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TB, Brochiectasis, Cystic fibrosis, Sarcoidosis and Lung cancer |
Tuberculosis
Tuberculosis caused mainly by Mycobacterium tuberculosis is a disease that has increased in prevalence in recent years, largely caused by the immuno-compromised HIV population, in the malnourished e.g. the materially deprived and in immigrants from underdeveloped countries. It is unlikely to be a great risk to dental staff unless the patient has an active pulmonary type in which case dental treatment is better deferred until control has been achieved. Pulmonary TB is usually spread by inhaling infected sputum and is highly infectious when active. A diagnosis of TB is suggested by chronic cough, haemoptysis, fever, night sweats and weight loss. Confirmatory tests include chest X-ray, sputum examination for acid and alcohol fast bacilli and the skin test or Mantoux test which shows a delayed hypersensitivity to a protein derived from Mycobacterium tuberculosis.
Bronchiectasis
Bronchiectasis is a condition where the bronchi are irreversibly dilated and act as stagnation areas for persistently infected mucus. It should be suspected in any persistent or recurrent chest infection. It may be congenital e.g. in cystic fibrosis or post infection e.g. TB, measles. Haemoptysis may occur. Intensive physiotherapy, antibiotics and bronchodilators are the mainstays of treatment.
Cystic Fibrosis
Cystic fibrosis is one of the commonest inherited diseases (1 in 2000 live births) and is autosomal recessive. The cells are relatively impermeable to chloride (hence diagnosis by measuring the chloride concentration of sweat) and thus salt-rich secretions are produced. The mucus is viscid and blocks glands. In the young adult or child recurrent chest infections are seen, bronchiectasis and pancreatic insufficiency also occur.
Lung Cancer
Lung cancer is usually linked to cigarette smoking and may present in various ways including cough and haemoptysis
Sarcoidosis
Sarcoidosis is a multi-system disorder of unknown aetiology and is characterised by non-caseating granulomata. It most commonly affects the lungs of young adults but may occur at any age. Thoracic Sarcoidosis classically presents incidentally as bilateral hilar lymphadenopathy on chest X-ray and is often asymptomatic. Gingival swelling found to be due to Sarcoidosis The mainstay of diagnosis is a rise in the Serum Angiotensin Converting Enzyme level. Treatment may be carried out using steroids, which may have implications for dental treatment as well as potential respiratory impairment.
Ref: British Dental Journal 14 June 2003; Volume 194, No. 11
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