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8/14/2019 Basic Principles of Oral Health Management for the HIVAIDS Patient
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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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June 2000
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.