Definition:
Inflammation of the gingiva, characterized by a
S: Patient
complains of bleeding, tender gum tissue.
O: Oral
exam reveals inflamed gingival tissues, which bleed easily upon
manipulation. There are characteristic
red bands of gingival tissue around the necks of one or more teeth.
A: Rule
out Rapidly-Advancing Periodontal Disease, Necrotizing Ulcerative Periodontal
Disease (NUP--see protocol), or Kaposi's sarcoma lesions.
P: NOTE: DISEASE MAY PROGRESS RAPIDLY into
Necrotizing Ulcerative Periodontitis (NUP). TREAT ORAL SYMPTOMS AGGRESSIVELY; refer to a
dentist and carefully educate the patient to improve oral hygiene.
TX:
1. PerioGard (0.12% chlorhexidine gluconate) rinse
BID for two weeks will relieve some of the symptoms. It is important to refer to a dentist for a
thorough dental prophylaxis (cleaning).
If the combination of cleaning and PerioGard
are not successful, it may be appropriate to add an antibiotic (preferably
narrow-spectrum, which will leave the gram positive aerobic flora unperturbed)
such as:
Metronidazole
500 mg po BID x 7 - 10 days (Note that patients
on ritonavir may experience symptoms due to
the small amount of alcohol in the capsules)
or
Augmentin 875 mg po BID x 7 - 10
days
2. Factor replacement for hemophiliacs prior
to all dental procedures, including cleaning.
Patient Education:
1. Good oral hygiene is CRITICAL to arresting
gum and tooth loss. Brush and floss
after every meal.
2. Get your teeth cleaned professionally at
least every 6 months.
3. Do
not drink alcohol while taking metronidazole, and for
at least 24-48 hours after last dose. If
on ritonavir, note
that some people experience symptoms.
Please call if you have nausea or vomiting.
4. Do
not eat or drink for 20 minutes after rinsing with PerioGard.
References:
Lamster IB, Grbic
JT, Mitchell-Lewis DA, et al. New concepts regarding the
pathogenesis of periodontal disease in HIV infection. Ann Periodontology
1998 Jul;3 (1):62-75.