Management of Periodontal Disease in Patients withHIVwww.hivguidelines.org
Purpose of the Guideline
Provide guidance on the management of HIV-associated periodontal lesions, which involves treating both bacteria and fungi.Key Point:Chronic nonhealing lesions may indicate a more serious condition, and oral health care providers can use biopsies to identify any neoplastic changes.
Recommendations:Linear Gingival Erythema (LGE)
Oral health care providers should treat LGE promptly before it evolves into a more severe form of periodontal disease. (A2)Oralhealth care providers should treat LGE with superficial debridement of affected tissue and antimicrobial rinse and schedule a follow-up appointment to determine if the patientisresponding to treatment. (A2)Key Point:Alack of response to conventional periodontal therapy is a key diagnostic feature of LGE; LGE is refractory to standard plaque control.
Recommendations:NecrotizingUlcerative Gingivitis & Periodontitis (NUG/NUP) Treatment
Oral health care providersshould:Treat NUG/NUPto prevent destruction of periodontal tissues. X-rays will determine the severity of the periodontal bone loss. (A2)Treatthe acute stage of NUG/NUP in the clinical setting as soon as possible after diagnosis; treatment should include superficial debridement of infected areas, root planing and scaling, and lavage/irrigation with an antimicrobial rinse (see full guideline for antimicrobial irrigation options). (A2)Providepatients with a treatment plan for follow-up home care that includes daily antimicrobial rinses (see full guideline for antimicrobial options) and instructions for and reinforcement of the importance of good oral hygiene and maintenance following treatment of acute disease and thereafter. (A2)Forpatients with severe or nonresponding NUG/NUP, oral health care providers should prescribe systemic antibiotics and concurrent treatment with an antifungal agent, as specified in the full guideline. (A3)
Recommendations:NUG/NUP Follow-Up
Oral health care providersshould:Evaluatehealing within 7 days of treatment and perform additional debridement if necessary. (A3)Re-evaluatethe patient 2 months after treatment to determine the need for further intervention. (A3)
Recommendations:Necrotizing Ulcerative Stomatitis and Stomatitis (NS/NUS) Treatment
Oral health care providersshould:Performbiopsy and refer patients to an oral surgeon, clinical pathologist, or oral medicine specialist whenNUS/NSis diagnosed. (A2)TreatNUS/NS with debridement of necrotic bone and softtissueand concurrent antimicrobial therapy, asspecified in full guideline.(A3)Includethe following as part of the treatment plan for patients with periodontal disease:Useof a pre-procedural antimicrobial rinse (A2)Localdebridement and disinfection using a 0.12% chlorhexidine gluconate or 10% povidone iodine (A2)Removalof necrotic debris and sequestration, along with scaling and root planing, with local anesthesia to proceed as tolerated by patient but no later than within 7 days of diagnosis (A2)Reinforcementof oral hygiene and home care instructions and prescriptions, including daily use of an antimicrobial rinse for 30 days, antibacterial therapy, nutritional supplementation/advice, and periodontal prescriptions (B2)
Medication Dosing
Preferred:Metronidazole, 250 mg three times per day for 7 daysAlternative:Augmentin, 500 mg two times per day for 7 daysForpatients allergic to penicillin:Clindamycin, 300 mg three times per day for 7 daysAsneeded for pain:Rinse with 2 teaspoons of xylocaine 2% viscous solution
Recommendations:Treatment of ChronicPeriodontalDisease
Oral health care providers should:Follow standardprocedures for the management of chronic pre-existing periodontitis. (A3)Performadditional diagnostic procedures (biopsy, cytologic smear, or culture) for lesions that show no healing within 10 days or refer the patient to a periodontist as indicated. (A3)
Access the Guideline
www.hivguidelines.org> Primary HIV Care > Management of Periodontal DiseaseAlso available:Printable pocket guide; printable PDF
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