ral Health Is Vital

WHAT IS HIV?

HIV stands for Human Immunodeficiency Virus

HIV weakens a person’s immune system, resulting in complications and higher susceptibility to various diseases

TARGET AUDIENCE

Youth with HIV/AIDS

Source: New York States Department of Health AIDS Institute; NIDRC.

12-18 year olds with xerostomia (dry

mouth)

YOUTH WITH HIV: GENERAL FACTS

Majority of HIV positive adolescents acquire their infection during the adolescent period

• In the U.S., approximately half of new HIV infection cases are within the range of 13-24 years old

With the introduction and improvement in antiretroviral (ARV) therapy, children and adolescents with HIV are now living longerHealth care providers are now more likely to encounter adolescents living longer with HIV

Source: New York States Department of Health AIDS Institute; NIDRC.

YOUTH WITH HIV & ORAL HEALTH

Caries is a cumulative disease that begins in early childhood

Periodontal disease begins in early adolescence

Teens have the highest disease rate of all child age groups

YOUTH WITH HIV & ORAL HEALTH

Youth infected with HIV are at higher risk for developing dental caries than those without

Source: New York State Department of Health AIDS Institute

Intrinsic factors:• Effects of HIV medications on salivary flow

Xerostomia• Delayed dental eruption• Progressive immunodeficiency

Extrinsic factors:• Limited resources/access to dental care• Lack of caregiver knowledge

YOUTH WITH HIV & ORAL HEALTH

Some symptoms suggestive of HIV in youth:

• Abnormal oral conditions: infections & lesions

• Developmental delays such as: Age-appropriate weight & height Age-appropriate neurological development Dental eruptions; retention of primary teeth

Source: Stenger 2006.

CHARACTERISTICS OF YOUTH WITH HIV

30-80% of HIV-infected individuals display oral abnormalities

Common oral conditions include:

• Xerostomia (dry mouth)• Oral candidiasis• Herpes• Kaposi’s sarcoma• Hairy leukoplakia

Oral candidiasis

Kaposi’s sarcomaSource: Stenger 2006

XEROSTOMIA

Xerostomia is a condition associated with a decrease or lack of saliva production, resulting in a dry mouth

WHY XEROSTOMIA?40% of patients HIV positive patients suffer from this condition

Lack of saliva production can result in diminished antimicrobial properties

Lead to a rapid increase in dental caries and many other serious periodontal diseases

Since this condition seems to prevail among HIV-infected individuals and it affects oral health, it will be our main focus to manage and prevent dental caries

(Stenger, 2006)

Large array of xerostomic medication• Antihistamines, Antidepressants, Antipsychotic,

Antihypertensive an Anticholinergic agentsSalivary gland hypofunction study on a cohort of HIV positive and HIV negative women:

• HIV + Resting unstimulated saliva production: 0.29mL/min• HIV – Resting unstimulated saliva production: 0.35mL/min

(M.Navazesh, 2000)

XEROSTOMIA AMONG HIV POSITIVE PATIENTS

Surface Coating of Mucosa and TeethAcid BufferingHumidifies and lubricates the mouthCohesive Food Bolus Formation to Facilitate SwallowingDigestive Enzymes for Starch HydrolysisAntimicrobial propertiesModulation of Demineralization and Remineralization of Tooth Structure

(John Hicks, 2003)

FUNCTIONS OF SALIVA

Plaque build-up around dentitionAcid release from metabolism of CarbohydratesLeading to dental caries and subsequent cavities if left untreated.

Plaque build-up: a multifactorial issue• Management of Plaque• Treatment of source of xerostomia

COMPLICATIONS OF XEROSTOMIA

Most effective manual method of plaque removal

TOOTH BRUSHING!!!!

Studies have shown that a combination of use of toothbrush, dental floss and tooth pick yields best results, compared to using any single device

(Max O. Schimd, 1976)

MANAGEMENT OF PLAQUE

PLAQUE REMOVING EFFECT

(Max O. Schimd, 1976)

Direct link between reduction of saliva flow and dental caries. (James Guggenheimer, 2003)

• Inability to clear foods containing sugars and acids from oral cavity

Symptomatic management of xerostomia involve the use of saliva stimulants and saliva substitutes.Drugs may also be used

TREATMENT OF XEROSTOMIA

Water:• Common saliva substitute• 15mL of water resulted in 12 minute subjective

improvement, and an objective improvement of 5.5 minutes.

