Asthma: Precautions before dental treatment?

My five-year-old has been diagnosed with asthma. Are there any precautions I should take before her next dental appointment? I am concerned that she might have an attack in the office.

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The dental office can be a common site for asthma attacks. Psychological and physical stress can precipitate an attack. Because both you and the dentist would like to prevent an attack, accurate information and clear communication are important. You should let the dentist know about the history of your daughter's asthma: how often she has attacks, what precipitates these attacks, the severity of the attacks and how attacks are best managed. The dentist should also be informed of any medications your daughter is taking.

Reduction of stress will also help decrease the chance of an attack. Nitrous oxide or conscious sedation may prove beneficial. Barbiturates and narcotics may predispose a patient to an attack; therefore, you and your dentist may wish to avoid these drugs. Aspirin and penicillin may also precipitate an attack. If specific allergens are known to cause an attack, the dentist should make attempts to eliminate these elements from the office.

If your daughter has an attack during dental treatment, the following management techniques should be observed: All dental treatment should be stopped immediately and the patient positioned comfortably; The patient may be allowed to sit, stand or lie down, according to the comfort level of the individual; A bronchodilator, such as that available in an inhaler, should be administered. (Ideally, the patient's own inhaler should be readily available.)

The most effective bronchodilators include drugs such as epinephrine, isoproterenol and metaproterenol. The instructions for dosing should be carefully followed. If necessary, oxygen can be administered. Injections of epinephrine may also be given if the inhaler is not working. If these management steps are ineffective, medical assistance should be summoned and hospitalization may be required.

Dental treatment should be postponed until the patient has fully recovered. If stress or psychological factors played a role in previous attacks, plans to reduce stress should be implemented to prevent future attacks during dental treatment.

It is estimated that asthma affects about six to eight million Americans. Children with asthma represent a significant number of emergency room visits each year.

Children are most commonly affected with extrinsic asthma or allergic asthma. Attacks may be caused by specific allergens such as dust, feathers, animal dander and plant pollens. Food and drugs may also cause an asthma attack. Many children with this type of asthma do not have asthma as adults.

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