Basic Oral Health for HIV Patients - University of WashingtonORAL HEALTH for HIV(+) PATIENTS •...
Transcript of Basic Oral Health for HIV Patients - University of WashingtonORAL HEALTH for HIV(+) PATIENTS •...
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NORTHWEST AIDS EDUCATION AND TRAINING CENTER
Basic Oral Health for HIV Patients
Mark M. Schubert, DDS, MSD Professor, Oral Medicine, University of Washington Dental Director, NW-AETC
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Value of Oral Health
Projects positive image!
Self-confidence!
Allows for normal oral function à Quality of life!
Social acceptability!
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Dental Disease Can Be Devastating
Can be devastating to patient’s self-confidence!! Can project an image that influences how others perceive you!
Socially displeasing
BAD BREATH
Can affect one’s employability
“Bad Appearance” = lower IQ Compromised
oral function
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Impact of Dental Health: The Obvious
• Ideal basic oral health defined: - No dental decay, fully functional dentition - No gingivitis / no periodontitis - No dental abscesses - No mucosal lesions / diseases; normal salivary function
• Benefits of oral health - Adequate oral function: Nutritional intake - speech - Prevention of pain and infection - Self-image: Esthetics – no bad breath - self-confidence
Poor oral health can adversely affect quality of life and limit career
opportunities and social contact as result of facial appearance and odor
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Impact of Dental Health: Less Obvious
Oral disease Systemic disease § Periodontal disease (infection) affects diabetes control
Poorly controlled diabetes worsens periodontal disease
§ Oral infections: Deep space infections Aspiration pneumonias (ICU patients) Cardiac disease: Endocarditis, CAD?
Heme/Onc disease à systemic spread Colon cancer associate with oral bacteria Dental infections àflare of chronic GVHD
§ Dental infections à? Affect HIV replication
§ SMOKING and Tobacco products
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What are the most common dental problems for HIV(+) patients?
♦ Dental Decay ♦ Gingivitis ♦ Periodontal Disease
Oral and Dental Disease
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ORAL HEALTH for HIV(+) PATIENTS
• Oral health should be integrated with primary care - Dental assessments and history should be part of primary health
assessments: Dentition status / Gingival health status
• Referral mechanisms need to be established between medical and dental providers
• Dental providers should collaborate with the primary medical care providers: information on the medication regimen, immune status, and health of their patients
• Primary care providers need to perform oral health care services: oral health screening, oral health education, and patient referral
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Factors Affecting Access to Dental Care
§ Lack of dental insurance
§ Limited financial resources
§ Shortage of dentists trained/willing to treat HIV pts.
§ Nonexistent adult dental Medicaid services
§ Patient fear of and discomfort with dentists
§ Perceived stigma within health care systems
§ Lack of awareness of the importance of oral health
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Bacterial plaque - Biofilm: 1) Proteins / carbohydrates (pellicle) 2) “Early” bacterial attachment 3) Secondary bacterial colonization
Bacteria and Dental Health
§ Acids!§ Enzymes!§ Inflammator
y products!
Decalcification of enamel / dentine!Inflammation / Infection of gingiva!
About 1,000 bacterial species can exist as part of the
dental biofilm !
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Factors Affecting Dental Health • Inadequate oral hygiene
- Not properly trained / Unmotivated • Diet promoting bacterial growth • Xerostomia:
- Medical treatments • Radiation • Medications
- Autoimmune diseases - Salivary gland infections - HIV infection and HAART
Ø Acidic diet/GERD/ beverages Ø Excessive wear / trauma
Substrate Teeth and Gums
Decay &
Gum Disease
Bacteria saliva
Acidic diet/GERD Wear/Trauma
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/
http://www.drdeanlodding.com/blog/2011/04/types-of-cavities-diagram/
Bacterial-Induced Dental Disease
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Tooth Decay
Gum Disease
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Basic Oral Hygiene
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Achieving Maximum Oral Health
Unfortunately there are no cell phone apps to give us oral health
– WE have to do it yourself!
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§ Soft toothbrush § Brushing techniques § Toothpastes § Remineralizing pastes
• Calcium / phosphate • Fluorides
Tooth Brushing
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Topical Fluorides
• Prescription Strength – 1.1% Neutral Sodium Fl - Prevents tooth decay - Re-mineralize / Slow or arrest active decay - Especially important for xerostomia patients
• Easy to use: - Brush on techniques - Oral rinses - Fluoride trays - Apply once a day
• Inexpensive “dental insurance”
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Flossing
§ Floss • Waxed / Unwaxed • Fine / Extra- fine • Glide™ / "teflon" floss
§ Hand flossing § Flossers
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§ Be sure “equipment” works for patient • Electric vs manual toothbrush • Type of floss and hands vs flosser
§ Correct technique is critical!! • Manual dexterity – DO IT RIGHT • Attention to detail
§ 2x/day brushing; 1x/day flossing • Don’t get lazy – be consistent • Modify habits to ensure success • Multi-task: floss while reading email, TV, etc.
Maximizing Effectiveness of Oral Hygiene
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Adjunctive Oral Hygiene Aids
§ Antibacterial rinses • Chlorhexidine • Doxycycline / Minocycline
§ Interproximal brushes
§ Tongue scrapers
§ Water irrigators
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Oral Health for HIV+ Patients • Oral health supports systemic health
• Effective oral hygiene requires effective training/follow-up - Basic oral hygiene needs to be consistent and done correctly! - Oral hygiene protocols: Basic protocols but adapted and customized
for specific patient needs and situations • Understand the basics of dental “infections”
Dental decay / Gingivitis / Periodontal disease
Dental health should be integrated into and supported by primary health care providers
AND primary health should be integrated into and
supported by routine dental health care providers
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But healthy,
too!
Beautiful Smiles – Fresh Breath !
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NORTHWEST AIDS EDUCATION AND TRAINING CENTER
Basic Oral Health for HIV Patients
Thank you Questions??
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