Comparative outcomes between HIV positive and negative endodontic patients
Purpose: To compare the presenting symptoms and the outcomes of root canal therapy between HIV positive and HIV negative endodontic patients over a 6-12 month period. Methods: Fifty-nine HIV negative and 46 HIV positive patients presented for endodontic treatment. Signs and symptoms were noted and compared for both groups of patients, together with demographic data and CD4 counts for the HIV positive patients. Endodontic procedures were evaluated after an 18-month period. Endodontic treatment was assessed using clinical factors (palpation, percussion, sensitivity to hot and cold, swellings, excessive bleeding), and radiographic factors (periapical radiolucency, root resorption, periodontal ligament space). Results: There was no statistically significant difference in the preoperative presenting symptoms of endodontic infections/conditions between HIV positive and HIV negative patients. The prevalence of radiographic caries in the presenting teeth was only 24% in the HIV positive patients compared with 95% in the HIV negative patients. For the HIV positive patients, the treatment time required to resolution of the endodontic infection was nearly twice (113 minutes) that of the HIV negative patients (52 minutes). Amongst the HIV positive patients still experiencing symptoms at 18 months, pain was more severe in those patients with lower CD4 counts (significance at the 90% level of confidence). Conclusion: Within the limitations of this study the following conclusions emerge: 1. Although the success rate was lower over the period of this study in HIV positive patients, the rate is sufficiently high to warrant treatment. 2. Patients who are HIV positive may present with more severe symptoms and during treatment more bleeding may be expected. 3. In keeping with best practice for immuno-compromised patients, it would be advantageous to put HIV positive patients on antibiotic cover during treatment. 4. The process of anachoresis may explain the high incidence of endodontic infections in teeth with no history of trauma or caries in the HIV positive group.
endodontics, hiv positive, hiv negative, comparison