Precautions for Dental Extraction in a Patient with Anemia and HIV
For a patient with anemia and HIV undergoing dental extraction, strict adherence to universal precautions and careful management of potential bleeding complications are essential to ensure optimal outcomes. 1
Infection Control Measures
- Always wear appropriate personal protective equipment including gloves, chin-length face shields or surgical masks with protective eyewear, and protective clothing such as gowns when performing dental extractions on patients with HIV 1
- Change gloves between patients and wash hands thoroughly before glove placement and after glove removal 1
- Use rubber dams, high-velocity air evacuation, and proper patient positioning to minimize formation of droplets, spatter, and aerosols during treatment 1
- Handle sharp instruments with extreme care, using one-handed "scoop" technique or mechanical devices for recapping needles to prevent needlestick injuries 1
- Place used disposable syringes, needles, and other sharp items in appropriate puncture-resistant containers located close to the treatment area 1
Management of Anemia
- Assess the severity of anemia by reviewing the patient's CBC results (current hemoglobin is 12.1 g/dL, which is mildly decreased) 2
- Consider that anemia in HIV patients may be multifactorial, resulting from medications, opportunistic infections, or HIV itself 2, 3
- Be aware that anemia independently correlates with increased mortality in HIV patients, regardless of CD4 count and viral load 2
- Monitor for signs of excessive bleeding during and after the procedure, as anemia may worsen if significant blood loss occurs 4, 5
Bleeding Management
- Implement local hemostatic measures including pressure packs, hemostatic agents (such as thrombin, Surgicel), and suturing as needed 5, 6
- Consider using dental appliances with vinyl polysiloxane silicone putty to provide greater coverage and pressure at extraction sites if bleeding is difficult to control 5
- Be prepared to manage prolonged bleeding that may occur due to anemia, especially if the patient has severe anemia or concurrent coagulopathy 4, 6
Pre-Extraction Assessment
- Evaluate airway, breathing, and circulation as the first priority, as maxillofacial procedures can potentially lead to complications 7
- Perform a thorough examination of the face, lips, and oral cavity after cleansing with water or saline 7
- Obtain appropriate dental radiographs to examine the tooth requiring extraction 7
Post-Extraction Care
- Instruct the patient on warm saline rinses to promote drainage and reduce inflammation 7
- Recommend alcohol-free antimicrobial mouth rinses such as 0.2% chlorhexidine to reduce bacterial load 7
- Advise the patient to avoid painful stimuli including smoking, alcohol, and spicy or hot foods 7
- Provide clear instructions on warning signs that should prompt immediate return, including increasing swelling or difficulty breathing/swallowing 7