3. PATHOGENESIS
HIV has a strong affinity for cells of the immune
system, most specifically those that carry the
CD4 cell surface receptor molecule
Helper T lymphocytes (T4 cells) are most
profoundly affected
Combined therapeutic regimens consisting of
antiretroviral agents and protease-inhibiting drugs
resulted in improvement in the health status of
HIV infected individuals
4.
Overall effect is gradual impairment of the
immune
system
by
interference
with
T4
lymphocytes
B lymphocytes are not infected, but the altered
function of infected T4 lymphocytes secondarily
results
in
B-cell
neutrophil function
dysregulation
and
altered
5.
HIV-positive individual at increased risk for
malignancy,
disseminated
infections
with
microorganisms and adverse drug reactions
because of altered antigenic regulation
HIV has been detected in most body fluids
It is found in high quantities only
blood, semen, and cerebrospinal fluid
in
6.
Transmission occurs by :
Sexual contact
Illicit use of injection drugs
Exposure to blood or blood products
Organ transplantation and artificial insemination
Heterosexual transmission -common cause of
AIDS
7.
High risk population includes :
Homosexual and bisexual men
Users of illegal injection drugs
Persons with hemophilia/coagulation disorders
Recipients of blood transfusions before april 1985
Infants of HIV-infected mothers
Promiscuous heterosexuals
Individuals who engage in unprotected sex with HIV positive
cohorts
8. CDC SURVEILLANCE CASE
CLASSIFICATION
Category A : includes patients with acute
symptoms or asymptomatic diseases, along
with individuals with persistent generalised
lymphadenopathy, with or without malaise
, fatigue , or low grade fever
9.
Category B : patients have symptomatic
conditions such as :
Oropharyngeal or vulvovaginal candidiasis
Herpes zoster
Oral hairy leukoplakia
Idiopathic thrombocytopenia
Constitutional symptoms of fever, diarrhoea
, and
weight loss
10.
Category C : patients are those with outright
AIDS , as manifested by life-threatening
conditions or identified through CD4+ T
lymphocyte levels of less than 200 cells /mm3
(< 14% of total lymphocytes)
11. ORAL AND PERIODONTAL
MANIFESTATIONS OF HIV INFECTION
Oral candidiasis
Oral hairy leukoplakia
Kaposi’s sarcoma and other
malignancies
Bacillary (epitheliod) angiomatosis
Oral hyperpigmentation
Atypical ulcers
12. ORAL CANDIDIASIS
Most oral candidal infections are associated with
candida albicans
Candidiasis is the most common oral lesion in HIV
diseases and found in 90% AIDS patients
1.
2.
3.
4.
It has 4 clinical presentations :
pseudomembraneous candidiasis
erythematous candidiasis
hyperplastic candiasis
angular cheilitis
19. ORAL HAIRY LEUKOPLAKIA
Epstein-Barr virus
Lateral borders of tongue, buccal
mucosa, floor of the mouth , retromolar area
and soft palate
Asymptomatic ,poorly demarcated keratotic
area
Vertical striations
Corrugated appearance
Surface may be shaggy and
appear hairy
21. KAPOSI’S SARCOMA
An HIV-positive individual with non-Hodgkin’s
lymphoma (NHL) or Kaposi’s sarcoma (KS) is
categorised as having AIDS
KS is most common oral malignancy associated
with AIDS
Multifocal vascular neoplasm
Human herpesvirus-8
First site - Oral cavity
Painless , reddish purple macules
Lesions manifests : nodules , papules and non
elevated macules
24. BACILLARY ANGIOMATOSIS
Infectious vascular proliferative disease with
clinical and histologic features similar to that of
Kaposi sarcoma.
Rickettsiae like organisms
Red, purple, or blue edematous soft tissue
lesions that may cause destruction of
periodontal ligament and bone
25.
Diagnosis
Epithelioid proliferation of angiogenic cells
accompanied by an acute inflammatory cell
infiltrate.
WarthenTreatment Starry Silver staining or electron
microscopy.
Erythromycin or doxycycline
Gingival
therapy
lesions - antibiotic + conservative periodontal
26. ORAL HYPERPIGMENTATION
Spots or striations on the buccal
mucosa, palate, gingiva or tongue.
Cause - Prolonged use of drugs for
HIV like zidovudine, ketoconazole
or clofazimine.
Zidovudine-excessive
pigmentation of the skin and nails.
Adrenocorticoid insufficiency – due
to prolonged use of ketoconazole ,
or by Pneumocystis carinii
infection or cytomegalovirus.
