Background:
Jim
is a new patient in your office. He was recently diagnosed as being HIV-positive
and he is taking AZT daily to manage his condition. Jim is concerned about
the presence of white "curd-like" patches on his oral tissues,
which has been present for about three weeks. He takes good care of his
teeth but his gums are now bleeding. What are the white patches? What
medication can he take to resolve his oral condition? What about his bleeding
gums? Can he take other medications while he is on AZT? How will this
change your dental hygiene care?
This lesson focuses on antiinfective,
anti-fungal and anti-viral agents that may be prescribed for your patient
by a dentist or physician. Even though you will not prescribe medications
for the treatment of a patient's oral condition, it is necessary to be
familiar with these agents so that you can review treatment regimens and
answer questions regarding these drugs and their uses.
 |
Pharmacology
for Dental Hygiene Practice ch. 6, pp. 77-103 and ch. 18, p.p. 251-259 |
Etiology
and Pathogenesis
As a dental hygienist you will encounter patients with a variety of oral and systemic conditions who may be taking medications prescribed by a physician or a dentist that may affect dental hygiene treatment. It is important to be familiar with the more common diseases and possible drug treatments, which are included in the chart below. Knowledge of these diseases and their treatments will enable you to provide the appropriate care for your patients in a safe and effective manner.
|
Disease |
Etiology & Pathogenesis |
Treatment |
|---|---|---|
|
Periodontal Diseases (periodontal abscesses, chronic adult periodontitis, rapidly progressive and juvenile periodontitis, acute necrotizing gingivitis and periodontitis.) |
Causative agent: various microbes ranging from gram+positive aerobes to gram-negative anaerobes and spirochetes forming plaque on tooth surfaces and gingival tissues. Inflammatory response causes edema, redness and bleeding of tissues, alveolar bone loss with furcation involvement and tooth mobility. |
Antiinfective agents such as:
|
|
Causative agent: Mycobacterium tuberculosis (gram-negative bacterium). Airborne transmission. Bacteria lodges in pulmonary alveoli where host immune response forms granulomas around organisms. Disease process may be stopped or continued destruction of lung tissue can occur. |
Anti-tuberculosis agents including:
|
|
| Candidiasis (Monaliasis, thrush) |
Causative agent: Candida albicans (yeast-like fungus). Present in normal flora, overgrows due to various conditions (antibiotic use, diabetes, xerostomia, etc). May present as white curd-like lesion or a painful, erythematous lesion. Chronic hyperplastic candidiasis may resemble leukoplakia. |
Antifungal agents like:
|
| Herpes Simplex-1 Infections (Primary Gingivostomatitis and Recurrent Herpes) |
Causative agent: Herpes Simplex-1 virus. Occurs as painful, ulcerations or vesicles on perioral skin, vermilion border of lips, attached gingival and hard palate. Systemic symptoms may include fever, cervical lymphadenopathy, and malaise. Self-limiting. Duration: 7-10 days. Virus remains dormant in Trigeminal ganglion with recurrent episodes being triggered by sunlight, emotional stress, fatigue and fever. |
Antiviral agents including:
|
|
Causative agent: Human Immunodeficiency Virus-1 (HIV-1). Infects CD4+ cells (T-helper lymphocytes, monocytes and macrophages). Impairs function of host humoral immune response. Increased susceptibility to opportunistic infections such as candidiasis, herpes, pneumocystis pneumonia, tuberculosis, and malignant tumors (Kaposi's sarcoma, etc.). Initial symptoms include generalized lymphadenopathy, fever, chronic fatigue, weight loss, and night sweats. |
Antiviral agents such as::
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