• New York State Department of Health. Prevention of secondary disease: preventive medicine. Oral health care. New York (NY): New York State Department of Health; 2008 Jul. 2 p. [2 references]

This is the current release of the guideline.

• Human immunodeficiency virus (HIV) infection
• Dental caries, gingival and periodontal disease, and oral cancer

Counseling
Prevention
Screening

Allergy and Immunology
Dentistry
Family Practice
Infectious Diseases
Internal Medicine
Preventive Medicine

Advanced Practice Nurses
Dentists
Health Care Providers
Nurses
Physician Assistants
Physicians
Public Health Departments

To provide guidelines for preventive oral health care in patients with human immunodeficiency virus (HIV) infection in primary care settings

Human immunodeficiency virus (HIV)-infected patients

1. Patient education about importance of preventive oral health care including dental visits, dental hygiene, and risks of developing oral cancer from tobacco and alcohol use
2. Oral cavity examination
3. Screening for behaviors and practices that contribute to dental caries
4. Referral to oral healthcare provider

Not stated

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

Not stated

Not stated

Expert Consensus (Committee)

Not applicable

Review

Not stated

Expert Consensus

AIDS Institute clinical guidelines are developed by distinguished committees of clinicians and others with extensive experience providing care to people with HIV infection. Committees* meet regularly to assess current recommendations and to write and update guidelines in accordance with newly emerging clinical and research developments.

The Committees* rely on evidence to the extent possible in formulating recommendations. When data from randomized clinical trials are not available, Committees rely on developing guidelines based on consensus, balancing the use of new information with sound clinical judgment that results in recommendations that are in the best interest of patients.

* Current committees include:

• Medical Care Criteria Committee
• Committee for the Care of Children and Adolescents with HIV Infection
• Dental Standards of Care Committee
• Mental Health Committee
• Women's Health Committee
• Substance Use Committee
• Physician's Prevention Advisory Committee
• Pharmacy Committee

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

External Peer Review

All guidelines developed by the Committee are externally peer reviewed by at least two experts in that particular area of patient care, which ensures depth and quality of the guidelines.

Preventive Oral Health Care in the Primary Care Setting

Primary care clinicians should educate patients about the importance of preventive oral health care, including dental visits; brushing, flossing, and rinsing; and the risk of developing oral cancer from use of tobacco and alcohol.

As part of the annual comprehensive physical examination, the clinician should examine the oral cavity visually and palpate the patient's lips, labial and buccal mucosa, all surfaces of the tongue and palate, and the floor of the mouth. The gingiva should be examined for signs of erythema, ulceration, or recession.

When patients present with severe dental decay, clinicians should screen for behaviors and practices that contribute to a higher risk of dental caries, including but not limited to the following:

• Drug use, especially crack cocaine and crystal meth
• Prolonged methadone maintenance
• Xerostomia (decreased salivary flow)
• Untreated dental decay

Referral to Oral Healthcare Providers

Clinicians should ascertain whether their patients have a regular oral health provider and should refer all human immunodeficiency virus (HIV)-infected patients for annual hygiene and intraoral examinations, including dental caries and soft-tissue examinations.

Clinicians should promptly refer patients who present with oral mucosal, gingival, or dental lesions to an oral healthcare provider for appropriate diagnostic evaluation and treatment.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

Appropriate preventive oral health care resulting in early recognition and timely treatment of oral diseases

Not stated

The AIDS Institute's Office of the Medical Director directly oversees the development, publication, dissemination and implementation of clinical practice guidelines, in collaboration with The Johns Hopkins University, Division of Infectious Diseases. These guidelines address the medical management of adults, adolescents and children with HIV infection; primary and secondary prevention in medical settings; and include informational brochures for care providers and the public.

Guidelines Dissemination

Guidelines are disseminated to clinicians, support service providers and consumers through mass mailings and numerous AIDS Institute-sponsored educational programs. Distribution methods include the HIV Clinical Resource website, the Clinical Education Initiative (CEI), the AIDS Educational Training Centers (AETC) and the HIV/AIDS Materials Initiative. Printed copies of clinical guidelines are available for order from the New York State Department of Health (NYSDOH) Distribution Center for providers who lack internet access.

