ORAL MANIFESTATIONS OF HIV INFECTION: CLINICAL CHARACTERISTICS, DIAGNOSIS, AND TREATMENT RECOMMENDAT

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ORAL MANIFESTATIONS OF HIV INFECTION CLINICAL
CHARACTERISTICS, DIAGNOSIS, AND TREATMENT
RECOMMENDATIONS
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DIAGNOSIS OF HIV RELATED ORAL LESIONS

• Oral examination procedures are the same for HIV
  patients as for all dental patients
• Diagnostic procedures must be appropriate to the
  identified problem
• Treatment should be based on either a provisional
  or definitive diagnosis
• Diagnosis should be re-evaluated if treatment is
  not effective

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ORAL MANIFESTATIONS OF HIV INFECTION

• Opportunistic diseases--manifestations of immune
  deficiency or derangement.
• Not caused directly by HIV
• The same lesions occur in association with other
  immune deficiency disorders

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HIV-RELATED ORAL LESIONS

• Infections
• Fungal, Viral, Bacterial
• Neoplasms
• Kaposis Sarcoma, Non-Hodgkins Lymphoma
• Other
• Non-specific or Aphthous-like Ulcers, Lichenoid
  or Drug Reactions, Salivary Gland Disease

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ORAL CANDIDIASIS

• Pseudomembranous
• Erythematous
• Hyperplastic
• Accompanying angular cheilitis

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PSEUDOMEMBRANOUS CANDIDIASIS

• Appearance white curd-like material that wipes
  off revealing an underlying erythematous mucosa
• Clinical Diagnosis generally made on the basis
  of appearance

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ERYTHEMATOUS CANDIDIASIS

• Appearance mucosal erythema and/or
  patchy-depapillation of the dorsal tongue
• Definitive diagnosis requires
• Identification of fungal hyphae in the lesion
• Response of the lesion(s) to antifungal therapy

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HYPERPLASTIC CANDIDIASIS

• Appearance as a leukoplakia (a white lesion that
  does not rub off)
• Definitive diagnosis requires
• Identification of fungal hyphae in the lesion
• Response of the lesion(s) to antifungal therapy
• If unresponsive to antifungal therapy, biopsy
  must be considered

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ANGULAR CHEILITIS

• Appearance erythema and/or fissuring at the
  corners of the mouth
• Frequently accompanies intraoral candidiasis

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TREATMENT OF ORAL CANDIDIASIS

• Topical Antifungal Therapy
• Systemic Antifungal Therapy

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HAIRY LEUKOPLAKIA

• Appearance white corrugated lesion on the
  lateral border of the tongue
• Clinical Diagnosis
• known seropositive patients
• patients with unknown HIV status
• definitive diagnosis requires identification of
  Epstein-Barr virus infected epithelial cells

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HAIRY LEUKOPLAKIA

• Treatment and Management
• Generally does not require treatment
• Antiviral treatment and topical podophyllum resin
  have been used to treat --the result is temporary
• May wax and wane without treatment

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ORAL ULCERS

• Herpes simplex infection
• Varicella zoster infection (Shingles)
• Cytomegalovirus infection
• Aphthous ulcers

• Histoplasmosis
• Lymphoma
• Necrotizing ulcerative gingivitis (NUG)
• Necrotizing ulcerative periodontitis (NUP)
• Necrotizing stomatitis (NS)

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HERPES SIMPLEX INFECTION

• Atypical herpes simplex ulceration is a frequent
  cause of mucosal ulceration
• Diagnosis may be confirmed using mucosal smear,
  viral isolation (culture) or biopsy
• Ulcers generally respond to systemic anti-viral
  treatment

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LOW INCIDENCE INFECTIONS

• Viral
• Varicella-Zoster
• Cytomegalovirus
• Fungal
• Histoplasmosis
• Bacterial
• Tuberculosis
• Syphilis

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MAJOR APHTHOUS-LIKE ULCERS

• Appearance persistent, nonspecific ulcers
• Biopsy and histologic examination may be
  necessary to exclude other causes
• Systemic and topical corticosteroid therapy have
  been successful management
• Topical tetracycline application and systemic
  thalidomide have also be used

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NON-HODGKINS LYMPHOMA

• Appearance necrotic, ulcerated or nonulcerated
  masses, when occurring in the oral cavity
• Diagnosis biopsy and histologic examination

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NECROTIZING ULCERATIVE PERIODONTAL DISEASE

• Characterized by painful gingival ulceration and
  may result in loss of alveolar bone
• Management
• antibiotic therapy
• debridement of necrotic tissue
• meticulous home care

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LESIONS CAUSED BY HUMAN PAPILLOMA VIRUS (HPV)

• Appearance exophytic, papillary, oral mucosal
  lesions
• Several different types of HPV have been reported
  to cause lesions
• May be multiple
• Often difficult to treat due to a high risk of
  recurrence

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PIGMENTED AND ERYTHEMATOUS LESIONS

• Kaposis sarcoma
• Mucosal melanin pigmentation
• Linear gingival erythema

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KAPOSIS SARCOMA

• Appearance Oral lesions appear as reddish
  purple, raised or flat
• Size ranges from small to extensive
• Behavior is unpredictable
• Definitive diagnosis biopsy and histologic
  examination
• No curative therapy--radiation treatment,
  chemotherapy and sclerosing agents have been,
  used to control oral lesions

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MUCOSAL MELANIN PIGMENTATION

• Single and multiple oral mucosal melanotic
  macules have been report to occur in HIV infected
  individuals
• Significance is not known
• Some have been associated with zidovudine therapy
• Treatment is not indicated

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LINEAR GINGIVAL ERYTHEMA

• Appearance a distinct band of erythema of the
  gingival margin
• Erythema does not respond to removal of local
  factors
• Cause is not known

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SALIVARY GLAND DISEASE

• Bilateral parotid gland enlargement occurs in HIV
  infected individuals
• Histology has been described as resembling
  autoimmune salivary gland disease with cystic
  changes

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SURGEON GENERALS REPORT ORAL HEALTH