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What are the effects of inhalation therapy on the oral cavity especially in the pediatric population?

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Asthma is a chronic inflammatory disorder of the lungs characterized by obstruction of airflow that causes wheezing, breathlessness, chest tightness and coughing. The prevalence of asthma in pediatric patients in 2014 according to the CDC was 8.6%. In children, asthma accounts for millions of schools days missed and millions of dollars for caretakers to take care of their children and days lost at work.

Inhalation therapy has been the main treatment for patients with asthma. Albuterol (Proventil, Ventolin) is used for acute asthmatic attack (bronchospasm). The action of the drug is bronchodilation since it is a beta-2 adrenergic receptor agonist.  Studies have shown that inhaled drugs have effects on the oral cavity based on dosage, frequency and duration. Management of these drugs and the oral cavity is important to keep pediatric patients caries free.

The use of inhaled medications increase the risk of caries and xerostomia. Use of beta-2 agonist is associated with an increase risk in caries because it effects salivary production. Prolonged use decreases salivary flow because the beta-2 receptors in the parotid and minor salivary glands are inhibited. The decreased salivary flow, which causes xerostomia, creates an environment with low pH and bacterial changes. The low pH affects the oral cavity negatively because it increases the risk for demineralization, which makes teeth more susceptible to caries. The changes in the oral cavity with lack of salivary flow brings rise to more bacteria such as Strep. mutans, which attacks the demineralized oral tissue. The saliva that usually flushes out the food retained in the mouth after eating is reduced or absent. So the reduced pH, food retention and bacterial change ultimately creates the perfect environment for caries.

Clinical management of these patients can include daily changes to increase salivary flow and keep the oral cavity moist. Frequent sipping of water, intake of a sugar free moist diet, chewing xylitol gum, rinsing with chlorhexidine are some management methods.  The parents and patients should be informed of the possible effects of inhalation therapy, the patients should be placed on a frequent recall with fluoride varnish and sealant placement.  Oral hygiene needs to be greatly emphasized and rinses to keep the oral cavity moist should be used.