ORAL HEALTH CONCEPTS IN HIV PATIENTS

ORAL HEALTHORAL HEALTH
CONCEPTS INCONCEPTS IN
HIV PATIENTSHIV PATIENTS
www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing Dental
Education

IntroductionIntroduction
The dentist may be the first health care worker to
diagnose the disease which may be predictive of the
disease progression.
AIDS epidemic is affecting the dentistry in numerous and
unanticipated ways.

HistoryHistory
Recognized for the first time in June 1981 at the C.D.C,
U.S.A.
Recognized in April 1986 in Chennai (Tamilnadu) ,
India.

According to WHO, in 2007:
33.2 million people living with HIV.
2.5 million people became newly infected.
2.1 million people died of AIDS.
2.5 million HIV infected people were from India.

Natural history of untreated HIV infection can be divided
into stages:
1. Initial viral transmission
2. Acute retroviral syndrome within the first 2-3 weeks
3. Recovery and seroconversion within first six weeks
4. Asymptomatic chronic HIV infection persists over 7-9
years
5. Symptomatic HIV infection- ARC
6. AIDS – 1-2 years before death.

Oral lesions are common in patients infected with HIV.
Oral manifestations seen in HIV infected patients differ
from immunocompetent individuals.
The presence of oral lesions may be an early diagnostic
indicator as well as useful marker of disease progression
and immunosuppression.

WHO collaborating center and EC Clearing House
revised the classification of oral lesions associated with
HIV infection on september 1992 into
Group I- Lesions strongly associated with HIV infection
Group II- Lesions commonly associated with HIV
infection
Group III- Lesions uncommonly associated with HIV
infection

Group I - Lesions strongly associated with HIV
infection:
Candidiasis
Oral Hairy leukoplakia
Kaposi’s sarcoma
Non-Hodgkin’s lymphoma
HIV associated periodontal disease

Group II - Lesions commonly associated with HIV
infection:
Bacterial infections-mycobacterium avium,
mycobacterium tuberculosis
Melanotic hyper pigmentation
Necrotizing stomatitis
HIV associated Salivary gland diseases
Thrombocytopenia
Viral infections:
Herpes simplex virus infection
Human papilloma virus infection
Varicella-zoster virus infection

Group III - Lesions uncommonly associated with HIV
infection
Bacterial infections-actinomyces israelli, Escherichia coli,
Klebsiella pneumonia
Cat scratch disease
Drug reactions
Bacillary epitheloid angiomatosis
Fungal infections other than candidiasis
Neurological disturbances
Recurrent aphthous ulcerations
Viral infections- Molluscum contagiosum

Oral CandidiasisOral Candidiasis
Pseudomembranous candidiasisPseudomembranous candidiasis
White or yellowish single or confluent plaques.
Easily rubbed off leaving bleeding underlying mucosa.

Erythematous candidiasisErythematous candidiasis
Palate and dorsum of the tongue
Reddish macular lesion, atrophic patches or
depapillation on the dorsum of tongue.

Hyperplastic candidiasisHyperplastic candidiasis
Appears as white or discolored plaques that may be
solitary or confluent and cannot be wiped off the
mucosa.
Associated with severe immune deterioration..

Angular chelitisAngular chelitis
Red ulcers and multiple fissuring at the corners of the
mouth.
Can be seen in all stages of HIV infection.

Treatment of candidiasis:
Topical treatment:
Nystatin oral suspension(100,000 units/ml).
1% clotrimazole ,2% ketoconazole cream.
Systemic Treatment:
Tab Fluconazole 200 mg on day 1, followed by 100 mg
daily for 14 days.

Oral hairy leukoplakiaOral hairy leukoplakia
Lateral borders of the tongue.
Surface may be smooth, corrugated or markedly folded.
Thick, hair-like projections.
Treatment:
Acyclovir 800mg orally 5 times daily.

Multifocal neoplasm of vascular endothelial origin,
manifests as red-blue or purple -blue macules or nodules.
Treatment:
Surgical excision.
Intralesional injections with Vinblastine sulfate(0.1mg/mm ).
Radiation -800 to 2000 rad.

Second most common malignancy in AIDS.
Soft tissue masses frequently associated with ulcerations
and may resemble kaposi ’s sarcoma.
Treatment:
Chemotherapy, radiotherapy or combination of both.

Presents as a distinctive linear band of erythema that
involves the free gingival margin and extends 2-3mm
apically.
Treatment :
Oral home care
Oral prophylaxis

Necrotizing ulcerative gingivitis
Ulceration and necrosis of one or more interdental
papillae with spontaneous gingival bleeding and mild to
moderate gingival pain .

Necrotizing ulcerative periodontitisNecrotizing ulcerative periodontitis
Spontaneous gingival bleeding.
Extensive soft tissue necrosis.
Severe loss of periodontal attachment.
Treament of NUG and NUP:
Debridement of necrotic tissue.
Metronidazole or Tetracycline 500 mg 4 times daily for a week.

May be an early sign of adrenal insufficiency or
secondary to medications.

A localized acute painful ulcerative lesion on mucosal
surfaces overlying bone.
Treatment:
Careful debridement
Antibiotics, local or systemic steroid therapy
Soft tissue stents

Includes salivary gland enlargement and xerostomia.
The parotid glands are most frequently affected.
Treatment:
Hydrate frequently .
Artificial saliva substitutes..

Lesions are more wide spread which occur in atypical
pattern and may persist for several months.
Treatment:
Acyclovir(200mg orally five times daily) for 5 days.

Skin and oral lesions are frequently unilateral and follow
the distribution of branches of the trigeminal nerve.
The skin lesions form crusts and the oral lesions coalesce to
form large ulcers.

Treatment:
Supportive care
Oral Acyclovir 800mg orally 5 times daily for 7 days.
Foscarnet 40-60mg/kg 3 times daily for Acyclovir
resistant herpes zoster.
Prevention of post herpetic neuralgia and dissemination.

Clusters of white, spike like projections, pink
cauliflower like growth or slightly elevated sessile
papules.
Treatment:
Intralesional injections of Interferon.
Surgical removal, Laser ablation and cryotherapy.

Common in immunocompromised individuals.
Oral ulcers are painful and have a gray base.
Treatment:
Acyclovir 800mg orally 5 times daily for 2 weeks.

Recurrent aphthous ulcerations are larger than 10mm in
diameter, well-circumscribed with indurated margins.
Treatment:
60-80mg of prednisone daily for 10 days.
Clobetasol or flucinonide gel applied directly to the lesion.

AIDS- “Prevention is better than cure”
Following measures used to prevent AIDS:
Educating, Counseling, Behavior modification.
Proper screening of blood.
Avoid sharing of needles by intravenous drug abusers.
Proper care by the health care professionals and those
who come in contact with blood and blood products to
prevent accidental exposure.

ORAL HEALTH CONCEPTS IN HIV PATIENTS

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