Demographics:
Patient: Kevin
Age: 16 years old
Gender: Male
Race: African-American
Age: 16 years old
Gender: Male
Race: African-American
Physical Assessment:
Height: 6'5"
Weight: 175 lbs
Healthy, fit
Patient exercises everyday in physical education class and after school he plays basketball the school team. He is the star player of the championship team so he practices drills from 3-6 pm. In the spring, he will be joining the championship swim team where he excels in the butterfly.
Weight: 175 lbs
Healthy, fit
Patient exercises everyday in physical education class and after school he plays basketball the school team. He is the star player of the championship team so he practices drills from 3-6 pm. In the spring, he will be joining the championship swim team where he excels in the butterfly.
Mental Assessment:
Despite his hectic and draining basketball schedule, patient still prioritizes school and loves reading and history. He is excited to apply to colleges and hopes that with his extracurricular activities and high G.P.A. he can get into the school of his choice. Patient claims to be a little stressed out with the upcoming playoff season and standardized tests that he will be taking soon.
Social Assessment:
Patient is outgoing and part of many school clubs. He is the star basketball player at his school and spends a lot of his free time practicing in the court. When off the court he enjoys reading and listening to music. When he does have quiet time, he plays his guitar with some friends.
Medical Assessment:
Patient states that asthma runs in the family. He mentions that both his grandfather and father have asthma. Patient was hospitalized at a young age for have severe asthma attacks. His family has their own Nebulizer as prescribed by his former pediatrician. Since, then, there have been no acute asthma attacks and now his asthma is mildly intermittent. Currently, he is using an inhaler as needed, most often during the summer, when stress or physically over fatigued from exercise. Patient's asthma is also triggered by pollen, tobacco smoke and cats. Inhaler is Albuterol sulfate (proair) 90mcg per actuation, which patient claims dries his mouth and has a "funny" after taste.
Patient is also allergic to sulfa.
Patient is also allergic to sulfa.
Dental History:
Patient has been wearing braces for almost 2 years now. He will have them removed in 2 months. Patient's last recare was 6 months ago for prophylaxis and sealant placements. Patient has sealants on all his first and second molars. Patient claims to gag when it comes to taking radiographs or when he tries to brush his tongue. Patient also has an occlusal guard which was made for him when he started basketball.
E/O I/O Assessment:
Extraoral: Patient appears healthy and happy. The head and face appear to be smooth and lack any significant findings. Lower right side of patient's neck, near his clavicle, presents with a 2x2 mm brown macule. Asymptomatic. Patient says that he has had it since he can remember. Slight TMJ clicking on right side.
Intraoral: Buccal Mucosa: Bilateral linea alba.
Palate: Maxillary Torus
Gingiva: Pink, firm, gingiva with slightly erythematous, bulbous and spongy upper and lower anteriors.
Tongue slightly coated
Saliva: slight xerostomia
Intraoral: Buccal Mucosa: Bilateral linea alba.
Palate: Maxillary Torus
Gingiva: Pink, firm, gingiva with slightly erythematous, bulbous and spongy upper and lower anteriors.
Tongue slightly coated
Saliva: slight xerostomia
Communication:
Important to communicate to patient that he needs to bring his inhaler with him to every appointment. Although mild, it is a good idea just in case any part of the procedure precipitates an attack.
Check the expiration date on the inhaler
Ask patient when the last asthma attack was and what triggered it
Ask patient the frequency of these attacks
Ask how stable the condition
Communicate with patient that for post-op pain, to stay away from medications with aspirin, NSAIDS, narcotics, erythromycin and ciprofloxacin as these may induce an asthma attack.
Speak to patient about emergency management in the event of an acute asthma attack.
Determine if the procedure to be done might stress the patient or be difficult to endure, or if the patient can tolerate the procedure
Lastly, communicate a calm, and supportive attitude and attempt to create a stress free environment as much as possible for the patient
Check the expiration date on the inhaler
Ask patient when the last asthma attack was and what triggered it
Ask patient the frequency of these attacks
Ask how stable the condition
Communicate with patient that for post-op pain, to stay away from medications with aspirin, NSAIDS, narcotics, erythromycin and ciprofloxacin as these may induce an asthma attack.
Speak to patient about emergency management in the event of an acute asthma attack.
Determine if the procedure to be done might stress the patient or be difficult to endure, or if the patient can tolerate the procedure
Lastly, communicate a calm, and supportive attitude and attempt to create a stress free environment as much as possible for the patient
Appointment Planning:
Short appointments to minimize stress
Appointments to be made in the late morning or late afternoon
Appointments to be made in the late morning or late afternoon
Client Positioning:
Patient prefers to not be laid back in a full supine position. Patient states to be able to breathe easier while in semi-supine position. Allowing the patient to sit in a semi-supine position is good to help in their breathing, while still allowing the hygienist to work effectively.
