In my continuing devotion to expanding the discussion on dentistry, I’m presenting an overview of periodontitis and associated systemic conditions.
Periodontal disease may be more severe in individuals affected with immune system disorders, and patients infected with human immunodeficiency virus (HIV) may have especially severe forms of periodontitis disease.
The incidence of necrotizing periodontal diseases may increase in the patient with HIV/AIDS. Patients who have received organ transplants or are undergoing cancer treatment, for example, may be taking immunosuppressing medications.
Special considerations required for treating such patients includes:
- Consultation and coordination of treatment with patient’s physician as necessary
- Controlling associated mucosal diseases and acute periodontal infections
- Administration of systemic or local medications (for example, antibiotics) only if indicated and administered in a manner that avoids opportunistic infections and adverse drug interactions
Satisfactory outcome for patients with systemic disorders may include the following:
- Significant reduction of clinical signs of gingival inflammation
- Reduction of probing depths
- Stabilization or gain of clinical attachment
- Reduction of clinically detectable plaque to a level compatible with gingival health
- Control of acute symptoms
Due to the complexity of systemic factors, control of periodontal diseases may not be possible.
A reasonable treatment objective, in such instances, is to slow the progression of the periodontal disease; progression of which may be characterized by the presence of:
- Persistent inflammation/infection of the gingival tissues
- Persistent or increasing probing depths
- Lack of stability of clinical attachment
- Persistent clinically detectable plaque levels not compatible with gingival health
- Radiographic evidence of progressive bone loss. In patients where the periodontal condition does not resolve, additional therapy may be required as well as further evaluation of the patient’s systemic condition
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