HIV status and the risk of post-extraction complications

Risk factors for post-tooth extraction complications in HIV-infected patients: A retrospective study

To assess the rate and risk factors of postoperative complications following tooth extraction in HIV-infected patients by CD4 count. The study subjects were 231 HIV-infected patients who underwent tooth extraction at our institution between January 2007 and December 2011. Results of blood test, underlying diseases, surgical site, extraction method, and postoperative complications were obtained from the medical records. The risk factors potentially involved in postoperative complications were analyzed by multivariate logistic regression. Patients were divided into two groups, 61 (26%) patients with CD4 count of <200 /μL, and 170 (74%) patients with ≥200 /μL. Of the 231 patients, 12 (5.2%) developed postoperative complications (alveolar osteitis, n=10; surgical site infection, n=2). The rate of complications was not different between the CD4<200 /μL group (1.6%), and the CD4≥200 /μL group (6.5%) (adjusted odds ratio (aOR): 9.328, 95% confidence interval (CI): (0.470, 185.229), p=0.1431). Surgical extraction method with bone excavation, but not CD4 count, were identified as risk factors for post-extraction complications (aOR: 22.037, 95%CI: (1.519, 319.617), p=0.0234). A low CD4 count is not a risk factor for post-extraction complications in HIV-infected patients. We advise that tooth extraction should be performed based on dental/oral condition, rather than delayed until improvement of CD4 count.

Alveolar Osteitis: A Review of Current Concepts

PURPOSE

The purpose of the present review was to explore the pathogenesis and etiology of alveolar osteitis (AO) to obtain a more intuitive understanding of the clinical prevention and management of the condition. The different treatment modalities were discussed through both the mechanistic understanding of AO and the evidence regarding the different modes of prevention and management.

MATERIALS AND METHODS

The Ovid Medline, PubMed, and Cochrane Central Register online databases were used to complete an advanced search using the MeSH term "dry socket," generating 756 results.

RESULTS

A total of 8 studies on the prevention of AO were included, with 66 studies included for review of the reported data overall. The information was categorized into incidence, etiology and pathogenesis, prevention, and management. The relevant background information and evidence for each category were summarized.

CONCLUSIONS

Understanding of the pathogenesis and etiology of AO has improved in recent years, which has been helpful for developing effective evidence-based treatment and prevention of the condition. Clinicians should be aware of the complexity and multifactorial nature of the etiology of AO and the current concepts regarding the prevention and treatment of AO.

Wound Healing Problems in the Mouth

Wound healing is a primary survival mechanism that is largely taken for granted. The literature includes relatively little information about disturbed wound healing, and there is no acceptable classification describing wound healing process in the oral region. Wound healing comprises a sequence of complex biological processes. All tissues follow an essentially identical pattern to complete the healing process with minimal scar formation. The oral cavity is a remarkable environment in which wound healing occurs in warm oral fluid containing millions of microorganisms. The present review provides a basic overview of the wound healing process and with a discussion of the local and general factors that play roles in achieving efficient would healing. Results of oral cavity wound healing can vary from a clinically healed wound without scar formation and with histologically normal connective tissue under epithelial cells to extreme forms of trismus caused by fibrosis. Many local and general factors affect oral wound healing, and an improved understanding of these factors will help to address issues that lead to poor oral wound healing.

Long-term outcomes of oral rehabilitation with dental implants in HIV-positive patients: A retrospective case series

Background

The existing information on oral rehabilitations with dental implants in VIH-positive patients is scarce and of poor quality. Moreover, no long-term follow-up studies are available. Hence, the aims of this study were to describe the long-term survival and success rates of dental implants in a group of HIV-positive patients and to identify the most common postoperative complications, including peri-implant diseases.

Material and Methods

A retrospective case series of HIV-positive subjects treated with dental implants at the School of Dentistry of the University of Barcelona (Spain) was studied. Several clinical parameters were registered, including CD4 cell count, viral load and surgical complications. Additionally, the patients were assessed for implant survival and success rates and for the prevalence of peri-implant diseases. A descriptive statistical analysis of the data was performed.

