oral surgery anatomy phsyiology_ppt (1).pptx

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1. MANAGEMENT OF IMMUNOCOMPROMISED PATIENTS BY DIYA SYED

2. Immunocompromised Patient An individual whose immune system is weakened or not functioning properly. This makes them more vulnerable to: - Infections - Diseases - Complications from minor illnesses Causes of Impairment: - Congenital (present from birth) - Acquired due to diseases - Induced by medical treatments

3. Some Common Diseases and Conditions that Can Cause a Person to be Immunocompromised HIV Tuberculosis Leukemia and Lymphoma Chemotherapy Autoimmune Diseases

4. Protocol for Management of HIV Positive Patients Routine Care - Annual dental check-up. - Oral prophylaxis every 6-12 months. - Annual radiographic assessment. Oral Surgical Procedures - Assess risk of septicemia. - Estimate hemostasis status. - Check CD4/CD8 counts, platelets, RBC counts. - Institute appropriate treatment schedule. Key Management Points - Identify, diagnose, and manage oral lesions (fungal, bacterial, viral). - Manage Xerostomia: Instruct patient to avoid tobacco and alcohol. - Cellulitis/Osteomyelitis: Penicillin V 2g/day + Metronidazole 400mg/8hr for 5-10 days.

5. Management of Occupational HIV Exposure Post-Exposure Prophylaxis (PEP) Regimens: Basic Regimen (4 weeks): - Zidovudine 300 mg (twice a day) - Lamivudine 150 mg (twice a day) Extended Regimen: - Basic Regimen + Indinavir 500 mg (thrice a day) - Basic Regimen + Protease Inhibitor.

6. Dental Management of Patients with TB Elective Treatment: Defer for patients with active TB. Emergency Treatment: Must be performed in a hospital setting with isolation protocols. Key Rule: Delay dental treatment until the patient is confirmed to be non-infectious. Drug Interactions - Rifampicin induces liver enzymes, reducing the efficacy of many drugs. - Avoid Erythromycin or Metronidazole if patient is on Isoniazid or Rifampicin (risk of liver toxicity).

7. Infection Control Measures for TB Screening: Ask about TB symptoms during medical history review. Airborne Precautions - Use of N95 respirator masks. - Treatment in a Negative Pressure Isolation Room (to prevent germs from spreading). Educate the Patient - Inform them about their health condition. - Instruct them to cover mouth and nose when coughing or sneezing. Use of Barriers - Dental team must wear gloves, protective glasses, and masks. Sterilization Protocol - All instruments must be properly sterilized before and after treatment. - Dentists must disinfect their hands after treatment.

8. Dental Management of Chemotherapy Patients Before Chemotherapy Complete dental evaluation 2-3 weeks before starting. Extract non-restorable teeth; treat caries and periodontal disease. Avoid prosthesis adjustments or new dentures.

9. During Chemotherapy Emphasize proper oral hygiene. Recommend mouth rinses: Saline, Sodium Bicarbonate, or Chlorhexidine. After Chemotherapy Best time to perform postponed dental procedures. Oral hygiene care: daily brushing, saline/bicarbonate rinses, oral lubricants with surface anesthesia, chlorhexidine mouthwash.

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