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Pathology · patient case with 3 questions

14-year-old with asthma and a nut allergy

Patient: 14-year-old girl attending with her mother.

Chief complaint: Her mother says she is unhappy with the appearance of her teeth.

History: Asthma managed with albuterol. Reported allergy to nuts. Otherwise healthy.

Findings: Mild crowding of the maxillary anterior teeth. No caries. No mucosal lesions at present.

Question 1

All of the following are appropriate history questions before treating her EXCEPT:

  1. Which medication do you use for your asthma?
  2. Does anyone in your family have asthma?
  3. When was your most recent asthma episode?
  4. What kind of reaction did you have to nuts?
Show answer and explanation

Correct answer: B. Does anyone in your family have asthma?

  • A. Knowing whether she uses a rescue or controller inhaler, and whether she has it with her, is directly relevant to managing an episode in the chair.
  • B. CORRECT — this is the exception. FAMILY HISTORY of asthma is epidemiologically interesting but changes nothing about how you manage THIS patient today. The other three each directly alter your treatment safety plan.
  • C. Recency and frequency of exacerbations are the best available index of her current control and therefore of her risk during treatment.
  • D. The nature of the nut reaction — anaphylaxis versus mild intolerance — determines your emergency preparedness and your choice of products.

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Question 2

What oral care recommendation follows from her inhaler use?

  1. Avoid drinking water for an hour after using the inhaler
  2. Brush immediately and vigorously after each use
  3. Apply the inhaler directly onto the gingiva
  4. Rinse the mouth with water after each inhaler use
Show answer and explanation

Correct answer: D. Rinse the mouth with water after each inhaler use

  • A. Withholding water does the opposite of what helps and worsens the dryness.
  • B. A simple water rinse is the standard advice; forceful immediate brushing is not required and can abrade.
  • C. Inhalers deliver drug to the airway and are never applied to gingival tissue.
  • D. CORRECT. Rinsing and spitting after inhaler use clears residual drug from the oropharynx. With corticosteroid inhalers this is the single most effective preventive step against oral candidiasis, and a spacer helps further. It also mitigates inhaler-related dryness.

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Question 3

Her inhaler use makes her particularly susceptible to which oral condition?

  1. Root caries
  2. Geographic tongue
  3. Dental fluorosis
  4. Oral candidiasis
Show answer and explanation

Correct answer: D. Oral candidiasis

  • A. Inhaler-associated xerostomia does raise caries risk generally, but the specific and classic association tested here is candidiasis.
  • B. Geographic tongue is a benign migratory glossitis with no link to inhalers.
  • C. Fluorosis results from excess fluoride during tooth development, long before and unrelated to inhaler use.
  • D. CORRECT. Inhaled medication, especially corticosteroid inhalers, predisposes to oropharyngeal CANDIDIASIS through local immunosuppression and drug deposition on the mucosa. That is precisely why rinsing after use is advised.

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