Principles of Oral Health

Management 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
 Module 2
Basic 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
 Oral Surgery
Antibiotic Therapy

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

June 2000
 Oral Surgery:
Extractions
• Post-Operative Complications
– Dry socket
– Other

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
 Periodontal
Considerations And The
HIV+ Patient

June 2000
 Periodontal
Considerations
Linear Gingival ERYTHEMA
(LGE)

June 2000
 Linear Gingival ERYTHEMA (LGE)
Frontal

June 2000
Linear Gingival ERYTHEMA (LGE) Side

June 2000
 Periodontal
Considerations

Necrotizing Ulcerative
Gingivitis (NUG)

June 2000
 Periodontal
Considerations

Necrotizing Ulcerative
Periodontitis (NUP)

June 2000
 Necrotizing Ulcerative Periodontitis
(NUP)

June 2000
 Necrotizing Ulcerative Periodontitis
(NUP)

June 2000
 Necrotizing Ulcerative Periodontitis
(NUP)

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
June 2000
 Guidelines To
Prevention Of Oral
Disease

June 2000
 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.

June 2000