Results

Nine participants (57 implants) were included. The patients’ median age was 42 years (IQR=13.5 years). The implant survival and success rates were 98.3% and 68.4%, respectively, with a mean follow-up of 77.5 months (SD=16.1 months). The patient-based prevalence of peri-implant mucositis and peri-implantitis were 22.2% and 44.4% respectively at the last appointment. Patients that attended regular periodontal maintenance visits had significantly less mean bone loss than non-compliant patients (1.3 mm and 3.9 mm respectively).

Conclusions

Oral rehabilitation with dental implants in HIV-positive patients seems to provide satisfactory results. In order to reduce the considerably high prevalence of peri-implant diseases, strict maintenance programmes must be implemented.

Key words:HIV infection, dental implants, oral implantology, complications, peri-implantitis, peri-implant diseases.

Characteristics of pyogenic odontogenic infection in patients attending Mulago Hospital, Uganda: a cross-sectional study

Background

Predisposing factors of pyogenic odontogenic infection include dental caries, pericoronitis, periodontitis, trauma to the dentition and the supporting structures or complications of dental procedures. The infections are usually polymicrobial involving normal endogenous flora. We characterised pyogenic odontogenic infection in patients attending Mulago Hospital, Uganda.

Results

Of the 130 patients, 62 (47.7%) were female. The most frequently involved fascial spaces were: the buccal, 52 (25.4%); submasseteric, 46 (22.4%) and the submandibular space, 36 (17.5%). Dental caries was the most prevalent predisposing factor, particularly of the lower third molar teeth. Viridans Streptococci Group and Staphylococcus aureus were the most frequent bacterial isolates: 23.5% and 19.4%, respectively. All Viridans Streptococci isolates were resistant to penicillin G, sulfamethoxazole/trimethoprim (cotrimoxazole), ampicillin and tetracycline, but susceptible to vancomycin. All Staphylococcus aureus strains were resistant to cotrimoxazole and ampicillin while retaining susceptibility to vancomycin, cefotaxime, linezolid, moxifloxacin and amoxicillin/clavulanate. Thirty five (26.9%) patients were HIV infected and the HIV status did not significantly influence the pattern of odontogenic infection.

Conclusions

Dental caries was the most prevalent predisposing factor for pyogenic odontogenic infection. High prevalence of bacterial resistance to ampicillin and cotrimoxazole suggests the need for regular antibiotic susceptibility tests of isolates and rational use of antibiotics in the management of these infections. Prevention requires strengthening of oral health in the community.

Dental extraction in the neutropenic patient

PURPOSE

To identify risks of dental extraction in patients with mild, moderate, and severe neutropenia.

MATERIALS AND METHODS

The authors undertook an observational study of 116 patients diagnosed with neutropenia and undergoing dental extractions in the Mayo Clinic Division of Oral and Maxillofacial Surgery. Absolute neutrophil count (ANC) was no higher than 1,500/μL. Predictors were ANC, age, diagnosis, number of teeth removed, type and location of extraction, length of antibiotic use, presence and type of bacteremia at the time of consultation or extraction, reason for consultation, indication for extraction, and use of any granulocyte colony-stimulating factor (GCSF). Primary outcomes were total complications, surgical site infections, delayed healing, and prolonged postoperative pain. Descriptive and bivariate analyses were undertaken, with statistical significance set at a P value less than or equal to .05.

RESULTS

One hundred sixteen patients underwent extraction while neutropenic. The overall complication rate was 8.6% (n=10). All were minor complications requiring simple interventions, if any. Complications were delayed healing, surgical site infection, and prolonged postoperative pain. Delayed healing was not associated with ANC. GCSF and related medications did not appear to affect outcomes in these patients.

CONCLUSION

The results of this preliminary study suggest that extraction of teeth in patients at all stages of neutropenia can be conducted safely. Complications of extraction were few and should be easily controlled. Further studies are required to clarify and stratify risk for future patients.

