Transcript The Health History and Review of HIV

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
June 2000
The Health History and
Review of HIV-Related Medically
Relevant Information
Michael Glick, DMD
June 2000
Medical assessment of HIV-infected
dental patients does not differ from that
of any medically complex dental patient
June 2000
Medical care for patients with HIV
disease is rapidly changing and any
medical assessment and evaluation of
infected patients needs to be
addressed with this concept
June 2000
The medical complexity of HIV-infected
individuals of importance to provision
of dental care is often associated with
non-HIV associated conditions
June 2000
Dental care for HIV-infected patients is
part of a multidisciplinary approach to
overall healthcare
June 2000
Teaching Objectives
• Obtain an appropriate medical history
• Assess the medical status of the dental
patient
• Be a resource to the patient in his/her
overall medical care
June 2000
Obtaining An Appropriate Medical
History
• Obtain a signed consent for medical information
• Methods of establishing a medical history
– orally or preprinted forms
– dialogue with primary medical providers
• Setting for obtaining an health history
• Appropriate and timely updates
June 2000
Medical Assessment
• Screening for underlying medical problems
• Assessment of the risks associated with provision
of dental care
• Evaluation of conditions and diseases that may
necessitate modification of dental care
• Assessment of the dental patient’s projected
overall health
June 2000
Screening For Underlying Medical
Problems
• Understanding of the questions of the
health history
• Performing an appropriate review of
systems
June 2000
Assessment Of The Risks Associated
With The Provision Of Dental Care
• Hemostasis
• Susceptibility to infections
• Drug actions and interactions
• Ability to tolerate dental care
June 2000
Hemostasis
• Hepatic disease
• Idiopathic thrombocytopenic purpura
June 2000
Susceptibility To Infections
• Leukopenia and neutropenia
• Hyperglycemia and diabetes
June 2000
Drug Actions And Interactions
• Polypharmacopiea
• Hepatic disease
• Renal disease
June 2000
Ability To Tolerate Dental Care
• Cardiovascular status
• Adrenal status
• Gastrointestinal status
June 2000
Assessment Of The Dental Patient’s
Projected Overall Health
• Appropriate use of the elements of the
medical history
• Development of an appropriate dental
treatment plan
June 2000
Elements Of An Health History
• Date
• Personal and demographic data
• Chief complaint / history of chief complaint
• Past medical history
• Date of last visit to primary care
provider/physician
June 2000
Elements Of An Health History Cont.
• HIV test result
• Reason for HIV test
• Risk factors for HIV
• HIV-associated illnesses
• CD4 levels
– first count; lowest count; and latest counts
June 2000
Elements Of An Health History Cont.
• Viral load
– first count; lowest count; and latest counts
• CBC and differential
• PT, PTT, INR
• Current medications
June 2000
Anti-Retroviral Medications
Nucleoside reverse transcriptase inhibitors
•
•
•
•
•
•
•
abacavir
didanosine
lamivudine
stavudine
zalcitabine
zidovudine
zidovudine +
lamivudine
June 2000
– Ziagen
– Videx
– Epivir
– Zerit
– HIVID
– Retrovir
– Combivir
ANTI-RETROVIRAL MEDICATIONS
Non-nucleoside reverse transcriptase
inhibitors
• delaviridine
– Rescriptor
• efavirenz
– Sustiva
• nevirapine
– Viramune
June 2000
ANTI-RETROVIRAL MEDICATIONs
Protease inhibitors
• amprenavir
– Agenerase
• indinavir
– Crixivan
• nelfinavir
– Viracept
• ritonavir
– Norvir
• saquinavir
– Invirase
June 2000
ANTI-RETROVIRAL MEDICATIONS
Ribonucleotide reductase inhibitors
• hydroxyurea
– Hydrea
Nucleotide reverse transcriptase
inhibitors
• adefovir
June 2000
– Preveon
ELEMENTS OF AN HEALTH HISTORY
CONT.
• Allergies and drug sensitivity
• Infections:
– hepatitis
– sexually transmitted diseases
– tuberculosis
• Tobacco use
• Alcohol use
• Recreational drug use
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ROLE OF THE DENTIST IN HIV CARE
• Provide routine dental care
• Recognize, treat, and understand the
significance of oral lesions
• Be part of the overall physical well-being
of all patients
June 2000
BE A RESOURCE IN THE OVERALL
MEDICAL CARE OF THE DENTAL
PATIENT IN CONCERT WITH PRIMARY
MEDICAL PROVIDERS
• Medication adherence
• Referral for drug/alcohol abuse
• STD prevention
• Screening for signs and symptoms of
drug side-effects
June 2000