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  1. 1. a i d s dr shabeel pn
  2. 2. <ul><li>ORAL MANIFESTATION OF HIV INFECTIONS </li></ul><ul><li>What is the importance ? </li></ul><ul><li>Oral cavity can be easily examined </li></ul><ul><li>Common </li></ul><ul><li>Early recognition diagnosis and treatment may reduce morbidity </li></ul><ul><li>Early diagnostic indicator </li></ul><ul><li>May change the staging </li></ul><ul><li>Predictor of progression of HIV done </li></ul>
  3. 3. Fungal lesions Viral Bacterial Neoplastic Minor oral ulcers
  4. 4. <ul><li>FUNGAL LESIONS </li></ul><ul><li>Oral Candidiasis </li></ul><ul><li>Candida albicani </li></ul><ul><li>Candida glabrata and C.tropicalis </li></ul><ul><li>Common oral manifestation of acute stage of HIV infection </li></ul>
  5. 5. <ul><li>Occur with falling CD4 + T cell count in middle and late stages of HIV </li></ul><ul><li>Other predisposing factors, are infancy, old age, antibiotic therapy, steroids and other immunosuppressive drugs, xerostamia, anaemia, endocrine disorders, primary and acquired immunodeficiency. </li></ul>
  6. 6. <ul><li>CLINICAL FEATURES </li></ul><ul><li>Burning mouth, problems eating spicy food and changes in taste. </li></ul><ul><li>Clinical appearance varies </li></ul><ul><li>Common are pseudomembranous and erythematous candidiasis </li></ul>
  7. 7. <ul><li>HISTOPLASTOMIES </li></ul><ul><li>Appear as oral ulcers </li></ul><ul><li>Diagnosis requires biopsy </li></ul><ul><li>Cryptococcus neoformans </li></ul><ul><li>Ulcerated mass in the hard palate. Biopsy of palatal ulcer is diagnostic. </li></ul>
  8. 9. <ul><li>VIRAL LESIONS </li></ul><ul><li>Painful persistent large intraoral ulcers </li></ul><ul><ul><li>Buccal/ labial mucosa 27%, tongue 25%, gingiva – 18% </li></ul></ul>
  9. 10. <ul><li>Recurrent herpes simplex (H.Labialis, cold sores) </li></ul><ul><li>Develop on the lips </li></ul><ul><li>Intraorally in the keratinised mucosa of palate and gingiva. </li></ul><ul><li>Begins as a burning sensation followed by small coalseing vesicles. </li></ul><ul><li>Ulcer surrounded by erythematous halo </li></ul><ul><li>No scan formation </li></ul><ul><li>Importance – Patients with advanced HIV disease may present several recurrence a year especially characterized by large confluent and extremely painful ulceration. </li></ul>
  10. 12. <ul><li>HERPES ZOSTER </li></ul><ul><li>Painful oral lesion or tooth ache </li></ul><ul><li>Usually unilateral </li></ul><ul><li>Follow the distribution of maxillary and /or mandibular branches of trigeminal nerve. </li></ul>
  11. 13. <ul><li>Human Papilloma </li></ul><ul><li>Oral wart </li></ul><ul><li>Papilloma </li></ul>
  12. 14. <ul><li>CYTOMEGALOVIRUS </li></ul><ul><li>Confused with aphthous ulcers, necrotizing ulcerative periodontitis and lymphoma </li></ul><ul><li>Aphthous ulcer </li></ul><ul><li>CMV Diagnosis by biopsy and immunohistochemistry </li></ul>
  13. 16. <ul><li>HAIRY LEUKOPLAKIA </li></ul><ul><li>Non movable corrugated or hairy white lesion on the lateral margins of tongue. </li></ul><ul><li>Occurs in 20% of person with asymptomatic HIV infection </li></ul><ul><li>Becomes more common as the CD4+T cell count falls </li></ul><ul><li>Non HIV patients who are affected are recipients of bone marrow, cardiac and renal transplants </li></ul>
