Medical Professionals Treating Children with Asthma and Allergies

Oral Health Fact Sheet for Medical Professionals Treating Children with Respiratory Disorders: Asthma and Allergies

Asthma is a chronic respiratory disease associated with airway obstruction, with recurrent attacks of paroxysmal dyspnea, and wheezing due to spasmodic contraction of the bronchi. (ICD 9 code 493.2)

Allergy is a hypersensitivity to an agent caused by an immunologic response to an initial exposure. (ICD 9 code 995.3)

Oral Manifestations and Considerations

Oral

• Increased caries risk, enamel defects
• Increased gingivitis and periodontal disease risk; and more calculus
• Higher rates of malocclusion and increased: overjet, overbite, posterior crossbite; high palatal vault
• Oral candidiasis, xerostomia, decreased salivary flow rate and salivary pH

Other Potential Disorders/Concerns

none

Oral Side Effects of Commonly Prescribed Medications

Sedation

Hydroxyzine and benzodiazepines recommended; avoid narcotics and barbiturates due to their histamine releasing properties → bronchospasm and potentiated allergic response.

Intravenous sedation

Use extreme caution due to limited control of the airway.

Avoid

aspirin, other salicylates and NSAIDS (due to allergies). May provoke a severe exacerbation of bronchoconstriction; use acetaminophen.

Parent/Caregiver Support and Guidance

• Prescribe EpiPen for a child with a severe allergy and remind child and parent to take EpiPen to dental visits
• Recommend rinsing with water thoroughly after using inhaler and taking each dose of sugar containing medication. Advise frequent water intake for patients taking xerostomic medication.
• Discourage consumption of cariogenic foods and beverages.
• Prescribe sugar-free medications, if available.
• Recommend preventive measures such as topical fluoride and sealants. Support the family in following dental care instructions.
• Advise the use of fluoridated toothpaste twice daily.
• Instruct caregiver on appropriate protocol following dental trauma (locate/preserve missing tooth and put in cold milk; seek immediate professional care).
• Review safety issues appropriate to the age of the child, such as mouth guards to prevent oral-facial trauma.
• Discuss habits that may harm the child’s teeth, such as propping baby bottles, putting child to bed with bottle.
• Refer to dentist any oral developmental abnormalities.

References

• Steinbacher, DM., Glick, M. (2001) The dental patient with asthma. An update and oral health considerations. Journal of American Dental Association, 132: 1229-1239.
• Ersin, NK., Gulen, F., Erondat, N., Cogulu, D., Demir, E., Tanac, R., Aydemir, S. (2006) Oral and dental manifestations of young asthmatics related to medication, severity and duration of condition. Pediatrics International, 48: 549-554.
• Faria, VCM., de Oliveira, MA., Santos, LA., Santoro, IL., Fernandes, ALG. (2006) The effects of asthma on dental and facial deformities. Journal of Asthma, 43: 307-309.

Additional Resources

• NIH Institute for Asthma and Allergies
• Special Care: an Oral Health Professionals Guide to Serving Young Children with Special Health Care Needs
• Bright Futures Oral Health Pocket Guide
• American Academy of Pediatric Dentistry: 2011–2012 Definitions, Oral Health Policies and Clinical Guidelines
• MCH Resource Center
• ASTDD – Special Needs
• Block Oral Disease, MA
• Free of charge CDE courses: MCH Oral Health CDE (4 CDE hours) NIDCR CDE (2 CDE hours)