Tissue laser biostimulation promotes post-extraction neoangiogenesis in HIV-infected patients

The aim of the study was to assess the rate of neoangiogenesis in extraction wound healing following exposure to biostimulating laser therapy and to analyze the correlation between parameters of neoangiogenesis as reflected by the number and surface area of newly formed blood vessels and clinical parameters such as gender, position of a tooth in the oral cavity, and CD4 lymphocyte count. Twenty-seven patients with confirmed HIV infection were enrolled in the study (6 women, 21 men). Eighty-nine teeth were extracted; 45 sockets were exposed to 6 J laser radiation (laser parameters were set as follows: wavelength, 820 nm; output, 200 mW; dose, 6 J/cm²; spot size, 38 mm²; continuous radiation) for five consecutive days following tooth extraction, and the remaining extraction wounds were left to heal spontaneously without laser irradiation. Antigen CD34 was assessed by immunohistochemistry as a marker of angiogenesis, and its expression was examined by computer-assisted histomorphometric image analysis. As a result, we report that biostimulating laser therapy in HIV-infected patients of varying degrees of immunodeficiency greatly accelerated post-extraction neoangiogenesis, regardless of the patient's gender, tooth position, number of roots, or number of CD4 lymphocytes in the blood. Application of low-level laser therapy for the treatment of tooth extraction wounds in HIV(+) patients greatly enhanced the formation of new blood vessels, which in turn promoted wound healing.

Periodontal disease in HIV/AIDS

Since the early 1990's, the death rate from AIDS among adults has declined in most developed countries, largely because of newer antiretroviral therapies and improved access to these therapies. In addition, from 2006 to 2011, the total number of new cases of HIV infection worldwide has declined somewhat and has remained relatively constant. Nevertheless, because of the large numbers of existing and new cases of HIV infection, the dental practitioner and other healthcare practitioners will still be required to treat oral and periodontal conditions unique to HIV/AIDS as well as conventional periodontal diseases in HIV-infected adults and children. The oral and periodontal conditions most closely associated with HIV infection include oral candidiasis, oral hairy leukoplakia, Kaposi's sarcoma, salivary gland diseases, oral warts, other oral viral infections, linear gingival erythema and necrotizing gingival and periodontal diseases. While the incidence and prevalence of these oral lesions and conditions appear to be declining, in part because of antiretroviral therapy, dental and healthcare practitioners will need to continue to diagnose and treat the more conventional periodontal diseases in these HIV-infected populations. Finding low-cost and easily accessible and acceptable diagnostic and treatment approaches for both the microbiological and the inflammatory aspects of periodontal diseases in these populations are of particular importance, as the systemic spread of the local microbiota and inflammatory products of periodontal diseases may have adverse effects on both the progression of HIV infection and the effectiveness of antiretroviral therapy approaches. Developing and assessing low-cost and accessible diagnostic and treatment approaches to periodontal diseases, particularly in developing countries, will require an internationally coordinated effort to design and conduct standardized clinical trials.

A Comparison of Chronic Periodontitis in HIV-Seropositive Subjects and the General Population in the Ga-Rankuwa Area, South Africa

The effect of HIV infection on the prevalence and the rate of progression of chronic periodontitis is not clear. The aim of this study was to compare parameters associated with the severity of chronic periodontitis in terms of periodontal probing depths, gingival recession, plaque indexes, and bleeding indexes of HIV-seropositive subjects and healthy age-matched control subjects, and of HIV-seropositive subjects on highly active antiretroviral therapy and those not receiving such treatment. Two cohorts of subjects with chronic periodontitis were recruited for this study over a period of six months. There were 30 HIV-seropositive subjects, and 30 control subjects. Periodontal probing depths, gingival marginal recession, plaque indexes, and bleeding indexes were compared by HIV serostatus, the use of highly active antiretroviral therapy, and CD4+ T-cell counts. All participants were black persons between the age of 18 and 45 and were of a similar socioeconomic status and age. The results of this study indicate that chronic periodontitis in HIV-seropositive subjects is similar in terms of mean periodontal probing depth, gingival marginal recession, plaque index, and bleeding index to that in healthy age-matched control subjects, and a low CD4+ T-cell count does not appear to be a risk factor for increased severity of chronic periodontitis.

Root coverage in an HIV-positive individual: combined use of a lateral sliding flap and resin-modified glass ionomer for the management of an isolated severe recession defect

BACKGROUND

Gingival recession is a frequent clinical finding in the general population. Exposed root surfaces are more likely to develop root sensitivity and root caries and pose esthetic concerns for the patient. Most root coverage procedures have been described on non-restored root surfaces. Limited data are available that describe root coverage procedures on restored root surfaces. To our knowledge, this is the first case report in which a severe recession defect and its associated carious lesion were managed using the combination of a lateral sliding flap and a resin-modified glass ionomer restoration in an HIV-positive individual.

