Alma Mutiarani Widi Marsha F. Lily Sutanto Sabila Madeina Amaliyatus Silmi
1406528301 1506668795 1506736285 1506728472 1406528314
“
Pasien pria usia 28 tahun dikonsul dari Gedung A RSCM. Pasien dikonsulkan
ke bagian penyakit mulut dengan diagnosis kerja toxoplasma ensefalitis,
HIV positif belum diberi ART, gangguan oklusi, dan sariawan. Pada
pemeriksaan, pasien mengeluhkan mulut tidak bisa dibuka lebar. Pada
pemeriksaan intraoral, ditemukan ada ulkus pada mukosa bukal regio 47,
berbentuk ireguler, dalam, dan terasa nyeri. Pasien ada riwayat kejang
sebelum masuk rawat inap rumah sakit. Pasien tidak ada riwayat transfusi
darah, tato, bukan pengguna narkoba suntik, namun ada riwayat
promiskuitas.
What is HIV?
36.9 million
people living with HIV/AIDS
worldwide in 2017
Mortality
940 000
people died of HIV-related
illnesses worldwide in 2017
Prevention
129
low- and middle-income
countries reported a total of
150 million people tested in
2014
Epidemiology
03 Laboratory
examination
History
(anamnesis)
01 02
Physical
examination -
clinical features
“
History (Anamnesis)
• Infections
• Neoplasms
HIV • Neuropsychiatric disease
Disease (B) • General deterioration
• Serious infections
AIDS (C) • Neoplasms
“
“
Laboratory Examination
ELISAs, Rapid Tests, Semi-
quantitative Antibody Assays,
Immunologic Western Blot Assays, Immune
System Deterioration as a
Consequence of HIV Infection.
Necrotising
stomatitis
Linear Gingival Erythema (LGE)
maximally and
durably suppress prevent HIV
plasma transmission
HIV viral load
J.W. Little, D.A. Falace. Dental Management of Medically Compromised Patient 8 th ed. 2012. US; Elsevier.
MEDICAL MANAGEMENT
J.W. Little, D.A. Falace. Dental Management of Medically Compromised Patient 8th ed. 2012. US; Elsevier.
ART and HAART
‐ ART :
recommended when the CD4+ count < 350 cells/μL and in those
with plasma HIV RNA levels greater than 55,000 copies/Ml.
strongly recommended for patients with CD4+ T cell counts
lower than 200 cells/μL and for those with AIDS.
J.W. Little, D.A. Falace. Dental Management of Medically Compromised Patient 8 th ed. 2012. US; Elsevier.
ART and HAART
‐ The classification of antiretroviral agents :
J.W. Little, D.A. Falace. Dental Management of Medically Compromised Patient 8 th ed. 2012. US; Elsevier.
Antiretroviral
Medication
DENTAL MANAGEMENT
J.W. Little, D.A. Falace. Dental Management of Medically Compromised Patient 8th ed. 2012. US; Elsevier.
Antimicrobial
Prophylaxis
71
DENTAL MANAGEMENT
J.W. Little, D.A. Falace. Dental Management of Medically Compromised Patient 8th ed. 2012. US; Elsevier.
DENTAL MANAGEMENT
TRANSMISSION OF HIV
‐ The risk of HIV transmission from infected patients to health care workers is very
low, reportedly about 3 of every 1000 cases (0.3%) needlestick or other sharp
instrument transmitted blood from a patient to a health care worker.
‐ Transmission of HIV lower than HBV (26%) and HCV (10%).
‐ After a needlestick : wounds and skin sites exposed to blood or body fluids should
be washed and mucous membranes flushed with water.
‐ The rate of transmission of HIV can be reduced by postexposure prophylaxis (PEP)
J.W. Little, D.A. Falace. Dental Management of Medically Compromised Patient 8th ed. 2012. US; Elsevier.
Post-exposure Prophylaxis (PEP)
‐ PEP means taking antiretroviral medicines (ART) after being potentially
exposed to HIV to prevent becoming infected.
‐ PEP should be used only in emergency situations and should be initiated as
soon as possible after the exposure, ideally within an hour, following a careful
risk assessment.
‐ In a change to previous guidelines, PEP is now generally not recommended
after 72h post-exposure.
‐ Use PEP once or twice daily for 28 days.
‐ NOT a substitute for regular use of HIV prevention methods, such as pre-
exposure prophylaxis (PrEP), which means taking HIV medicines daily to lower
your chance of getting infected.
https://www.hiv.gov/hiv-basics/hiv 75
Post-exposure Prophylaxis (PEP)
76
CONTROL INFECTION
https://www.ada.org/en/member-center/oral-health-topics/hiv
STANDARD PRECAUTION
GLOVES
‐ Wear gloves:
If you have open or healing wounds, or skin infections.
When in contact with saliva, mucous membranes, or blood.
When in contact with blood-soiled items, body fluids or surfaces contaminated by them.
When examining all oral lesions.
‐ Replace torn or punctured gloves immediately.
‐ Use new gloves for every patient.
GOWN
‐ Wear gowns when blood or body fluids are likely to soil clothing.
‐ Change gowns daily or when visibly soiled with blood or body fluids.
Wear masks, face/eye protection or chin-length plastic face shields (with safety glasses or goggles)
to protect your mouth and nose (oral and nasal mucosa) from the splatter of blood, saliva or gingival
fluid.
https://www.ccohs.ca/oshanswers/diseases/aids/dental.html
STANDARD PRECAUTION
‐ Use disposable materials. Dispose in plastic bags.
‐ Place needles and sharp instruments in puncture-resistant containers before disposal.
‐ Routinely sterilize instruments used in all dental procedures store in sterile packs or
pouches.
‐ Sterilize after each use any other dental instruments that come in contact with oral
tissues such as amalgam condensers, plastic instruments of handpieces and burs. High-
level disinfect if sterilization is not possible.
‐ Cover equipment and surfaces that may become contaminated and are not easy to clean
with impervious-backed paper, tin foil or clear plastic wrap. Remove and replace the
covering for each patient.
‐ Thoroughly clean blood and saliva from supplies used in mouth (impression material, bite
registration). Clean and disinfect.
https://www.ccohs.ca/oshanswers/diseases/aids/dental.html
References