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Principles of Oral Health

Management for theHIV/AIDS Patient

A Course of Training forthe Oral HealthProfessional

Made possible from a grant to the New York State

Department of Health AIDS Institute from theHIV/AIDS Bureau, Division of Community BasedPrograms, Health Resources and ServicesAdministration, DHHS

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Module 2Basic Principles OfManagement

Stephen N. Abel, DDS, MS

Francisco Ramos-Gomez, DDS, MS,MPH

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Basic Principles Of

ManagementThe 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 solelybased on HIV status.

By focusing on routine and preventivecare, dentists can maintain and improvethe quality of life for patients with HIV.

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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) willensure more successful treatmentoutcomes.

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General Treatment

PlanningThe initial visit should include a

completely documented overviewof the patients overall oralcondition along with medical statusreview.

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Restorative

Considerations Most principles are similar to those of

the general population

Poor candidates for extensiverestoration include those with:

rampant caries

reduced salivary flow

oral acidity

dysgusia

compromised motor skills upper airway obstruction

poorly controlled oral manifestations

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Xerostomia

Impacts on hard and soft tissue

Impacts on quality of life

Treatments are available

(prescription and OTC)

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Oral Surgery:Treatment Planning

Guidelines

Follow same principles as other

medically complex patients. Communicate

Immune-compromised patients

may at some points be moresusceptible to infection, bleedingand delayed healing

Update the medical history

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Oral Surgery

Antibiotic Therapy

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Antibiotic Pre-medicationIn The Absence Of

Infection

To prevent complications

associated with post-proceduralbleeding, delayed healing orinfections.

According to AHA guidelines toprevent SBE

Neutropenia

Indwelling catheters?

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Oral Surgery:

Extractions Post-Operative Complications

Dry socket

Other

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Oral Surgery

Incidence of post-proceduralcomplications is no greater than inother populations

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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 inHIV+ population

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Dental Caries

Cariogenic potential of drugs

HIV-associated xerostomia Drug associated xerostomia

Acid reflux

If recurrent caries cannot becontrolled, extensive crown andbridge should be avoided

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Periodontal

Considerations And TheHIV+ Patient

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PeriodontalConsiderations

Linear Gingival ERYTHEMA(LGE)

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Linear Gingival ERYTHEMA (LGE)Frontal

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Linear Gingival ERYTHEMA (LGE) Side

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PeriodontalConsiderations

Necrotizing UlcerativeGingivitis (NUG)

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PeriodontalConsiderations

Necrotizing UlcerativePeriodontitis (NUP)

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Necrotizing Ulcerative Periodontitis(NUP)

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Necrotizing Ulcerative Periodontitis(NUP)

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Necrotizing Ulcerative Periodontitis(NUP)

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Implants

Studies to date have demonstratedno differences in the success rateof implants between HIV+ andHIV- patients

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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

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Endodontic

Considerations Endodontic treatment and post-

procedural complications.

Consider one-step endodontictherapy when appropriate.

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Orthodontic

Considerations Factors to consider before

instituting therapy

Factors to consider due to non-treatment

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Prosthodontic

Considerations Most principles are similar to the

general population.

Special considerations should be givento those with: candidiasis xerostomia

wasting syndrome slower bone remodeling resulting in

more frequent relines

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Guidelines ToPrevention Of Oral

Disease

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Additional HIV Oral

Health Guidelines Review any issues surrounding HIV

drug adherence

Work to teach other members ofthe primary care team tounderstand the importance of oral

health as a component ofcomprehensive HIV care.