Aids and the periodontium / dental implant courses

AIDS and the Periodontium
INDIAN DENTAL ACADEMY
Leader in continuing Dental
Education
www.indiandentalacademy.com

• Acquired immunodeficiency syndrome-
condition was first reported in 1981 and
viral pathogen the human
immunodeficiencydeficiency virus (HIV)
was first identified.

• The virus causing AIDS was
independently identified by a team of
French scientists named it as LAV
(lymphadenopathy associated virus)
and by a team of Americans led by
Dr.Robert C. Galow who named it as
HTLV-III (Human T-lymphocytotrophic
virus-III), both in 1983.

Indian Dental academy
• www.indiandentalacademy.com
• Leader continuing dental education
• Offer both online and offline dental
courses

• The International committee on
nomenclature of viruses named it “The
HIV” in 1986. To date, 2 types of HIV
have been identified, HIV-1 and HIV-2.

• Human immunodeficiency virus belongs to
lenti virus subgroup of family retroviridae
(lenti-slow). This has an envelope & single
stranded linear RNA.
• HIV has reverse transcriptase enzyme which
enables the virus to produce DNA and then
gets integrated into the host cell.

• HIV 1 and HIV 2 belong to the lentivirus subfamily.
HIV 1 is most common. HIV 2 is more closely
related to simian immunodefeciency virus and
identified predominantly in West Africa.
• The primary pathogenic mechanism in HIV infection
is the damage caused to the CD4 T Lymphocytes.
CD4 T Lymphocytes decrease in no. as a result
there is damping effect on the cell mediated
immunity. www.indiandentalacademy.com

Transmission occurs through
 Blood / Blood products
 Vaginal fluid
 Seminal fluid
 Breast milk
Infects other uninfected persons
 Unprotected sexual contact.
 Transfusion of contaminated blood/blood
products
 Use of unsterilized needles, syringe and other
instruments
 Mother to child (in utero, during delivery or
breast feedingwww.indiandentalacademy.com

CLASSIFICATION AND STAGING
• 1982,CDC developed a surveillance
case definition for AIDS based on
presence of opportunistic illnesses or
malignancies secondary to the
defective immunity.

• Category A ->includes patients with acute
symptom or asymptomatic along with individuals
with persistent generalized lymphadenopathy
with or without malaise, fatigue or low grade
fever.
• Category B -> patients have symptomatic with
includes development of oropharyngeal
candidiasis or oral hairy leukoplakia or
symptoms of fever,diarrhoea and weight loss.
• Category C ->patients are with outright AIDS as
manifested by life threatening conditions
identified by CD4+
T4 lymphocytes levels of less
than 200/cu mm

Oral and Periodontal manifestations of HIV
Infection
• More than 95% of AIDS patients have
head and neck lesions.
• The oral lesions in HIV infection are
indicative of and not specific for HIV
disease. They should be regarded as
markers of HIV disease in correlation with
the medical history and with other clinical
and laboratory studies

• Oral lesions are mainly result of cellular
immunodeficiency and can be etiologically
divided into 4 groups
• Infections (bacterial,viral.fungal)
• Neoplasms
• Drug reactions
• Lesions of unknown cause.

Found on lateral borders
of tongue usually has
bilateral distribution.
Characteristic vertical
striations imparting a
corrugated appearance
and when dried may
appear hairy.
This condition is
suggested to be
associated with Epstein
Barr virus.
Oral hairy luekoplakia

• Lesions can be succesfully removed,with
lasers or conventional surgery.
• Therapy with zidovudine or topical vitamin A,
• Lesions reappear when therapy is
discontinued.

Linear gingival
erythema
characterised by fiery
red band along the
margin of the gingiva
and diffuse erythema
of attached gingiva.
There is no ulceration
or evidence of pocket
formation.www.indiandentalacademy.com

• Scale and polish affected area with subgingival
irrigation in chlorhexidine.
• Chlorhexidine mouthrinse is prescribed
• Patient should be placed on 2-3months recall.

Necrotising Ulcerative Gingivitis
(Bacterial infection)
Presents with fiery red
and swollen gingiva.
In acute stage,
ulceration, necrosis and
sloughing of both margin
of gingiva and tip of
interdental papilla is
common finding.
Pain,bleeding and
halitosis are common
symptoms.

• Basic treatment includes cleaning and
debriding of affected areas with a cotton
pellet soaked with Hydrogen peroxide
• Patient seen daily for the first week, at each
visit debridement of affected areas is
repeated.
• Systemic antibiotics such as metronidazole
or amoxicillin in case of severe tissue
destruction or localised lymphadenopathy.www.indiandentalacademy.com

Necrotising ulcerative periodontitis (NUP)
NUP characterised by
gingival ulceration and
necrosis and rapid
progressive destruction
of periodontal
attachment and bone
with loosening of teeth
Spontaneous bleeding,
deep seated pain are
common symptoms

• Therapy includes
-local debridement
-scaling and root planing
-irrigation with chlorhexidine gluconate
-Antibiotics with metronidazole
250mg qid.

Can present as
erythematous,
asymptomatic nodular
swelling.
Gingiva, palate and
tongue are most
commonly affected
sites.
Bacillary Angiomatosis
Treatment includes broad spectrum antibiotics in
conjunction with excision of lesion

Characterised by watery
papules or more smooth
surfaced lesions
commonly seen on
gingiva occasionally on
palate and tongue.
Condyloma Acuminatum
(Infection with human papillomavirus)

Oral candidiasis.
Maybe the initial sign of
HIV infection in
otherwise healthy
patients.
HIV infected patients
may have 2 forms of
candidal infection
;psuedomembrabnous
form and the
erythematous form.

Early lesions of HIV related candidiasis
responsive to topical antifungal, therapy
Nystatin –Oral suspensions 100,000U/ml,
Rinse with 1 tsp qid.
Advanced lesions like hyperplastic candidiasis
may require systemic therapy
Ketoconazole(Nyzoral) 200mg tablets, bid forwww.indiandentalacademy.com

an endothelial cell
multicentric vascular
neoplasm
characterised by
increased capillary
growth and
appearance of
hemosiderin.
Kaposi’s Sarcoma
Its prevalence increases significantly with
progression of disease.www.indiandentalacademy.com

• Treatment include laser excision radiation
therapy or intralesional injection with
vinblastine.
• In responsive patients treatment continued
till 2 weeks.
• Lesions tend to recur though.

Develops in patient’s
with CD4 count < 100
cells/cumm.
Posterior gingiva,soft
palate and fauces are
commonly associated.
Rapidly growing red or
purplish painless or
painful mass may be
ulcerated.
Non Hodgkin’s Lymphoma
Tooth loosening and parasthesia common
symptoms. www.indiandentalacademy.com

Foscarnet, interferon
associated with
ulcerations.
Xerostomia and altered
taste sensation
described in conjunction
with use of drug
dithiocarb..
Adverse Drug Reaction
Alternative therapy with different drugs should be
used

• Oral Hyperpigmentation
Increased incidence of oral
hyperpigmentation appears as spots or
striations on the buccal mucosa, palate,
gingiva or tongue. This could be secondary
to medications such as zidovudine or
ketoconazole

Atypical ulcers and delayed healing
• In HIV infected patients herpes may
involve all the mucosal surfaces and
extend to skin and may not resolve in the
expected 7-10 days but persist for months.
• Recurrent apthous stomatitis also seen in
these patients.

• Oral viral infections are usually treated
with acyclovir (800 mg qid for 2 weeks)
• Topical corticoid therapy fluocinonide gel
applied 3 -6 times daily.

Aids and the periodontium / dental implant courses

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