METHODS

A 53-year-old male patient with a 25-year history of HIV infection presented for comprehensive care. The facial surface of tooth #22 had a fractured composite restoration, recurrent decay, and a Miller Class III recession defect. The lesion was restored with resin-modified glass ionomer and root coverage was obtained by a lateral sliding flap mobilized from the adjacent edentulous ridge. After 8 weeks, surgical access was used to correct a previously undetected void in the restoration.

RESULTS

Uneventful healing was observed at the 1-, 4-, 8-, 10-, 12-, and 24-week postoperative visits. Root coverage of 5 mm along with a 2-mm band of keratinized tissue was obtained at 24 weeks. The gingiva displayed no signs of inflammation and was tightly adapted to the root surface with minimal probing depths circumferentially.

CONCLUSION

Successful root coverage was obtained on a resin-modified glass ionomer-restored surface in an HIV-positive individual.

Wound infection rates in elective plastic surgery for HIV-positive patients

BACKGROUND

Human immunodeficiency virus (HIV)-positive patients suffer from a unique set of aesthetic challenges, frequently requiring plastic and reconstructive surgical intervention. This study was designed to evaluate the overall wound infection rates for elective surgery in this patient population, focusing specifically on differences between transdermal (both open and minimally invasive) and transoral procedures.

METHODS

Charts were reviewed for all patients with an International Classification of Diseases, Ninth Edition code of V08 (asymptomatic HIV infection, CD4 count >200 cells/microl) who underwent surgery by the senior author (S.P.D.) at this tertiary care hospital between January 1, 2000, and October 1, 2007 (39 patients, 98 procedures). Indication for surgery, type of procedure performed, wound infection rates, length of follow-up, status of HIV infection, and HIV treatment status were all documented. Data were collected according to internal review board protocol. Infection rates were compared between study groups and with the existing surgical literature.

RESULTS

Statistical analysis revealed no significant difference in wound infection rate between open and minimally invasive procedures when a transdermal approach is used (10 percent and 0 percent, respectively; p > 0.05). However, there was a significantly increased infection rate in transoral surgery when compared with these two groups (71 percent; p < 0.001).

CONCLUSIONS

These findings indicate that there is a greatly increased risk of wound infections for HIV-positive patients undergoing transoral surgery when compared with transdermal surgery and historical norms.

Non-surgical management of an oro-antral fistula in a patient with HIV infection

BACKGROUND

The risk of post-extraction complications is higher in patients who are immunosuppressed compared to other patients with normal immune function. In addition, invasive dental procedures are more likely to have serious complications in these patients. This case report demonstrates an effective non-surgical procedure to treat an oro-antral fistula in an HIV-infected man.

METHODS

The oro-antral fistula was de-epithelialized under local anaesthesia and the patient wore a surgical splint continuously, removing it only for cleaning, for an eight week period. Chlorhexidine gel was regularly applied to the fitting surface of the splint and the oro-antral communication. The patient was reviewed on a regular basis.

RESULTS

This procedure resulted in resolution of the patient's symptoms within two weeks. Complete healing of the oro-antral fistula was evident following eight weeks of wearing the surgical splint.

CONCLUSIONS

This procedure provided an effective method of treating an oro-antral fistula in an immunocompromised patient without causing any detrimental effects to the patient's overall health. Adequate pre-surgical assessment of patients prior to extractions is important in all patients to help prevent the occurrence of such complications.

Oral complication risks after invasive and non-invasive dental procedures in HIV-positive patients

BACKGROUND

Limited published scientific evidence is available to provide guidance to clinicians on possible increased risks of invasive oral procedures associated with the human immunodeficiency virus (HIV) status of the patient. The aim of this study was to assess post-procedural complications in patients infected with HIV.

MATERIAL AND METHODS

This was a retrospective cross-sectional study of the records of 101 consecutive HIV patients treated at the School of Dentistry of Madrid Complutense University and Sandoval STD Clinic in Madrid between January 2003 and February 2005. Data were gathered by an experienced dental practitioner using a structured epidemiological questionnaire for information on gender, age, HIV transmission category, medical history, hepatitis B virus (HBV) or hepatitis C virus (HCV) coinfection and other diseases, TCD4+ and TCD8+ count, HIV viral load (VL), platelet count, neutrophil count, international normalized ratio and haemoglobin level; tobacco and alcohol intake, highly active antiretroviral treatment and presence of oral lesions. Information was also collected on complications related to dental treatment (invasive or non-invasive) during the previous 6 months. Chi-squared test and Fisher's exact test were used to establish statistical significance.

