1. Oral manifestations are among the earliest signs of HIV infection. Conditions like oral candidiasis, oral hairy leukoplakia, and Kaposi's sarcoma are strongly associated with HIV.
2. Other less common conditions include necrotizing gingivitis/periodontitis, infections by Mycobacterium tuberculosis or M. avium-intracellulare, and salivary gland diseases.
3. The progression of oral lesions correlates with declining CD4 counts and worsening immune suppression in patients with HIV/AIDS.
Dental Plaque
Soft deposits that form the biofilm adhering to the tooth surface or other hard surfaces in the oral cavity, including removable & fixed restorations”
Bowen , 1976
Bacterial aggregations on the teeth or other solid oral structures
Lindhe, 2003
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
Not only the lesions in the body helps us to know about syphilis but also a minute nodule or lesion helps us to discover the syphilis. He who knows syphilis knows the medicine well. Earlier you found the disease the treatment and the prognosis will be good. Discover syphilis through your body's gateway.
One of the most painful but easy-to-treat dental emergencies is a dry socket.
• Dry socket symptoms are experienced after a tooth extraction.
• This condition requires follow-up care by the doctor who performed the surgery, an oral surgeon or a dentist who is familiar with how to treat it.
For more information, contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
#drysocket #management #thirdmolarextraction #extractioncomplications
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Dental Plaque
Soft deposits that form the biofilm adhering to the tooth surface or other hard surfaces in the oral cavity, including removable & fixed restorations”
Bowen , 1976
Bacterial aggregations on the teeth or other solid oral structures
Lindhe, 2003
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
Not only the lesions in the body helps us to know about syphilis but also a minute nodule or lesion helps us to discover the syphilis. He who knows syphilis knows the medicine well. Earlier you found the disease the treatment and the prognosis will be good. Discover syphilis through your body's gateway.
One of the most painful but easy-to-treat dental emergencies is a dry socket.
• Dry socket symptoms are experienced after a tooth extraction.
• This condition requires follow-up care by the doctor who performed the surgery, an oral surgeon or a dentist who is familiar with how to treat it.
For more information, contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
#drysocket #management #thirdmolarextraction #extractioncomplications
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This presentation is helpful for the dental student interested in dealing with the infectious disease AIDS.
The material also includes evidence based article on the relation of the HIV stage on periodontal status.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
3. INTRODUCTION
• HIV INFECTION serious disorder affecting
immune system
• Body’s normal defenses against infection break
down
• Host is vulnerable to life-threatening infections/
conditions including malignances.
4. AIDS most advanced stage of HIV infection
• THE PROGRESSION OF HIV TO AIDS IS DEFINED BY CD4
COUNT < 200/Cu.mm OR ABOUT 14% OF CD4- T
HELPER CELLS
4
5. • AIDS is defined as a condition indicative of a defect in
cell mediated immunity occurring in a person with no
known cause for immunodeficiency other than the
presence of HIV.
• Acquired - not inherited
• Immune - attacks the immune system
• Deficiency - by destroying certain WBC
• Syndrome- a group of symptoms / illnesses that occur
as a result of the HIV Infection.
6. • Before 1956 – patients from Central Africa – reported with
strange pneumonia - Gay fever ( GRID)
• Extra ordinary out break of Pneumocystis Carinii pneumonia
and Kaposi’s Sarcoma in previously fit young men -
Los Angeles and NewYork
• In 1981, the HIV epidemic has spread beyond gay males,
Haitians, and hemophiliacs, and affected many people
worldwide.
• 1982 – condition began to be referred as AIDS
HISTORICAL REVIEW
7. • 1st report of AIDS – by US CDC – in morbidity mortality
weekly report
• In 1986, the initial cases of AIDS was found in chennai–
by Dr. Sunithi solomon
8. CDC – 1993 - AIDS Definition
“The occurrence of one or more group of life-
threatening opportunistic infections,
malignancies, neurologic diseases and other
specific illness in patients with HIV infection or
with CD4 counts less than 200/cu mm”
11. PATHOGENESISHIV in blood
stream
Entrapped in
lymphnodes
Presence of virus
evokes antigenic
stimulation
Activates CD4
T cells,
macrophage
TNF ALPHA, IL-6
INCREASED NO OF CD4
12.
