Oral Manifestations

Key Points

Treatments

Hairy Leukoplakia (HL)
  • Indicates HIV & immunosuppression
  • irregular, hyperkeratotoic, corrugated non-scrapable white plaques
  •  painless
  • usually bilaterally on lateral borders of tongue
  • superficial candidiasis infection also present
  • usually asymptomatic, rarely requires TX
  • most commonly cause d by Epstein-Barr virus
  • Predictor lesion for HIV-AIDS
  • Time frame generally 24 months-3 years to AIDS, CD4 count below 150
  • Nearly every person w/ HL is antibody positive to HIV
  • Biopsy needed to confirm diagnosis
Acyclovir (Zovirax)

topical application of Podophyllum

Linear gingival erythema-(LGE) forme rly known as HIV-associated gingivitis
  • initial subtle clinical changes
  • marginal inflammation (red band) usually 2-3 mm
  • diffuse red lesions of attached gingiva, usually generalized
  • no attachment loss, ulceration, or pain
  • spontaneous bleeding & BOP
  • limited response to conventional dh therapy
  • high number of gram-negative rods
  • usually a precursor to NUP
  • important to identify early to prevent extensive breakdown
  • scale and root plane
  • prescribe chlorhexidine/in office irrigation
  • reevaluate 2-3 weeks
  • retreat if not resolved
NUG (necrotizing ulcerative gingivitis)
  • can be chronic or acute
  • ulceration & destruction of interdental papillae (looks punched out)
  • spontaneous bleeding
  • very painful w/ gray pseudomembrane around gingival margin
  • no fever
  • SRP & gingival curettage
  • irrigate w/ iodine
  • chlorhexidine mouth rinses
  • good OH
  • Metron idazole
Necrotizing ulcerative periodontitis-( NUP) formerly known as  (HIV-Associated Periodontal Disease) 
  • resembles ANUG & rapidly progressive periodontitis
  • rapid onset & progression
  • severe soft tissue destruction
  • gingival ulceration/interproximal cratering & necrosis
  • spontan eous bleeding
  • deep, acute aching pain
  • exposure of bone
  • 10 mm of bone loss can occur in as little as a 3 month period
  • may act as a reservoir for Candida infection, because a high % of yeast found in plaque
  • CD4 counts below 100
  • SRP &  gingival currettage
  • irrigate w/ iodine
  • chlorhexidine mout h rinses twice a day
  • good OH
  •  systemic antibiotics as necessary Metronidazole (Flagyl) is drug of choice
  • patient should be seen frequently
Kaposi sarcoma
  • most common malignancy in AIDS
  • red, blue to purple mass that may ulcerate & bleed
  • 90% of AIDS patients develop
  • singular or multiple, macular or nodular
  • biopsy must be preformed to distinguish from other gingival lesions
  • aggressive & often fatal
  • can be found all over body orally (palate both hard & soft is most common)
  • if seen other than palate it is usually more aggressive
  • must be reported
  • chemotherapy
  • surgical excision to decrease size
  • radiation therapy
  • no effective TX 
  • radiation is most common treatment

 

Pseudomembranous candidiasis (Thrush)
  •  white patches that can be scraped off leaving a red ulcerated tissues
  • resembles cottage cheese
  • found on buccal mucosa & palat e, most commonly on mucobuccal fold
  • burning sensation, metallic taste
  • when tongue is affected loss of papillae
  • predictor lesion for progression to AIDS
 

 

Systemic
Nizoral & Diflucan

Mouth rinse
Nystatin

Troches
Mycelex (Clotrimazole)

Bath for prosthetic appliances
Mycostatin (Nystatin)

Hyperplastic candidiasis
  • white lesion that does not scrape off
  • burning sensation
  • responds to antifungal medication
  • usually noted after diagnosis of AIDS
(same as above)
Erythematous candidiasis
  • (atrophic) fiery red
  • may be localized or generalized
  • mild persistent discomfort
  • discomfort in swallowing
  • predictor lesion for progression to AIDS
(same as above)
Atropic candidiasis
  • "denture stomatitis"
  • erythematous mucosa limited to area covered by denture or partial
  • petechiae-like- generalized & granular
(same as above)
Angular cheilitis
  • white plaques fissure/cracks at labial commissures
  • may be due to other factors s uch as nutritional deficiencies
  • mainly seen in elderly 
  • Clotrimazole ointment 1%
Cytomegalovirus (CMV) 
  • belongs to herpes family
  • causes eye complications in AIDS patients
  • rarely causes oral lesions
  • found in saliva of AIDS patie nts
  • associated with severe immunosuppression & CD4 count below 100
  • histologic confirmation for diagnosis
  • severe lesions, IV viral medications may be needed
Herpes Zoster
  • severe painful eruptions along path of trigeminal nerve
  • may affect middle age-elder ly patients
  • indicator of HIV in young or high risk groups or impaired immune system
  • antiviral, corticosteriods
Herpes lesions
  • herpes labialis
  • Acyclovir (Zovirax)
Non-Hodgkin's lymphoma
  • commonly seen lymphoma associated in AIDS
  • can occur anywhere intraorally
  • ulcerated mass of soft tissue-bleeds easily
  • bone destruction accompanies the malignancy & is seen on radiographs
  • palate most common site; gingiva
  • need biopsy for diagnosis
  • aggressive lesions only months to survive
  • chemotherapeutic drugs
  • radiation
Human Papillomavirus (HPV)

 

  • verruca vulgaris-(common wart); most frequent lesion,  most located in anogenital area but seen also orally, usually multiple on mucosal sites
  • condyloma acuminatum-  transmitted by sexual contact
  • found in anogenital region
  • focal epithelial hyperplasia
 
  • surgical excision
  • surgical excision
  • no treatment
Pneumocystis carnii pneumonia
  • caused by a pr otozoan infection
  • pneumonia most commonly found in HIV patients
  • systemic bacteria
 

Major apthous ulcers

 

  • usually large, painful, nonhealing
  • CD4 count usually below 100

 

  • topical corticosteroids
  • oral antibiotics
 

Persistent Generalized Lymphadenopathy (PGL)

  • early clinical sign which warns of progression to AIDS
  • present longer than 3 months
  • involves 2 or more sites
 
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