This is revision of a proposal originally reviewed in June 1992. As the prevalence of HIV infection increases, dentists may expect more of their patients to be HIV positive. Tooth extraction s common for HIV+ patients, compared to HIV- patients. anecdotal observations have let to the opinion that HIV+ patients can undergo tooth extraction without an increased risk of complications. However, preliminary data by the principal investigator in a retrospective study of 145 patients with extractions suggested a much higher rate of postextraction complications among those who were HIV+ (20.9% complication rate) than among those who were HIV- (3% rate). A prospective cohort study is proposed that will have as specific aims: 1) comparison of postextraction complication rate between HIV+ and HIV- patients; 2) description of the types and frequencies of postextraction complications; 3) description of the management of postextraction complications; and 4) identification of risk factors associated with postextraction complications. The cohort will consist of 165 patients (half of them HIV+, the other half HIV-) who require the extraction of one or more teeth. The study design calls for assessment of study variables preoperatively and at three times over a three-week postoperative period. Besides HIV status, primary study variables involve evaluation of treatment outcome, including assessment of postextraction wounds and complications such as local wound infection, localized alveolitis, bleeding, and pain. The number of postextraction follow-up visits required, and the need for a postextraction procedure or hospitalization to manage the complication will also be recorded to assess the relative morbidity of the post extraction complication. For those who are HIV+, disease will be staged based on the presence or absence of oral disease as well as CD4 levels in order to determine if the complication rate is related to disease stage. Potential confounding variables to be studies in case adjustment for them is needed include age, sex, number of teeth, nutritional status, tobacco usage, preoperative diagnosis, presence or absence of local infection or space infection hematologic variables, type of anesthesia, and cell mediated immunity. The sample size for the study is designed to provide 80% power for detecting differences in complication rates between HIV+ and HIV- groups of the same magnitude as that observed in the preliminary data (20% versus 5%) using a significance level of 0.05 for a two-tailed test, and assuming a 10% lost to follow-up.
| Dodson, T B (1997) Predictors of postextraction complications in HIV-positive patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84:474-9 |
| Dodson, T B (1997) HIV status and the risk of post-extraction complications. J Dent Res 76:1644-52 |
