WREB - patient acceptance

[Dr.McSultry]

hey WREB people:

so I've been struggling to find a WREB pt. for perio and finally have one but he's HIV+ and had a joint replaced a little over 2 years ago. Here are a few questions relating to this scenario:

1. I understand that the ADA recommends pre-medicating people with joint replacements within the last 2 years...but every oral sx. I've talked to says that the rule is extended beyond the 2 year limit if the pt. is immunocompromised (like in my pt.'s case). Can I go ahead and premedicate my pt. prior to scaling and root-planing without any fear of being "questioned" by the floor examiners?

2. Nowhere in the WREB manual does it say anything about not being able to use HIV+ pts. So I'm hoping this is kosher. But what I'm a little skeptical about is the use of a cavitron (and we all know how much time it could save!). If universal precautions are used, is it OK to use a cavitron on this pt. without fear of excessive aerosolization? The main thing is...even if I'm cool with it, will the examiners be cool with it?
I know a couple of people that used cavitrons on HCV+ pts. for NERBS - the virulence is so much higher for this so I cannot imagine why they should create a problem with HIV+ pts.

ANY input will be greatly appreciated.

Thanks

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[K2 Dental]

Good questions. We have been taught not to use cavitron on HIV+ pts. Having just taken the wreb I would say that pt. selection is key. You do not want to be stressed about pt. rejection. It is a tough call. You can choose to hand scale but it will just take longer. Not really a big deal imo because you have plenty of time to finish everything. I was done by Sat. and did not have to come back today (Sun.) to finish. I agree with the premed and if any questions can you get a med consult so that you have a paper there to show the floor examiners. Good Luck!!!

 

[futurdentist]

so how do u actually chose a wreb patient for the perio part? what do u need to see? calculus? how much? anybody could have calculus?
are we looking for bone loss?
i am very confused about the Patient selection part!

 

[K2 Dental]

Hey there. Refer to your WREB manual but the criteria are :

8 clickable sites of subgingival calculus.
2 teeth with 5mm or more pockets.
There are also criteria on the number of teeth in the arch and the number of posterior teeth. Check out the manual and it will answer all your questions.

Good Luck!