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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. The Health History and Review of HIV-Related Medically Relevant Information Michael Glick, DMD

  3. Medical assessment of HIV-infected dental patients does not differ from that of any medically complex dental patient

  4. Medical care for patients with HIV disease is rapidly changing and any medical assessment and evaluation of infected patients needs to be addressed with this concept

  5. The medical complexity of HIV-infected individuals of importance to provision of dental care is often associated with non-HIV associated conditions

  6. Dental care for HIV-infected patients is part of a multidisciplinary approach to overall healthcare

  7. Teaching Objectives • Obtain an appropriate medical history • Assess the medical status of the dental patient • Be a resource to the patient in his/her overall medical care

  8. Obtaining An Appropriate Medical History • Obtain a signed consent for medical information • Methods of establishing a medical history • orally or preprinted forms • dialogue with primary medical providers • Setting for obtaining an health history • Appropriate and timely updates

  9. Medical Assessment • Screening for underlying medical problems • Assessment of the risks associated with provision of dental care • Evaluation of conditions and diseases that may necessitate modification of dental care • Assessment of the dental patient’s projected overall health

  10. Screening For Underlying Medical Problems • Understanding of the questions of the health history • Performing an appropriate review of systems

  11. Assessment Of The Risks Associated With The Provision Of Dental Care • Hemostasis • Susceptibility to infections • Drug actions and interactions • Ability to tolerate dental care

  12. Hemostasis • Hepatic disease • Idiopathic thrombocytopenic purpura

  13. Susceptibility To Infections • Leukopenia and neutropenia • Hyperglycemia and diabetes

  14. Drug Actions And Interactions • Polypharmacopiea • Hepatic disease • Renal disease

  15. Ability To Tolerate Dental Care • Cardiovascular status • Adrenal status • Gastrointestinal status

  16. Assessment Of The Dental Patient’s Projected Overall Health • Appropriate use of the elements of the medical history • Development of an appropriate dental treatment plan

  17. Elements Of An Health History • Date • Personal and demographic data • Chief complaint / history of chief complaint • Past medical history • Date of last visit to primary care provider/physician

  18. Elements Of An Health History Cont. • HIV test result • Reason for HIV test • Risk factors for HIV • HIV-associated illnesses • CD4 levels • first count; lowest count; and latest counts

  19. Elements Of An Health History Cont. • Viral load • first count; lowest count; and latest counts • CBC and differential • PT, PTT, INR • Current medications

  20. abacavir didanosine lamivudine stavudine zalcitabine zidovudine zidovudine + lamivudine Ziagen Videx Epivir Zerit HIVID Retrovir Combivir Anti-Retroviral Medications Nucleoside reverse transcriptase inhibitors

  21. delaviridine efavirenz nevirapine Rescriptor Sustiva Viramune ANTI-RETROVIRAL MEDICATIONS Non-nucleoside reverse transcriptase inhibitors

  22. amprenavir indinavir nelfinavir ritonavir saquinavir Agenerase Crixivan Viracept Norvir Invirase ANTI-RETROVIRAL MEDICATIONs Protease inhibitors

  23. hydroxyurea Hydrea ANTI-RETROVIRAL MEDICATIONS Ribonucleotide reductase inhibitors Nucleotide reverse transcriptase inhibitors • adefovir • Preveon

  24. ELEMENTS OF AN HEALTH HISTORY CONT. • Allergies and drug sensitivity • Infections: • hepatitis • sexually transmitted diseases • tuberculosis • Tobacco use • Alcohol use • Recreational drug use

  25. ROLE OF THE DENTIST IN HIV CARE • Provide routine dental care • Recognize, treat, and understand the significance of oral lesions • Be part of the overall physical well-being of all patients

  26. BE A RESOURCE IN THE OVERALL MEDICAL CARE OF THE DENTAL PATIENT IN CONCERT WITH PRIMARY MEDICAL PROVIDERS • Medication adherence • Referral for drug/alcohol abuse • STD prevention • Screening for signs and symptoms of drug side-effects

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