My last CD4 was 402,and my VL was in the 50,000's. On august 14,I started Combivir bid,and Viracept 1250mg bid. I went to my dentist(who doesn't know about my HIV status)because of pain and a lump on my gum. He said it was an abscess caused by a failed root canal,I also need to have an impacted wisdom tooth removed because it is preventing tx for a carie on the tooth next to it. I went to my oral surgeon(who also doesn't know about my status) who removed the impacted wisdom tooth first and put me on Veetids 500mg q6hrs x5 days. He said in order to fix the failed root canal he would have to cut a window in the gum,it's an upper tooth,but that there's always the possibility of a sinus infection. He stated that the sinus infections are easily resolved with antibiotics if they should occur. Since I've had problems for over 20yrs with my sinuses(I've had a turbinectomy and septoplasty in'98)and because of my status what precautions do you recommend before the surgery on my abscessed tooth.I'm already on the Veetids. Please help! The surgery on the failed root canal is in about 2weeks. Thanks a lot.

From a medical/dental point of view, based on your history of sinus problems, I would suggest you contact your ENT (ear, nose and throat specialist) for an opinion concerning this procedure. As I do not have access to your sinus and/or dental films, it would be almost impossible for me to offer much more of an opinion on whether or not the procedure is indicated.

There are a few other points which may prove helpful:

1. Available scientific evidence proves that HIV positive patients do NOT have any more post operative complications from oral surgical procedures when compared to HIV negative controls. This research is based on the removal of 3rd molars (wisdom teeth).

2. HIV positive individuals do not need to be pre-medicated for invasive dental procedures such as oral surgery or periodontal scaling and root planing based on serostatus alone. Approximately 1% of HIV positive individuals are neutropenic (have a low white blood cell count) which would require pre-medication, but this is more the exception than the rule. In your case, since the tooth is abscessed, you would need to be on antibiotic therapy prior to the procedure.

3. Nutrition: The procedure you are about to undergo can lead to significant discomfort. I would suggest that you have some nutritional supplements available such as Boost, which will help offset any nutritional deficits. One way to save some money would be to use Carnation Instant Breakfast as a supplement.

4. I would suggest you have a means of providing both heat and cold to the affected area as indicated by your surgeon. There are gel packs available which can be placed in the freezer or microwave. Again, if cost is a factor, you can heat a bag of rice and place it in a towel for heat or place a package of frozen peas, again in a towel for cold.

5. Carefully follow the post operative instructions given to you by your surgeon. Most complications arise from smoking and/or drinking alcoholic beverages in the first 24 hours. A sample of post operative instructions cane be found within Dental Patient Education Section of HIVdent at the following URL: http://www.hivdent.org/_peag/peagindex.htm

6. Finally, I would be remise if I did not mention the following: Whereas I understand the trepidation involved with disclosing HIV status due to past episodes of "refusal to treat", dentistry's response to HIV/AIDS has significantly improved in the past several years. I am not implying that all dentists will respond positively, as dictated by the Americans with Disabilities Act, but a much greater percentage do realize the risk of transmission is highly remote (there has never been a documented case of a dental health care worker seroconverting after an exposure in the dental setting). Any medical/dental provider will be able to provide better care if they have an accurate medical history.

Best of luck with your surgery!

DR