DH Procedures:
Aerosols from dental procedures provide a risk for the patient. Some precautions and instruments to stay away from are the air polisher, ultrasonic scaler and power-driven polisher. Bacteria from the plaque can be inhaled by the patient and trigger an attack, and the materials from the air and power driven polisher can also be breathed in and make breathing difficult for patient.
Patient states that he gags easily, so avoiding the reflex is important.
If patient shows to be highly stressed from the procedure, nitrous oxide may be used to help calm the patient.
Because patient is allergic to sulfa, anesthetics without epinephrine is indicated for this patient.
Always assess patient's breathing pattern and check for difficulty breathing.
Patient states that he gags easily, so avoiding the reflex is important.
If patient shows to be highly stressed from the procedure, nitrous oxide may be used to help calm the patient.
Because patient is allergic to sulfa, anesthetics without epinephrine is indicated for this patient.
Always assess patient's breathing pattern and check for difficulty breathing.
Safety Precautions:
Ask the patient:
1. To bring their inhaler, and before the procedure starts, to place inhaler on the counter.
2. When their last asthma attack and whether or not we are in the season when their allergies are most active and easily triggered.
3. To raise their hand if they have trouble breathing.
As a clinician, it is necessary to avoid excessive aerosol production or too many instruments in patient's mouth. Knowing they easily gag is important as well in preventing a possible incident.
1. To bring their inhaler, and before the procedure starts, to place inhaler on the counter.
2. When their last asthma attack and whether or not we are in the season when their allergies are most active and easily triggered.
3. To raise their hand if they have trouble breathing.
As a clinician, it is necessary to avoid excessive aerosol production or too many instruments in patient's mouth. Knowing they easily gag is important as well in preventing a possible incident.
OHI
Because patient has an inhaler, sometimes it alters his taste and creates xerostomia. There is an increased risk of candidiasis with the inhaler. I would recommend that after using the inhaler, the patient should rinse out with water to prevent that from occurring and to rinse some of the taste out. A spacer can be attached to the inhaler to also prevent candidiasis.
Since the patient also has braces, it is difficult for the patient to maintain his oral hygiene. The use of interdental aids should be presented to patient as well as educating the patient. Patient can use the end tuft brush and floss threaders to help clean in between his braces.
Xerostomia should be discussed with the patient and the use of mouthrinses or lozenges which help with xerostomia is recommended. Because the patient is young, he may respond better to the use of Xylitol gums, mints or lozenges.
Stress the importance of compliance and educate the patient about oral hygiene and the effect of sugar on teeth and caries. Discuss how the gums are affected because of his braces as well as from his medications. Fluoride can also be prescribed for this patient.
Since the patient also has braces, it is difficult for the patient to maintain his oral hygiene. The use of interdental aids should be presented to patient as well as educating the patient. Patient can use the end tuft brush and floss threaders to help clean in between his braces.
Xerostomia should be discussed with the patient and the use of mouthrinses or lozenges which help with xerostomia is recommended. Because the patient is young, he may respond better to the use of Xylitol gums, mints or lozenges.
Stress the importance of compliance and educate the patient about oral hygiene and the effect of sugar on teeth and caries. Discuss how the gums are affected because of his braces as well as from his medications. Fluoride can also be prescribed for this patient.
Personal Reflection
I chose this topic because my family has asthma from my father's side. There are three of us in our family, and of us three, my younger brother has it the worst. Despite his asthma, he still tried to fight it and strengthen his lungs by joining sports. Growing up he learned to swim, joined the cross country team, played tennis and joined badminton. Just recently he finished a half-marathon with obstacles called the Tough Mudder. He always brings his inhaler wherever he goes. Most of the time I know that he has trouble breathing because he will start to cough lightly, but frequently. Sometimes I can tell he has trouble breathing because I notice that he takes deeper breaths. He tells me that when he's tired or stressed he notices that he has trouble breathing. I am very proud of my brother and how he has coped thus far with his asthma. I believe that asthma is a common condition that I will see in the dental office. Knowing how to manage the patient is very important because during an asthma attack, it is easy to lose control or forget what needs to be done for the patient. Knowing how to avoid an attack is crucial as well.
Additional Information
Included are links for a video presentation of what asthma is how it affects the airways.
Images from Google Images and the American Lung Association
Additional info taken from Dental Hygiene Theory and Practice, Darby and Walsh, 2010.
Videos from American Lung Association and Youtube
Additional info taken from Dental Hygiene Theory and Practice, Darby and Walsh, 2010.
Videos from American Lung Association and Youtube