Immunodeficiency+disorders

= When Three Take Away or Big ideas From Carranzaon Immunodeficiency Disorders and Periodontal Disease Discuss each Big Idea =

Some oral manifestations of HIV may include:

 * 1) Oral Hariy Leukoplakia- Is found on the lateral borders of the tongue. It is asymptomatic poorly demarcated kertotic area ranging in size. Can appear as imparting a corrugated appearance, or the surface may appear as shaggy or "hairy". This lesion does not ripe off.
 * 2) Candidiasis- Is a fungus found in the normal flora, it proliferates on the surface of the oral mucosa under certain conditions. An over growth of this condition is seen when the host is diminished, as seen in debilitated patients or in patients receiving immunosuppressive therapy. Most common lesion in HIV patients.
 * 3) Kaposi's Sarcoma- Also most common in HIV patients The gingiva and palate are common sites. This oral condition is rare and cause is unknown. It is a malignant tumor and is classified as a localized slow growing lesion. In early staged the lesion is painless, reddish, purple macules with a brown, blue, or purple color.
 * 4) Types of Gingival and Periodontal diseases for HIV include:
 * 5) Linear Gingival Erythema: Linear gingival erythema is persistent, linear, bleeds easily, and erythematous gingivitis that has been associated and seen in some HIV positive patients.Linear gingivitis lesions may be localized or generalized. The erythematous gingivitis may be limited to marginal tissue, may extend to the attached gingiva, or it may extend into the alveolar mucosa (Carranza, pp. 527-528). When presented with a case of linear gingival erythema, the affected sites should be scaled and polished. This would be followed by subgingival irrigation either with chlorhexidine or 10% providone-iodine. Oral hygiene instructions must be reinforced and patient must be instructed of thorough and meticulous home care procedures. Follow-up re-evaluation of the areas or sites in 2-3 weeks after the initial therapy. It is best be advised that linear gingival erythema that may be refractory to treatment. The patient should be placed on a 2-3 month re-care schedule and mintored for more more severe periodontal diseases such as NUG or NUP.

Clinically patients with immunodeficiency disorders will present to the office with: These patients radiographs will show:
 * Herpetic lesions
 * Oral Candidiasis
 * Exaggerated inflammation
 * Bleeding may also be increased
 * Inconsistent lamina dura
 * Inconsistent trabecular pattern
 * Widened PDL
 * Loss of bone structure

Leukemia and Agranulocytosis are cell disorders that can effect wound healing, bleeding, tissue appearance, and the patients susceptibility to infection.
 * Another disorders that can compromise a patient's immune system that Carranza discusses are Blood Dyscrasias**

__Leukemia__- requires the following treatment plan:

1. Refer the patient for a medical consultation 2. Prior to the start of chemotherapy, a thorough periodontal treatment plan should be developed with the assistants of the patients physician. This should include: 3. During the acute phase of leukemia, patients should only receive periodontal treatment if its an emergency. 4. Oral ulcerations and mucositis are treated palliatively with agents such as viscous lidocaine. in addition the pateint can be given antibiotics in order to prevent secondary infections. 5. Oral candidiasis is common in this disorder and it can be treated with nystatin. 6. In chronic leukemia and the remission phase, scaling and root planing can be performed, but the patients platelet count and bleeding time should be measured on the day of the treatment.
 * Monitor the patients bleeding time, coagulation time, PT, and platelet count by laboratory testing daily.
 * Administer antibiotic coverage before any treatment to reduce risk of infections
 * Extract all hopeless teeth 10 days prior to the start of chemotherapy
 * Periodontal debridement and thorough oral hygiene instructions should be provided to the patient.

__Agranulocytosis__- causes an increse in susceptibility to infection. The patients white blood cell count is reduced and granular leukocytes are reduced or disappear. It is common for these diseases to have severe periodontal destruction. Periodontal treatment should be performed during the remission phase of the disease with antibiotic therapy. During treatment the clinician should be conservative in order to reduce the patients risk of infection. Extraction of hopeless teeth can take place after a consultation with the patients physician. The patient should also be instructed on proper oral hygiene care (Carranza, 669).

__Agammaglobulinemia-__ is an immune deficiency resulting from inadequate antibody production caused by a deficiency in B cells. Agammaglobulinemia can be congenital or acquired. Congenital agammaglobulinemia is caused by an X-linked recessive gene therefore ony affecting males. Agammaglobulinemia affects approximately 1:100,000 males. Acquired or late-onset agammaglobulinemia is also know as common variable immunodeficiency (CVID). The disorder is characterized by the onset of recurrent bacterial infections in the second and third decades of life, resulting from drastic decrease in immunogloblin and antibody levels. CVID is not genetic and affects both males and females. Both forms of agammaglobulinemia are characterized by recurrent bacterial infections, especially in the ear, sinus, and lung infections. Patients are also susceptible to periodonal infections; aggressive periodontitis is a common finding in children diagnosed with agammaglobulinimia. (Carranza, Klokkevold, Takei, & Newman 2006)