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
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
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
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
Top Related