|
Respiratory Infections |
|
¨ Infections of the respiratory tract may be acute or chronic and may be of the upper (i.e. vocal cords or above) or lower tract. ¨ Infections of either are a contra-indication to GA, which should be deferred until resolution has occurred. ¨ An upper respiratory tract infection (URTI) will readily progress to the lower tract if a GA is given. URTIs may occur as part of the common cold, as pharyngitis or tonsillitis and as a laryngotracheitis. The latter in children may cause stridor ('croup'). ¨ The paranasal air sinuses may become infected secondary to a viral URTI (a viral cause being most common.
Sinusitis In maxillary sinusitis (which may also occur secondary to periapical infection of intimately related teeth) pain in the cheek and/or upper teeth is worsened by lowering the head and there is a mucopurulent nasal discharge. The maxilla over the antrum is tender to palpation. An occipito-mental radiograph may show increased radiopacity of the antrum but this can often be difficult to assess objectively and may be due to a thickened mucosal lining rather than acute infection Analgesics and antibiotics e.g. amoxicillin, erythromycin or doxycycline for 2 weeks may be required. In addition a decongestant such as ephedrine may be useful however this should be for short term use (less than 2 weeks). In chronic sinusitis, formal drainage of the antrum may be required.
Lower respiratory tract infections are often viral, but bacterial infection will frequently supervene. There are signs of systemic upset e.g. fever, pleuritic pain (sharp pain on inspiration), cough, green/yellow sputum and possibly haemoptysis. The patient (especially the elderly) may appear confused and indeed this may be the only sign that something is wrong. There will often be dyspnoea (the subjective feeling of a shortage of breath).
Pneumonia¨ Primary pneumonia occurs in previously healthy individuals and is often caused by pneumococci or 'atypical' organisms. ¨ Secondary pneumonias occur in patients with impaired defences e.g. in malignancy or Chronic Obstructive Airways Disease (COAD) such as chronic bronchitis and emphysema. ¨ An inadequately treated pneumonia may lead to a lung abscess. Aspiration of a foreign body from the mouth can also be a cause.
Ref: British Dental Journal 14 June 2003; Volume 194, No. 11
|