RESULTS

Data were gathered on 314 dental procedures in 101 patients. The overall complication rate was 2.2% (7/314); in 147 invasive procedures, seven complications (4.8%) were documented (one persistent pain, two prolonged bleeding, three infections, one bone sequestrum) including extractions, periodontal scaling, endodontic treatment and biopsy. No differences were found in TCD4+, TCD8+, platelet count, HBV or HCV co-infections or HIV VL between patients with and/or without complications. Patients with complications were mainly in B stage of HIV disease (P=0.020). Oral lesions and smoking habit>20 cig day-1 were documented in 83.3% (P=0.086) and 50% (P=0.060), respectively, of patients with complications.

CONCLUSIONS

The complication rate was 2.2% overall and 4.8% after invasive dental procedures. Presence of oral lesions, smoking habit or HIV clinical stage B may be predictive factors for oral complications in HIV patients. No relationship was found between complications and virological, immunological or other laboratory values. Studies with wider samples and negative control group are warranted to confirm the absence of an association between HIV positivity and higher risk of oral complications.

Does prophylactic administration of systemic antibiotics prevent postoperative inflammatory complications after third molar surgery?

PURPOSE

To estimate and compare the frequencies of inflammatory complications after third molar (M3) surgery in subjects receiving intravenous prophylactic antibiotics or saline placebo.

MATERIALS AND METHODS

Using a placebo-controlled, double-blind, randomized clinical trial, the investigators enrolled a sample composed of subjects who required extraction of at least 1 impacted M3 and requested intravenous sedation or general anesthesia. The predictor variable was treatment group classified as active treatment (penicillin or clindamycin for penicillin-allergic subjects) or placebo (0.9% saline). Study medications were randomly assigned. Both surgeon and subject were blinded to treatment assignment. The medication was administered intravenously prior to any incision. The outcome variable was postoperative inflammatory complication classified as present or absent and included alveolar osteitis (AO) or surgical site infection (SSI). Other variables were demographic, anatomic, or operative. Descriptive and bivariate statistics were computed. Statistical significance was set at P < or = .05, single-tailed test of hypothesis.

RESULTS

The sample was composed of 118 subjects (n = 59 per study group). In the active treatment group, there were no postoperative inflammatory complications. In the placebo group, 5 subjects (8.5%) were diagnosed with SSI, (P = .03). No subject met the case definition for AO. All SSIs were associated with the removal of partial bony or full bony impacted mandibular M3s.

CONCLUSION

In the setting of third molar removal, these results suggest that the use of intravenous antibiotics administered prophylactically decrease the frequency of SSIs. The authors cannot comment on the efficacy of intravenous antibiotics in comparison to other antibacterial treatment regimens, eg chlorhexidine mouthrinse or intrasocket antibiotics.

Management of mandibular third molar extraction sites to prevent periodontal defects

PURPOSE

Persistent periodontal defects on the distal aspect of the mandibular second molar (M2) is a reported complication of mandibular third molar (M3) extraction. The purpose of this study was to measure the efficacy of demineralized bone powder (DBP) or guided-tissue regeneration therapy (GTR therapy) in preventing periodontal defects on the distal aspect of the M2 following M3 extraction.

MATERIALS AND METHODS

We implemented a single-blind, randomized, controlled clinical trial composed of a sample of subjects > or = 26 years of age who required extraction of bilateral M3s. The primary predictor variable was treatment group. Each subject was randomly assigned to receive either DBP or GTR therapy. Within subjects, 1 M3 site was randomly selected to be the experimental site and the opposite M3 served as a control and was permitted to heal without intervention. The primary outcome variable was the change in attachment levels (AL) and probing depths (PD) on the disto-buccal aspect of M2 between T 0 (immediate preoperatively) and T 4 (26 weeks postoperatively). Appropriate sample size estimates, descriptive, bivariate, and multivariate statistics were computed.