27. ATYPICAL ULCERS
HIV-infected patients have a higher incidence
of recurrent herpetic lesion and aphthous
stomatitis
Atypical large , persistent , non
specific, painful ulcers
Caused by herpes simplex virus
(HSV),
varicella-zoster virus (VZV)
, epstein-barr virus (EBV) , cytomegalovirus
(CMV)
28.
Herpes labialis in HIV infected individuals
responsive to topical antiviral therapy
Acyclovir , pencyclovir , doconasol
Reduces healing time of lesion
29.
Recurrent aphthous stomatitis
Sites : oropharynx, oesophagus, or other areas of
GIT.
Treatment:- Topical or intralesional
corticosteroids,chlorhexidine, antimicrobial mouth
rinses, oral tetracycline rinses
31.
HAART drugs
Insulin resistance, gynecomastia, blood
dyscrasias, nausea, development of kidney
stones, TEN, oral warts
Individuals with Hepatitis C + HIV co- infection
are susceptible to liver cirrhosis
32.
Lipodystrophy :-
Redistribution of body fat
Gaunt facial features yet display excessive abdominal
fat or even a fat pad on the rear of the shoulders (buffalo
hump)
Severe systemic hyperlipidemia
Oral or perioral adverse effects :- oral lichenoid
reactions, xerostomia, altered taste sensation, perioral
parasthesia, and exfoliative cheilitis
34. Linear Gingival Erythema
A persistent, linear, easily bleeding, erythematous
gingivitis
Microflora of LGE similar to periodontitis
Linear gingivitis lesions :Generalized
Localized
Most commom among IDUs
Lesion usually undergo
spontaneous remission
35.
Management
The affected sites should be sealed and
polished
Subgingival irrigation with chlorhexidine or 10
% povidone-iodine
Oral hygiene instructions
Reevaluation after 2 to 3 weeks
36. Necrotizing Ulcerative Gingivitis
Lesions are punched-out, crater-like depressions at
the crest of the interdental papillae
Painful
Cleaning and debridement of affected areas with a
cotton pellet soaked in peroxide after application of
a topical anaesthetic
Avoid tobacco, alcohol and
condiments
0.12% chlorhexidine gluconate
Metronidazole or amoxicillin
Antifungal medication
37. Necrotizing Ulcerative
Periodontitis
Necrosis and ulceration of the
coronal portion of interdental papillae
and gingival margins
Extension of NUG in which bone loss
and periodontal attachment loss
occur
It is characterized by soft tissue
necrosis,
rapid
periodontal
destruction and interproximal bone
loss
Both localized and generalized
NUP is severely painful at onset, and
immediate treatment is necessary
Painless
& deep interproximal
craters
38.
Therapy
for
NUP
includes
local
debridement, scaling and root planing, in-office
irrigation with an effective antimicrobial agent
such as chlorhexidine gluconate, or povidoneiodine
Metronidazole (250 mg with two tablets taken
immediately and then one tablet 4 times daily
for 5-7 days)
Prophylactic prescription of a topical or
systemic antifungal agent
39. Necrotizing Ulcerative Stomatitis
Severe progressive lesion
with extension into the
vestibular area and the
palate
NUS may be severely
destructive
and
acutely
painful, affects significant
areas of oral soft tissue and
underlying bone.
NUS is often associated with
41. Chronic Periodontitis
It is reported that the incidence and severity of
chronic periodontitis are similar in HIV +ve and HIV –
ve groups
Gingival recession and early attachment loss
Tongue lesions consistent with hairy leukoplakia
were most common among seropositive homosexual
males
42.
Management
Periodontal therapy and implant replacement
Based on the overall health status of the
patient
The degree of periodontal involvement
The motivation and ability of the patient to
perform effective oral hygiene
44.
Infection control measures
Strict adherence to established methods of
infection control, based on guidance from ADA
and CDC
Compliance, with universal precautions , will
minimise risk to patients and dental staff
45.
Goals of therapy
Restoration and maintenance of oral health
Comfort and function
Conservative , nonsurgical periodontal
therapy, performance of elective surgical
periodontal procedures, implant placements
should be a treatment option
47.
Psychologic factors
HIV infection of neuronal cells
may affect brain function
dementia
Influence the responsiveness of
affected patients to dental
treatment
Coping with a life-threatening
disease may elicit depression
, anxiety and anger
48.
Treatment should be provided in a calm, relaxed
atmosphere and stress to the patient must be
minimized
Early diagnosis and treatment of HIV infection
can have a profound effect on the patient’s life
expectancy and quality of life
Editor's Notes
It should be determined from the health history, physical evaluation, and consultation with the patient’s physician.