Transcript Basic Principles of Management

Principles of Oral Health
Management 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
Module 2
Basic 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 Surgery
Antibiotic 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 HIVpatients
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 postprocedural complications.
• Consider one-step endodontic therapy
when appropriate.
June 2000
Orthodontic Considerations
• Factors to consider before instituting
therapy
• Factors to consider due to nontreatment
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.
June 2000