affected will be virtually free of symptoms by the time they become adults. The
aetiology is poorly understood but it is a complex disorder involving immunological,
infectious, biochemical, genetic, and psychological factors. Acute episodes of
coughing and wheezing are often precipitated by exposure to allergens and irritants,
such as cold air or noxious fumes and emotional stress. Drug therapy is now the
mainstay of treatment both prophylactically and during acute exacerbations.
Dental management of asthma
Dental treatment itself can cause emotional stress, which may precipitate an attack.
Routine dental care with local anaesthesia is not usually a problem; if in doubt, invite
the child to take a puff of their inhaler before commencing. Steroid inhalers for
asthma do not generally cause adrenal suppression and insufficiency. However, there
is recent evidence that some of the newer generation of steroid inhalers may cause
suppression. If in doubt contact the child's physician.
General anaesthesia for severe asthmatics usually requires in-patient hospital
admission.
Recently, a study has been published linking dental erosion with asthma. This may be
due to an increased likelihood of gastro-oesophageal reflux in people with asthma or
to acidic long-term medication or to the increased consumption of erosive beverages
due to 'drying' of the oral mucosa by inhalers.
Key Points
Of relevence to the dental management of asthma:
- Erosion due to
⎯reflux;
⎯increase consumption of acidic beverages. - General anaesthesia may require in-patient admission.
- The new generation of steroid inhalers may cause adrenal suppression.
16.4.2 Cystic fibrosis
Cystic fibrosis is an autosomal-recessive multisystem disorder predominantly of the
exocrine glands. Thick viscid mucus is produced, particularly in the lungs, which
leads to chronic obstruction and infection of the airways and to malabsorption. It is
the most common genetic condition in Caucasians, with approximately 5% of the
population being carriers and 1 in 2000 of live births affected. The abnormal gene has
been located on the long arm of chromosome 7.
The clinical manifestations of the condition are variable and some patients remain
asymptomatic for long periods. Coughing is the most constant symptom of pulmonary
involvement and this may lead to recurrent respiratory infections and bronchiolitis.
Sufferers often undergo regular physiotherapy to clear chest secretions. Lung disease
progresses leading to exercise intolerance and shortness of breath (1102HFig. 16.6). More
than 85% of affected children show evidence of malabsorption due to exocrine
pancreatic insufficiency. Symptoms include frequent, bulky, greasy stools and a
failure to thrive despite a large food intake.