Over the Counter substitutes:• In the form of lozenges and mouth sprays• Mucin, a common constituent of saliva is

commonly prescribed and is known to have twice the improvement of water.

(Davies, 1997)

SALIVA SUBSTITUTES

Acids:• Ascorbic acid (Vitamin C)• Citric acid (lemon juice)

Sugarless chewing Gum• Stimulates taste receptors, which

stimulate salivary flow

(Davies,1997)

SALIVA STIMULANTS

Our product features a care pack” with all the essential tools for healthy oral hygieneThe main product is a USB-wristband

OUR PRODUCT

Technological world• 84% own a laptop, desktop computer, cell phone or personal digital device

Stigmatization against HIV youthAccess to information• Powerpoint • Helpful resources

WHY TECHNOLOGY

THE CARE PACK

Also included in this care pack, you will find:

• Reusable Bag• Toothbrush• Toothpaste• Floss• Small Spray Bottle• Sugar-free Chewing Gum• Notepad, Clipboard and Pen• Brushing/Flossing Technique Guide• USB-wristband

USB KEY

Main product: USB-wristband• Educate the patient• Raise awareness/Spread theword• Personal Use

Spread the word.Raise awareness.Wear it. Store it. Pass it along.

How To Use Me:- Use to store data- Wear it proudly and pass it

along to friends

REUSABLE BAG

Spread the word.Raise awareness.Save the environment.

How To Use Me:- Lunch bag - Make-up bag - Storage bag

TOOTHBRUSH

Spread the word.Raise awareness.Have a clean mouth.

How To Use Me:- Use with toothpaste

& brushing guide

TOOTHPASTE

Spread the word.Raise awareness.Have a sparkling mouth.

How To Use Me:- Use with toothbrush & brushing guide

FLOSS

Spread the word.Raise awareness.Have a fresh mouth.

How To Use Me:- Floss using the floss guide

SPRAY BOTTLE

Spread the word.Raise awareness.Refresh your mouth.

How To Use Me:- Spray into mouth

as needed

SUGAR-FREE GUM

Spread the word.Raise awareness.Say goodbye to a dry mouth.

How To Use Me:- Chew throughout the day

CLIPBOARD

Spread the word.Raise awareness.Keep things organized.

How To Use Me:- As a clipboard for class

NOTEBOOK & PEN

Spread the word.Raise awareness.Write it down.

How To Use Me:- Write down and monitor your appointments with the dentist

Dentist should wear the wristband for convenience and to raise awarenessPlug USB-wristband into USB port of a computerGo through the presentation with the patient and explain the importance of oral hygiene to prevent dental caries Give patient “care pack” to take homePatient can review the information at home as many times as desiredPass it onto friends

WHAT TO DO

LINKS

YEAH – Youth Empowerment Against HIV/AIDShttp://www.yeah.org.au/About-Us.aspx

Australian Dental Associationhttp://www.ada.org.au/

Davies, A. N. (1997). The management of Xerostomia: A review. European Journal of Cancer Care , 6, 209-214.James Guggenheimer, P. A. (2003). Xerostomia Etiology, Recognition and Treatment. The Journal of American Dental Association .John Hicks, F. G.-G. (2003). Biological factors in dental caries: role of saliva and dental plaque in the dynamic process of demineralization and remineralization (part 1). The Journal of Clinical Pediatric Dentistry , 47-52.Max O. Schmid, O. P. (1976). Plaque-removing effect of a toothbrush, dental floss, and a toothpick. Journal of Clinical Periodontology , 157-165.New York State Department of Health AIDS Institute. (2001, December). HIV Clinical Resource. Retrieved March 9, 2011, from Oral Health Management in Children and Adolescents With HIV Infection: http://www.hivguidelines.org/clinical-guidelines/hiv-and-oral-health/oral-health-management-in-children-and-adolescents-with-hiv-infection/Stenger, M. (2006). Oral Manifestations of HIV Disease. Perspective

REFERENCE LIST