Advanced Education In General Dentistry

Patient Case: Pulmonary Disease

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T.D. is a 19 year old man referred to the Oral Surgery Clinic for evaluation and treatment of his partially impacted wisdom teeth. The patient had been seen and treated by the general dentist the previous week for pericoronitis around tooth # 17. The pain and swelling had subsided with conservative therapy, and now the patient wishes to have his wisdom teeth extracted.

PMHx: Asthma -> 2 hospitalizations, never intubated
Medications: Pepcid, Albuterol, Atrovent, Prednisone 10 mg qD for 6 months which ended 1 month ago
No Known Drug Allergies

Questions For The Patient

  1. How often do you have an asthma attack?
  2. Have you ever gone to the hospital ER for your asthma? How often? When was the last time?
  3. What triggers your asthma attacks?
  4. Have you ever been hospitalized for your athsma? How many times? When was the last time?
  5. Have you ever been intubated? How many times? When was the last time?
  6. Have you ever taken steroid for you asthma? When? For how long? How much?
  7. Do you have your inhalers with you?
  8. Have you had any recent respiratory illness?

Implications For Sedation

The main goal of interviewing this patient is to determine the severity of the patient's asthma, the possible need for perioperative steroids or premedication. This patient will need peri-operative "stress" steroids because of his recent long-term prednisone usage. Careful auscultation of the patient's lungs prior to the procedure is vital.

Summary Of Treatment

  1. Vitals Monitoring
  2. Sedation
  3. Supplemental Oxygen
  4. Stress Dose Steroids
  5. Preoperative Pulmonary exam
  6. Preoperative Inhaler use

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