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Principles of Oral Health Management for the HIV/AIDS Patient

Principles of Oral Health Management for the HIV/AIDS Patient. A Course of Training for the Oral Health Professional.

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Principles of Oral Health Management for the HIV/AIDS Patient

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  1. 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

  2. Module 2Basic Principles Of Management Stephen N. Abel, DDS, MS Francisco Ramos-Gomez, DDS, MS, MPH

  3. 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.

  4. 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.

  5. General Treatment Planning • The initial visit should include a completely documented overview of the patient’s overall oral condition along with medical status review.

  6. 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

  7. Xerostomia • Impacts on hard and soft tissue • Impacts on quality of life • Treatments are available • (prescription and OTC)

  8. 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

  9. Oral SurgeryAntibiotic Therapy

  10. 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?

  11. Antibiotic Administration During And After Treatment In The Presence Of Oral Infection

  12. Oral Surgery: Extractions • Post-Operative Complications • Dry socket • Other

  13. Oral Surgery • Incidence of post-procedural complications is no greater than in other populations

  14. 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

  15. 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

  16. Periodontal Considerations And The HIV+ Patient

  17. Periodontal Considerations Linear Gingival ERYTHEMA (LGE)

  18. Linear Gingival ERYTHEMA (LGE) Frontal

  19. Linear Gingival ERYTHEMA (LGE) Side

  20. Periodontal Considerations Necrotizing Ulcerative Gingivitis (NUG)

  21. Periodontal Considerations Necrotizing Ulcerative Periodontitis (NUP)

  22. Necrotizing Ulcerative Periodontitis (NUP)

  23. Necrotizing Ulcerative Periodontitis (NUP)

  24. Necrotizing Ulcerative Periodontitis (NUP)

  25. Implants • Studies to date have demonstrated no differences in the success rate of implants between HIV+ and HIV- patients

  26. 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

  27. Endodontic Considerations • Endodontic treatment and post-procedural complications. • Consider one-step endodontic therapy when appropriate.

  28. Orthodontic Considerations • Factors to consider before instituting therapy • Factors to consider due to non-treatment

  29. 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

  30. Guidelines To Prevention Of Oral Disease

  31. 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.

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