Guidelines Implementation

The HIV Clinical Guidelines Program works with other programs in the AIDS Institute to promote adoption of guidelines. Clinicians, for example, are targeted through the CEI and the AETC. The CEI provides tailored educational programming on site for health care providers on important topics in HIV care, including those addressed by the HIV Clinical Guidelines Program. The AETC provides conferences, grand rounds and other programs that cover topics contained in AIDS Institute guidelines.

Support service providers are targeted through the HIV Education and Training initiative which provides training on important HIV topics to non-physician health and human services providers. Education is carried out across the State as well as through video conferencing and audio conferencing.

The HIV Clinical Guidelines Program also works in a coordinated manner with the HIV Quality of Care Program to promote implementation of HIV guidelines in New York State. By developing quality indicators based on the guidelines, the AIDS Institute has created a mechanism for measurement of performance that allows providers and consumers to know to what extent specific guidelines have been implemented.

Finally, best practices booklets are developed through the HIV Clinical Guidelines Program. These contain practical solutions to common problems related to access, delivery or coordination of care, in an effort to ensure that HIV guidelines are implemented and that patients receive the highest level of HIV care possible.

Living with Illness
Staying Healthy

Effectiveness
Patient-centeredness

• New York State Department of Health. Prevention of secondary disease: preventive medicine. Oral health care. New York (NY): New York State Department of Health; 2008 Jul. 2 p. [2 references]

Not applicable: The guideline was not adapted from another source.

2008 Jul

New York State Department of Health - State/Local Government Agency [U.S.]

New York State Department of Health

Physicians' Prevention Committee

Chair: Victoria L Sharp, MD, Saint Luke's Roosevelt Hospital, New York, New York

Committee Members: Bruce D Agins, MD, MPH, New York State Department of Health AIDS Institute, New York, New York; Oladipo A Alao, MD, MPH, Harlem Hospital Center, New York, New York; Julia H Arnsten, MD, MPH, Albert Einstein College of Medicine , Montefiore Medical Center, Bronx, New York; Alvaro F Carrascal, MD, MPH, New York State Department of Health AIDS Institute, Albany, New York; Kevin Fiscella, MD, University of Rochester School of Medicine and Dentistry, Rochester, New York; Douglas G Fish, MD, Albany Medical College, Albany, New York; Donna C Futterman, MD, Children's Hospital at Montefiore, Bronx, New York; Victor K Inada, MD, APICHA Primary Care Clinic Asian & Pacific Islander Coalition on HIV/AIDS, Inc, New York, New York; Barbara E Johnston, MD, Saint Vincent's-Manhattan Comprehensive HIV Center, New York, New York; David D Kim, MD, Astor Medical Group, LLP, New York, New York; Joseph R Masci, MD, Elmhurst Hospital Center, Elmhurst, New York; David S Rubin, MD, New York Hospital Queens, Flushing, New York; Sanjiv S Shah, MD, MetroPlus Health Plan, New York, New York; Benjamin W Tsoi, MD, MPH, New York City Department of Health and Mental Hygiene, New York, New York; Rona M Vail, MD, Callen-Lorde Community Health Center, New York, New York; Milton L Wainberg, MD, New York State Psychiatric Institute, New York, New York

Clinical Education Representative: Mary Anne Brown, RN, BSN, MA, Upper Hudson Primary Care Consortium, Glens Falls, New York

Liaison: M Monica Sweeney, MD, MPH, Liaison to the New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, New York, New York

AIDS Institute Staff Liaisons: L Jeannine Bookhardt-Murray, MD, Harlem United Community AIDS Center, New York, NY; Daniel A O'Connell, New York State Department of Health AIDS Institute, Albany, New York

Principal Contributors: Stuart Fischman, DMD, SUNY at Buffalo, Buffalo

Not stated

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI Institute on September 2, 2008.