  14. 18. BACTERIAL INFECTION Periodontal Disease Necrotising ulcerative periodontitis - Rapid and severe course Linear gingival erythema – relative mild form
  15. 19. <ul><li>MYCOBACTERIUM AVIUM INTRACELLULARE </li></ul><ul><li>Palatal and gingival granulomatous masses </li></ul><ul><li>Diagnosed by AFB staining of biopsy specimens </li></ul>
  16. 20. <ul><li>NEOPLASTIC LESION </li></ul><ul><li>This may occur intraorally either alone or association with skin and disseminated lesion. </li></ul><ul><li>Common in men </li></ul><ul><li>First manifestation of late stage of HIV </li></ul>
  17. 21. <ul><li>DIFFERENTIAL DIAGNOSIS </li></ul><ul><li>Vascular lesion – haematoma, haemangioma </li></ul><ul><li>Pyogenic granuloma </li></ul><ul><li>Bacillary angiomatosis </li></ul><ul><li>Oral melanotic macules </li></ul><ul><li>No bleeding associated with a biopsy of oral KS aspiration prior to biopsy may be useful to rule out haemangioma. Sudden appearance is characteristic. </li></ul>
  18. 22. <ul><li>LYMPHOMA </li></ul><ul><li>Firm painless swelling that may be ulcerated </li></ul><ul><li>Occur anywhere in the oral cavity </li></ul><ul><li>Soft tissue involvement </li></ul><ul><li>Bony involvement </li></ul>
  19. 23. <ul><li>DIFFERENTIAL DIAGNOSIS </li></ul><ul><li>Confusion with major aphthous ulcers and rarely pericoronitis associated with an erupting third molar </li></ul><ul><li>Diagnosis made by histologic examination of biopsy specimen. </li></ul>
  20. 24. <ul><li>OTHER ORAL LESIONS </li></ul><ul><li>Recurrent Aphthous ulcers (RAU) </li></ul><ul><ul><li>Cause unknown – Stress and unidentified infectious agents </li></ul></ul><ul><ul><li>Minor RAU – Well circumscribed with erythematous margin. </li></ul></ul><ul><ul><li>Solitary lesion of 0.5-1cm </li></ul></ul><ul><ul><li>Herpetiform type RAU- Clusters of small ulcers </li></ul></ul>
  21. 25. <ul><li>Major RAU – Extremely large necrotic ulcer 2-4cm </li></ul><ul><li>Idiopathic thrombocytopenic purpura may first manifest as oral lesion in HIV infected patients </li></ul><ul><li>Xerostomia </li></ul>
  22. 26. <ul><li>Oral manifestation in children with AIDS </li></ul><ul><li>Children infected with HIV develop severe immunosuppression very early </li></ul><ul><li>Earlier than adults </li></ul><ul><li>Fungal infections are more </li></ul>
  23. 27. <ul><li>DIAGNOSIS </li></ul><ul><li>Detection of antiviral protein </li></ul><ul><li>CD4+ T Cell count – oral abnormalities result from changes in the immune status of HIV carrier – Due to reduction in the number of CD4 + T cells and / or modification of CD4 / CD8 ratio. </li></ul><ul><li>Increased T8 cells in germinal centres. </li></ul>
  24. 28. <ul><li>TREATMENT </li></ul><ul><li>Most of the opportunistic infections are incurable. But by aggressively treating the acute disease, the infection can be controlled and suffering of patient decreased. </li></ul>
  25. 29. <ul><li>Cryptococcus – Amphotericin B 0.5- 0.8mg/kg/d iv </li></ul><ul><li>Bacterial- Ampicillin </li></ul><ul><li>Trimethoprim- Sulphamethoxazole </li></ul><ul><li>Chloramphenicol </li></ul><ul><li>Ceftriaxone </li></ul><ul><li>Viral - Ganciclovir IV </li></ul>
  26. 30. PREVENTION Teach ABC of AIDS prevention A bstrain B e faithful Use C ondom Dental Surgeons – High risk category - use gloves, Goggles, Facemask. Every patient is HIV positive until other wise proved.
  27. 31. THANK YOU