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Medically Compromised Patient Care

Course Number: 628


The human immunodeficiency virus (HIV) is found in bodily fluids and is transmitted via blood, semen, vaginal secretions, and breastmilk. HIV is the etiologic agent for the acquired immunodeficiency syndrome (AIDS). Currently, there are no reports of HIV seroconversion in dental professionals in the U.S. after percutaneous exposure (PME). In HIV disease, the number of CD4+ T lymphocytes decrease as the viral load and the symptoms of disease and the incidence of oral infections/lesions related to the HIV infection increases. A patient is usually diagnosed if their viral load is > 3000 copies/mL. A healthy individual has a CD4+ count of 800-1200 mm3, but if it falls below 200 mm3, that is indicative of late-stage disease or AIDS infection. The count of the T-helper cells is most commonly used to track progression of the infection and helps to determine the extent of treatment.

When preparing for dental treatment, a medical consult is needed if current lab reports aren’t available to determine patient’s current CD4 and level of immunosuppression. Antibiotic premedication is necessary only if the patient is experiencing severe immune neutropenia (i.e., ANC less than 500 cell/mm3).1 It is ok to use nitrous oxide sedation and local anesthetic with vasoconstrictor. Standard precautions and personal protective equipment should be worn and any oral lesions should be documented if observed. An oral pathology consult and medical consult may be indicated in that case. If the patient will be needing an extraction, request that they bring their latest lab results with them and review the platelet, white blood cell and red blood cell counts.

Table 14 includes helpful follow-up questions for dental patients with HIV.

Table 14. Follow-Up Questions for HIV Patients(1)
  • When were you diagnosed with HIV/AIDS?
  • When was your last complete blood count and do you have the results with you?
  • How has your overall health been recently?
  • Have you recently experienced any infections?
  • Are you on any medications for this condition?