RESULTS

Twelve subjects in the DBP group and 12 subjects in the GTR-therapy group completed the study. For both treatment and control sites, between T 0 and T 4, there were statistically significant improvements in AL (> or = 2.2 mm; P <.001) and PD (> or = 2.6 mm; P <.001). Within-subjects comparisons showed no significant differences in AL or PD between treatment and control M3 sites ( P > or =.3) at T 0 or T 4.

CONCLUSION

The results of this study suggest that attachment levels and probing depths improve after M3 removal. In this sample, DBP or GTR therapy did not offer predictable benefit over no treatment.

Types, frequencies, and risk factors for complications after third molar extraction

OBJECTIVES

The study objective was to identify the types, frequency, and risk factors for complications after third molar (M3) extractions.

STUDY DESIGN

This retrospective cohort study consisted of patients who had 1 or more M3s removed between 1996 and 2001. Risk factors were grouped into demographic, general health, anatomic, and operative. Outcome variables were operative or inflammatory complications. Data were analyzed using descriptive, bivariate, and multivariate statistics.

RESULTS

The study sample was composed of 583 patients (57.0% male) with a mean age of 26.4 +/- 8.4 years. The overall complication rate was 4.6%. Increasing age, a positive medical history, and the position of the M3 relative to the inferior alveolar nerve were associated with an increased risk for complications.

CONCLUSION

While age, medical history, and M3 anatomy cannot be altered directly, these factors may be modified indirectly, resulting in a potential decrease for postoperative complications.

HIV disease

Much has been learned about HIV disease during its first 20 years of existence in North America. The virus can now be successfully suppressed by HAART therapy, yet complete viral eradication from the body has not been demonstrated, and HIV transmissions continue to occur at an alarming rate. With support of the immune system, many HIV-infected patients will avoid oral and systemic opportunistic illnesses (or at least significantly prolong their time to onset). The number of HIV-infected patients under dental care is expected to increase in the future. Thus, dentists are fortunate that oral health care can be provided safely in the community setting for all but the very sickest of AIDS patients.

Complications in HIV-infected and non-HIV-infected haemophiliacs and other patients after oral surgery

Dental extractions and other oral surgical procedures, including local analgesic injections, potentially can cause problems in haemophiliac and HIV infected persons. There are few data on treatment results in HIV-infected haemophiliacs compared with non-HIV-infected haemophiliacs. The oral surgery treatment results in 48 patients with special needs, including HIV-infected haemophiliacs, non-HIV-infected haemophiliacs, HIV-infected non-haemophiliacs, and a group with other medical problems were therefore studied. Around 20% of the haemophiliacs developed post-oral surgical complications, which was not significantly different whether or not they were HIV-infected. However, complications were less frequent (8%) in HIV-infected non-haemophiliacs or other patients with special needs. Although the patient groups are not large, it would appear that haemophiliacs had more postoperative complications but that the presence of HIV infection had no notable influence on treatment outcome.

An update on HIV and periodontal disease

With the advent of newer pharmacological approaches to the treatment of human immunodeficiency virus (HIV) infection, the incidence and progression of both atypical and conventional periodontal diseases are changing. The incidence of necrotizing periodontitis and gingival diseases of fungal origin appears to be on the decline as a result of these therapies that have led to increased life spans for HIV patients. However, in cases where these therapies lose their effectiveness and HIV patients relapse into an immunosuppressed state, these conditions may recur. Recent evidence has shown that HIV patients with more conventional periodontal diseases such as chronic periodontitis may have increased attachment loss and gingival recession when compared to their HIV-negative counterparts. This pattern of loss of periodontal support may be due in part to a diffuse invasion of opportunistic bacterial infections, viruses, and fungi into the gingival tissue, leading to a more elevated and more diffuse destructive inflammatory response in the periodontal soft and hard tissues. While the accepted approaches to treating the spectrum of periodontal diseases in HIV patients remain essentially unchanged over the past 15 years, the impact of newer systemic therapies on patient immunocompetence may influence treatment decisions.

