Effect of dental treatment on lung function

Brian Schmid DMD 02/19/10

Authors: Tanya Matthew BDS, Paul S Casamassamo DDS, Stephen Wilson MA PhD.
Reference: JADA Vol 129, August 1998
Main topic: lung function in asthma patients undergoing dental treatment.
Summary: 5-19% of children have some some form of bronchial asthma. The most common triggers for asthmatic attacks include: cigarette smoke, physical exercise, viral and bacterial infections, weather changes including cold temperatures, air pollutants and other allergens and also emotional stress. It has been recommended that dentists limit theur manipulatin of the hyperactive airway during fluoride treatment, radiography and use of cotton rolls. Also, prophylactic use of asthma medication. A semi-reclined or upright can also be used. It is estimated that 40% of attacks are caused by emotional stress. There are also several documented cases of allergies to dental materials, so a rubber dam is recommended to avoid exposure and particularly misting of tooth structure and restoration materials which may irritate the sensitive airway.
57 patients between 6-18 y.o. were chosen and had their lung function tested before, during, immediately post operatively and 30 minutes post operatively for prophylaxis and/or operative visits. Questionnaires were also given to their parents to determine severity of disease, control for several factors and to elucidate how their childs asthma affects their everyday life. All were scheduled after 1pm to control for Circadian changes. The mean patient was 11.8 y.o. and split almost equally for male and female. Fourteen patients (18.8%) showed a clinically significant decrease immediately post-operatively and 12 (16.2%) showed decreased lung function 30 minutes post operatively. Immediate post op and 30 minute post op lung function decrease were associated and predictive. Baseline lung function was the best predictor of post operative lung function. Since spirometry is unliklely to be performed in the dental setting, a thorough history is the best predictor of how sensitive the patient is to attacks and to distinguish common triggers. Severity of asthma and time since last hospital visit were not correlated to incidence of decreased lung function. Clinically 1 in 10 patients had decreased lung function and in this study no clinical variables pertaining to asthma were able to predict a decrease in lung function due to routine dental treatment.
Evaluation: This is a well organized study and reinforces the importance of taking good histories and applying their suggestions clinically.