How Aids And Hiv Affect Dental Work
If you or a loved one is HIV positive or has AIDS
, you may require some special care when it comes to having dental work done. There are about 80,000 AIDS cases in India and 1.5 million people infected with HIV.
According to experts, if the trend continues, India could have as many as 30 million people with HIV by the year 2010- about twice today's worldwide count. AIDS, or Acquired Immunodeficiency Syndrome, is a highly lethal, progressively epidemic viral infection that destroys the immune system, increasing the individual's susceptibility to infectious disease and cancer.
Severe immune suppression defined as a CD4 cell count below 200cells /mm3 is, as of Jan 1993, an AIDS diagnosis. For most HIV infected patients, there is a long clinical latency period, often extending to seven to eight years.
There are at least 10 genetic types or clades of the human immunodeficiency virus, each antigenically distinct, with different clades predominant in different parts of the world. At a recent international conference on AIDS, a new triple drug therapy has been declared to be effective.
The HIV virus must get into the blood stream to infect a person. In order for infection to occur, 3 things must happen. One must be exposed to blood, pre-cum, semen, vaginal secretions, or breast milk, the virus must get directly into the blood stream through some fresh cut, open sore, abrasion etc., and the transmission should go directly from one person to the other very quickly.
The ADA strongly affirms that Universal precautions are an effective and adequate means of preventing transmission of HIV virus from dental health care workers to patients and vice versa. Based on the experience of numerous general dentists over the last 10 to 15 years, patients infected with HIV can safely be treated in general dental settings.
However, establishment of dedicated clinics for HIV infected patients may be justified because clinical staff in such settings develop increased clinical experience and will be able to manage more complex patients with greater confidence.To minimize complications after dental procedures, a thorough and appropriate medical assessment is necessary.
The main concern for dentists treating HIV infected cases are increased bleeding tendencies, post operative infections, drug interactions, adverse reactions, and prognosis for survival. The mode of HIV transmission influence the provision of dental care.
Hemophiliacs demand modifications of dental care, moreover, they have a high prevalence of hepatitis B, hepatitis C, and hepatitis delta virus infection. Intravenous drug users (IVDUs) also have a high prevalence of hepatitis B and hepatitis C viral infections.
Children with perinatally acquired HIV are considered to be at greater risk for caries than their siblings, more so with advancing disease. Patients also show increased adverse reactions toward other antibiotics, including amoxicillin-clavulanic acid, ciprofloxacin, dicloxacillin, erythromycin and clindamycin, when their CD4 cell count decreases.
During the course of HIV disease, all patients develop oral alterations, but none of these lesions are specific for HIV disease, and they can be present in other immune suppressed individuals. These lesions range from asymptomatic, subtle changes of the oral mucosa that are secondary to a decreased salivary flow or candidiasis to rapidly destructive lesions, such as necrotizing stomatitis, necrotizing ulcerative periodontitis, deep mycoses, and cancers.
The treatment of some of these oral lesions can be handled in a dental office on an outpatient basis. When treatment includes radiation, cancer chemotherapy, and long term intravenous medication for neoplasms, it is advantageous for the dentist to be a part of the treatment team instead of being the primary provider.
The treatment team may have a general internal medicine specialist who takes care of the patient's non- infectious needs, and an infectious disease specialist to attend to all HIV related care. Community based organizations and social support networks are also involved with a multitude of services, including psychological counseling and drug rehabilitation.
Though it has been suggested that dental hand-pieces are capable of transmitting HIV in a dental setting, there has never been any reports that such a transmission has occurred. Special attention should be paid to dentists who are more susceptible to diseases potentially transmitted in a dental setting.
They include pregnant women, due to their immunologic changes and the developing foetus; dentists with the habit of excessive alcohol intake; those who had undergone splenectomy, radiotherapy, and long term corticosteroid therapy; also, dentists suffering from diseases that have an impact on the first and secondary defense against infections such as diabetes mellitus, chronic renal failure, leukemia or HIV.
As you can see, precautions must be taken to ensure that this disease is not spread, and is treated with sensitivity. If you or a sick loved one requires dental work, be sure to be open with your dentist right away.
by: Ignacio Lopez
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