Fungal Infection, HIV and Ultrasonics
This month’s questions as featured in Dimensions of Dental Hygiene.
Ann Eshenaur Spolarich, RDH, PhD, is a physiologist, independent research consultant, and national continuing education provider in Cave Creek, Ariz. An editorial advisory board member for Dimensions, she wrote an article on adverse drug reactions and the oral cavity in the November 2006 issue of Dimensions, which appears here.
QUESTION What is most effective in clearing up a tongue with red spots, glossy middle, and some white coating? I’m assuming it is candida related.
ANSWER If it is a fungal infection, the patient will require a course of antifungal therapy using a prescription product, such as nystatin. Typically, the patient will suck on nystatin troches or pastilles five times per day for at least 1 week of therapy. Topical products are best because they are safer (fewer drug interactions). However, compliance is essential because the products work best the longer they stay in contact with the dentures. Remember to teach patients to treat their mouthguards and throw out anything that is used intraorally, like toothbrushes, to avoid cross-contamination during and after treatment. As always, get a proper diagnosis of the condition before proceeding.
Tip: After treatment, I give my patients two separate manual toothbrushes—one is blue and the other is green. I then advise them to use the blue toothbrush during treatment only. After treatment, they throw it out and switch to the green one.
HIV and Ultrasonics
Roberta Shaklee, DDS, practices full time in Denver as a periodontist and is a former dental assistant and dental hygienist. She also teaches part time at the University of Colorado in Denver and is a Dimensions editorial advisory board member. She wrote an article on ultrasonics in the October 2006 issue, which is available here.
QUESTION When treating a newly diagnosed periodontal patient who has had HIV/AIDS for more than 10 years, is ultrasonic instrumentation contraindicated? When are HIV/AIDS patients considered too involved to be treated at a general practice and then where do we refer?
ANSWER All dental practitioners should be using standard precautions (previously called universal precautions), to prevent all possible infections. Visit the Centers for Disease Control and Prevention for more information (www.cdc.gov). Because all dental and health professionals should be protecting themselves already, ultrasonic use is fine to use on HIV/AIDS patients. The use of the ultrasonic may even be safer because the risk of an instrument stick is less. I spoke with Kim Laudenslager, RDH, MPA, who lectures nationally on Occupational Safety and Health Association (OSHA) requirements and standard infection control precautions, and she agreed that ultrasonic usage is acceptable on HIV infected patients.
Regarding the referral of patients who are HIV infected, please see the Guidelines for the Management of Patients With Periodontal Diseases, recently published by the American Academy of Periodontology (AAP). You can click through to this document from the Dimensions homepage or download it from the AAP website at www.perio.org. The Guidelines divide patients into three levels. Patients who would likely benefit from comanagement by the referring dentist and the periodontist are level two. Medical and behavioral risk factors are included in this level. HIV infected patients fall under this category because they have a compromised immune system. As with all patients who have a periodontal disease, if the referring office feels a patient may be better treated in a periodontal practice, ie, severe chronic periodontitis, furcation involvement, vertical defects, aggressive periodontitis, etc, then the patient should be referred as soon as possible.
From Dimensions of Dental Hygiene. February 2007;5(2): 38.