principles of oral health management for the hiv/aids patient a course of training for the oral...
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Principles of Oral HealthManagement for the
HIV/AIDS Patient
A Course of Training for the Oral Health Professional Made possible from a grant to the New York State
Department of Health AIDS Institute from the HIV/AIDS Bureau, Division of Community Based Programs, Health Resources and Services Administration, DHHS
June 2000
Module 2Basic Principles Of
Management
Stephen N. Abel, DDS, MS Francisco Ramos-Gomez, DDS, MS,
MPH
June 2000
Basic Principles Of Management
• The principles of good oral health care are the same for people with HIV as they are for all dental patients.
• There is no evidence to support alterations in oral health care solely based on HIV status.
• By focusing on routine and preventive care, dentists can maintain and improve the quality of life for patients with HIV.
June 2000
General Treatment Planning
• Oral health can impact upon systemic health; systemic health can impact upon oral health.
• Modifications of care are similar to other medically compromised patients.
• Individual needs assessments (fiscal, physical and psychosocial, etc) will ensure more successful treatment outcomes.
June 2000
General Treatment Planning
• The initial visit should include a completely documented overview of the patient’s overall oral condition along with medical status review.
June 2000
Restorative Considerations
• Most principles are similar to those of the general population
• Poor candidates for extensive restoration include those with:
– rampant caries– reduced salivary flow– oral acidity– dysgusia– compromised motor skills upper airway obstruction– poorly controlled oral manifestations
June 2000
Xerostomia
• Impacts on hard and soft tissue• Impacts on quality of life• Treatments are available
– (prescription and OTC)
June 2000
Oral Surgery: Treatment Planning
Guidelines• Follow same principles as other
medically complex patients.• Communicate • Immune-compromised patients
may at some points be more susceptible to infection, bleeding and delayed healing
• Update the medical history
June 2000
Oral SurgeryAntibiotic Therapy
June 2000
Antibiotic Pre-medication In The Absence Of
Infection
• To prevent complications associated with post-procedural bleeding, delayed healing or infections.– According to AHA guidelines to
prevent SBE– Neutropenia– Indwelling catheters?
June 2000
Antibiotic Administration During And After Treatment In The Presence Of Oral
Infection
June 2000
Oral Surgery: Extractions
• Post-Operative Complications– Dry socket – Other
June 2000
Oral Surgery
• Incidence of post-procedural complications is no greater than in other populations
June 2000
Summary Of Oral Surgery Considerations
• Collaborate with other members of primary care team.
• Routine antibiotic use is contraindicated• Hemostatic function assessment is
indicated before extensive surgery• Aseptic technique reduces post-
procedural complications• Incidence of complications no higher in
HIV+ population
June 2000
Dental Caries
• Cariogenic potential of drugs• HIV-associated xerostomia• Drug associated xerostomia• Acid reflux• If recurrent caries cannot be
controlled, extensive crown and bridge should be avoided
June 2000
Periodontal Considerations And The
HIV+ Patient
June 2000
Periodontal Considerations
Linear Gingival ERYTHEMA (LGE)
June 2000
Linear Gingival ERYTHEMA (LGE) Frontal
June 2000
Linear Gingival ERYTHEMA (LGE) Side
June 2000
Periodontal Considerations
Necrotizing Ulcerative Gingivitis (NUG)
June 2000
Periodontal Considerations
Necrotizing Ulcerative Periodontitis (NUP)
June 2000
Necrotizing Ulcerative Periodontitis (NUP)
June 2000
Necrotizing Ulcerative Periodontitis (NUP)
June 2000
Necrotizing Ulcerative Periodontitis (NUP)
June 2000
Implants
• Studies to date have demonstrated no differences in the success rate of implants between HIV+ and HIV- patients
June 2000
Endodontic Considerations
• Endodontic treatment appears to offer many benefits and few drawbacks for HIV patients– Reduced infection risk– Reduced need for extraction– Improved ability to chew– Improved self-esteem
June 2000
Endodontic Considerations
• Endodontic treatment and post-procedural complications.
• Consider one-step endodontic therapy when appropriate.
June 2000
Orthodontic Considerations
• Factors to consider before instituting therapy
• Factors to consider due to non-treatment
June 2000
Prosthodontic Considerations
• Most principles are similar to the general population.
• Special considerations should be given to those with:– candidiasis– xerostomia– wasting syndrome– slower bone remodeling resulting in
more frequent relines
June 2000
Guidelines To Prevention Of Oral
Disease
June 2000
Additional HIV Oral Health Guidelines
• Review any issues surrounding HIV drug adherence
• Work to teach other members of the primary care team to understand the importance of oral health as a component of comprehensive HIV care.