Case Study: a patient with Parkinson’s Disease and HIV

I have a patient who I have been treating for almost 20 years.  When he first came to me, he was positive for HIV, taking the normal medications, and was managing his health and oral health quite well. He did have quite a bit of recession which he decided not to treat because of the cost. He also has an overbite that puts a lot of pressure on his teeth.

Over the past couple of years he has developed Parkinson’s Disease, and is now taking more medicine, which seem to have contributed to his dental problems.  On one of his lower canines he developed decay on the lingual (tongue side) at the gum line which was extensive and most difficult to access for a good restoration. He has visited a periodontist to try to help access this tooth. However, he now has decay on several of these teeth. In addition the canine has broken at the gum line and needs to be extracted.

He is also exhibiting extreme bone loss on his lower incisors, plus a lot of gum line decay on the lingual of the second premolar on the same side as the canine which was recently removed.

The current recommendation is to have his incisors removed along with the premolars which are in guarded condition. The alternative is to have a lower appliance fabricated that will replace the one missing tooth, and constructed in a way that other denture teeth can be added as the teeth are lost.

For me, it is disappointing to see a patient deteriorate to the point that I can’t do anything to save some of these teeth. Although medicines are helpful in controlling a specific medical condition, many side effects can require their own treatment.