
- congestive heart failure
- pulmonary hypertension
What are 7 ways to medically manage sleep-related breathing disorders?
- weight loss
- nasal dilator strips
- nasal decongestant
- topical corticosteroids
- avoid supine position: tennis balls
- avoid alcohol, sedatives, muscle relaxants at bed time
- smoking cessation
What does PAP stand for?
positive airway pressure
What are 4 dental related treatment indications of sleep-related breathing disorders?
- primary snoring
- mild-moderate OSA
- no response to PAP
- severe OSA: failure to have initial trial of PAP