Commonly Used Medications Metabolized in the Liver Cont.
Use extreme caution for patients with prolonged bleeding as ASA and NSAID can make it worse
Anesthetics - lidocaine has not been associated with any side effects when used appropriately
Antibiotics – metronidazole and tetracylcine metabolism may be severely impaired in patients with acute hepatitis or cirrhosis and should not be used
Diagnosis and Treatment of Oral Manifestations of HIV & HCV Infection
Fungal Disease Candidiasis- Candida albicans
Occurs in persons with poorly controlled diabetes, pregnancy, hormone imbalance, those receiving broad spectrum antibiotics, long term steroid treatment, cancer therapy and other immunocompromised individuals
Oral lesions may be erythematous, pseudomembranous, hyperplastic or angular cheilitis, DD-oral hairy leukoplakia
Topical therapy with nystatin or clotrimazole is effective. Treatment length is usually 10-14 days, follow up in 2 weeks
Clotrimazole 10mg, 1 tab 5x/day, dissolve slowly and swallow, 10 day treatement
Systemic treatment with fluconazole 100 mg/day for 10 days for oropharyngeal/r esophageal disease, follow up in 2 weeks
Linear Gingival Erythema
Necrotizing Ulcerative Gingivitis
Necrotizing Ulcerative Peridontitis
Linear Gingival Erythema - profound erythema of the free gingival margin, responds poorly to treatment, usually asymptomatic.
Treatment - plaque removal and reinforce good oral hygiene, follow up in 2 weeks, frequent recalls, chlorhexadine
HIV Necrotizing Gingivitis- erythema with ulceration and loss of interdental papillae.
Treatment - aggressive plaque removal, debridement, and reinforce good oral hygiene, follow up in 1 week, frequent recalls, chlorhexadine
Periodontal Disease Cont.
HIV Necrotizing Periodontitis - erythema, necrotic tissue and bone, halitosis, severe pain and loose teeth.
Treatment - removal of necrotic tissue, chlorhexadine rinsing with additional use of metronidazole, follow up in 3-4 days, frequent dental visits and reinforcement of good oral hygiene.
Herpetic simplex ulceration
Human Papillomatous growth
Bilateral symmetrical white corrugated lesions on the lateral borders of the tongue as a result of reactivation of EBV
Usually asymptomatic, requires no treatment but podophyllum resin peels may be used
67 year old HIV+ female presents to clinic for full mouth extractions and fabrication of full upper and lower dentures. Eight root tips are present in each arch and all are asymptomatic. Patient has a current complaint of burning tongue and trouble swallowing. She says that she has had this before and her doctor gave her “some pink pills and it cleared it right up.”
Medical history reveals: diabetes 1987, PCP July 1998, cervical cancer September 1999, esophageal candidiasis march 2000 and April 2000.
Patient V Cont.
Current medications: Nelfinavir, HIVID, Ziagen, Bactrim, Insulin 2x/day