HIV感染者の歯科診療

We treated 44 patients infected with human immunodeficiency virus (HIV) in the Department of Oral Surgery, Nagoya University Hospital. From these patients, we present three remarkable cases that highlight the problems of dental management for the HIV infected.<BR>Case 1: CD4 95/μl, CD4/CD8 0.28 showed a hematologically severe stage of HIV infection and a clinically diagnosed AIDS related complex (ARC). Severe oro-pharyngitis and phlegmon of the oral floor suddenly appeared on the right side without any prodrome. Inflammation was resolved after seven days of administration of imipenem (100mg/day) and ganciclovir (10mg/day). Opportunistic infection originated from a pericoronitis of the right lower wisdom tooth. This case suggests that special attention should be paid to oral hygiene in HIV infected patients.<BR>Case 2: Severe type Hemophilia A showed CD4 343/μl, CD4/CD8 0.26 and was clinically evaluated as an asymptomatic carrier (AC). Three wisdom teeth were extracted under administration of factor VIII. Unfortunately because anti factor VIII inhibitor transiently appeared, it was hard to achieve hemostasis. Consequently, as a countermeasure, it was necessary to admit the patient to a private room in order to prevent cross-contamination in the hospital.<BR>Case 3: This was a HIV infected patient who could not see a dentist periodically in spite of several ongoing problems, especially an oral cavity infection, because the nearest hospital that would accept the HIV infected was far from the patient's place of residence. For fear of loss of employment and discrimination, it was impossible for this patient to disclose his HIV infection to colleagues. Therefore, he was often scolded in his company about seeing a dentist in another city and for being admitted to a hospital for treatment of dental problems. From the point of view of social support, providing a framework for the dental treatment of the HIV infected is urgent.