Asthma and Dental Procedures: What Your Dentist Needs to Know

Why Asthma Matters in the Dental Chair

Asthma is a chronic inflammatory airway disease affecting around 8–10% of the Indian population. For most asthmatic patients, dental treatment is entirely routine. However, certain triggers common in the dental setting — stress, certain medications, latex, strong odours, and the supine (lying flat) position — can provoke bronchospasm if proper precautions are not taken.

Always inform Dr. P Meghana about your asthma before any procedure. Share the type of asthma (mild, moderate, severe), what your current medications are, and whether your asthma is well controlled. Poorly controlled or exercise-induced asthma requires more careful planning.

Bring Your Inhaler to Every Appointment

This is the single most important step. Always bring your reliever inhaler (usually Salbutamol / Ventolin) to every dental appointment. Inform the dental staff at the start of the visit so it is within reach at all times. If you use a preventer inhaler (like Budesonide or Fluticasone), take it as usual on the day of your appointment.

NSAIDs and Aspirin-Sensitive Asthma

A subgroup of asthmatic patients (approximately 10–20%) have what is called aspirin-exacerbated respiratory disease (AERD) or aspirin-sensitive asthma. In these patients, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac, naproxen, and ketorolac (Ketorol DT) can trigger severe bronchospasm within minutes of ingestion.

If you have asthma, always tell your dentist before they prescribe any pain relief. Paracetamol is the safest analgesic for asthmatic patients and is effective for most dental pain. NSAIDs should be avoided unless you have confirmed NSAID tolerance.

• •Safe for asthmatic patients: Paracetamol (Crocin, Dolo 650)
• •Use with caution — only if known to tolerate: Ibuprofen
• •Avoid in aspirin-sensitive asthma: Ketorolac (Ketorol DT), Diclofenac, Naproxen
• •For severe pain: Tramadol may be an alternative — discuss with your dentist

Local Anaesthesia and Asthma

Local anaesthetics used in dentistry (such as lidocaine) are safe for asthmatic patients. The small amount of epinephrine (adrenaline) present in local anaesthetics with vasoconstrictors is also generally safe at dental doses — the theoretical risk of bronchospasm from epinephrine is outweighed by its benefit in prolonging anaesthesia and reducing the dose needed.

However, some local anaesthetic cartridges contain sodium metabisulphite as a preservative for the epinephrine. In sulphite-sensitive asthmatic patients (a rare subset), this can rarely trigger a reaction. Plain local anaesthetics without epinephrine (such as plain 3% mepivacaine) can be used if there is a concern.

Latex Allergy in Asthmatic Patients

Asthmatic patients are at higher risk of latex allergy. Latex is used in some dental gloves and rubber dams. If you have a known or suspected latex allergy, inform your dentist before the appointment. Latex-free gloves and latex-free rubber dams are available and should be used routinely.

If a Bronchospasm Occurs During Treatment

In the unlikely event of a bronchospasm during a dental procedure, the following steps should be taken immediately: sit the patient upright, stop all dental work, administer the patient's own reliever inhaler (2–4 puffs), and monitor closely. If there is no improvement within 15 minutes or if the attack is severe, call emergency services. The dental clinic should have a salbutamol inhaler in its emergency kit.