Oral and dental care and treatment protocols for the management of HIV-infected patients

This paper describes the workings of the workshop dedicated to oral and dental care and treatment protocols for the management of HIV-infected patients. The questions addressed were: 1) What are the current ethical issues in dental care of HIV patients, do they need to be addressed? 2) Do we need to modify the dental care we give HIV-positive patients? 3) When is it necessary to give antibiotic prophylaxis to HIV-positive patients? 4) What is the evidence for the effective treatment of oral lesions associated with HIV? 5) What is the most successful palliative treatment for KS? 6) Can we provide clinical treatment that has a scientific basis rather being trial based? 7) Is ddI + hydroxy-urea an effective African alternative to HAART? 8) What is the influence of protease inhibitors and HAART on the excretion of HIV in saliva? 9) What is the effect of anti-HIV therapy on the oral mucosa and oral health? This workshop did not fully cover the issue of ddI and hydroxy-urea as an alternative HIV therapy as this was considered to be the remit of general physicians caring for patients with HIV and AIDS rather than that of oral health care workers.

A systematic review of complication risks for HIV-positive patients undergoing invasive dental procedures

BACKGROUND

This systematic literature review determined the strength of evidence regarding whether patients with human immunodeficiency virus, or HIV, are at higher risk of developing complications from invasive oral procedures than similar patients without HIV.

TYPES OF STUDIES REVIEWED

MEDLINE and EMBASE searches of the English literature from the early 1980s through April 2000 yielded five articles meeting the inclusion and exclusion criteria: original research, concurrent treatment of HIV-positive and HIV-negative subjects, presence of complications (for example, local or systemic infection, bleeding, alveolitis, delayed healing) resulting from extractions, orthognathic surgery, periodontal therapy, endodontic therapy, placement of dental implants, prophylaxis, or scaling and root planing.

RESULTS

The authors found no studies involving orthognathic surgery, periodontal therapy, dental implants, prophylaxis, or scaling and root planing, and only one study reporting few immediate endodontic therapeutic complications. Thus, the evidence is insufficient with respect to any additional risk associated with these procedures among people with HIV/AIDS. Because of the few studies, low overall complication rates and variability in results from different analytic approaches, the authors consider the evidence to be too poor to rule in or out a meaningful relationship between HIV status and complications from tooth extractions.

CLINICAL IMPLICATIONS

Limited published scientific evidence is available to guide clinicians in regard to possible increased risks of invasive oral procedures associated with the HIV status of the patient.

Hospital course of HIV-positive patients with odontogenic infections

OBJECTIVE

The study purpose was to compare and contrast the hospital course of patients who are human immunodeficiency virus-positive (HIV+) and human immunodeficiency virus-negative (HIV-) who were admitted to manage their odontogenic infection.

STUDY DESIGN

We used a retrospective case-control study design and a sample derived from patients admitted for management of their odontogenic infections. Cases and controls were defined as patients who were HIV+ or HIV-, respectively. HIV status was determined by patient self-report. Outcome variables included admission temperature (degrees Celsius) and white blood cell count, number of fascial spaces infected, days with temperature >38 degrees C, need for intensive care, and length of hospital stay.

RESULTS

The study sample consisted of 60 patients (10 HIV+ cases and 50 HIV- controls matched for age and sex) with a mean age of 32.8 +/- 6.6 years and was predominantly male (78%). Significant differences existed between patients who were HIV+ and those who were HIV- for the following variables: admission white blood cell count, number of days with maximum temperature >38.0 degrees C, and use of the intensive care unit.

CONCLUSIONS

The study results suggest that patients who are HIV+ who are admitted for management of odontogenic infection have a significantly more intense hospital course than those who are HIV-. However, the overall length of hospital stay is not significantly different.

The risk of serious odontogenic infections in HIV-positive patients: a pilot study

OBJECTIVE

The purpose of this study was to perform a preliminary test of the hypothesis that patients infected with the human immunodeficiency virus (HIV) have an increased risk for serious odontogenic infections in comparison with HIV-negative patients.

STUDY DESIGN

To address the research purpose, we used a case-control study design. A case was a serious odontogenic infection requiring inpatient management. A control was a nonserious odontogenic infection that could be managed on an outpatient basis. The ratio of controls to cases was 2:1. HIV status was determined by record review.

RESULTS

The sample was composed of 300 patients. Sixteen patients (5%) were HIV-positive. Overall, 37.5% of the HIV-positive patients had serious infections; this compared with 33% of the HIV-negative patients (odds ratio = 1.21; 95% confidence interval = 0.43-3.44; P = .79).

CONCLUSIONS

The results of this pilot study suggest that HIV-positive patients do not have an increased risk for developing serious odontogenic infections.