13. Oral manifestations
• Represent earliest manifestations
• First meeting regarding oral problems – 1986 –
European Economic Community in Copenhagen
• 1989 - j. pindborg revised
• 1989 - WHO collaborative center and EC Clearing
house
• Revised classification by EC Clearing house - 1992
14. Sept 1992 revised classification of oral lesions associated with
adult HIV INFECTION
• GROUP 1 : LESIONS STRONGLY ASSOCIATED WITH HIV
INFECTION
• CANDIDIASIS : pseudomembranous , erythematous
• Oral hairy leukoplakia
• Non – hodgkins lymphoma
• Kaposi’s sarcoma
• Periodontal disease –
• linear gingival erythema
• Necrotising ulcerative gingivitis
• Necrotising ulcerative periodontitis
15. • Group 2 : lesions less commonly associated with HIV
infection
• BACTERIAL: M. AVIUM INTERCELLULARE
M. TB
• MELANOTIC HYPERPIGMENTATION
• NECROTISING ULCERATIVE STOMATITIS
• SALIVARY GLAND DISEASE – DRY MOUTH
UNI/BILATERAL SWELLING OF MAJOR SALIVARY
GLANDS
• THROMBOCYTOPENIC PURPURA
• ULCERATION OTHERWISE NOT SPECIFIED
19. RECURRENT APHTHOUS STOMATITIS
VIRAL INFECTIONS
• CYTOMEGALO VIRUS
• MOLLUSCUM CONTAGIOSUM
“ Classification & Diagnostic Criteria For Oral Lesions In
H.I.V. Infections. EC – Clearing House On Oral Problems
Related To H.I.V. Infection & W.H.O. Collaborative
Centre On Oral Manifestations Of Immunodeficiency
Virus J Oral Pathol Med 1993; 22: 289-91”
20. CLASSIFICATION OF OROFACIAL LESIONS
ASSOCIATED WITH HIV IN PEDIATRIC PATIENTS
GROUP 1 – LESIONS COMMONLY ASSOCIATED WITH
HIV IN PEDIATRIC PATIENTS
• Candidiasis
• HSV Infection
• Linear gingival erythema
• Recurrent aphthous ulcers
major /minor /herpetiform
21. • GROUP 2 – LESIONS LESS COMMONLY ASSOCIATED
WITH HIV IN PEDIATRIC PTS
• BACTERIAL INFECTIONS OF ORAL TISSUES
• PERIODONTAL – NUG , NUP
• NUS
• SEBORRHEIC DERMATITIS
• VIRAL INFECTIONS – CMV , HPV , MOLLUSCUM
CONTAGIOSUM , VARICELLA ZOSTER , HERPES ZOSTER
, VARICELLA , XEROSTOMIA
22. • GROUP 3 – LESIONS STRONGLY ASSOCIATED WITH
HIV ( RARE IN CHILDREN)
• NEOPLASM , KS , NON HODGKIN’S LYMPHOMA
OHL , TB RELATED ULCERS
• Ramos – Gomez Fj , Flait Zc , Catapanop , Et.Al
Classification , Diagnostic Criteria & Treatment
Recommendations For Oro Facial Manifestations In
Hiv Infected Pediatric Patients. Collaborative Work
Group On Oral Manifestations Of Pediatric Hiv
Infection. J Clin Pediatric Dent 1999;23:85-96
23. GROUP 1
1.ORO PHARYNGEAL CANDIDIASIS ( OPC)
• One of initial manifestation of HIV
• 90% of untreated
• 60% - atleast 1 episode per yr with frequent recurrences
• Chiefly caused by yeast – c.albicans
• Other : c. glabrata, c.dubliniensis
• C. tropicalis, c.parapsilosis, c.kruseii
• C.novergensis
24. • Pseudomembranous : commonest form
• characterized by Creamy yellow curd
like plaques that can be easily removed
with wiping with a cotton gauze
or tongue depressor,
often leaving a red, raw base.
Erythematous Form (atrophic) is characterized by reddish
macular lesion .
• loss of papillations when involving the tongue dorsum.
25. • Angular cheilitis affects the labial
commissures & results in
cracking, ulceration &
pseudomembrane formation.
• Hyperplastic: appear white and hyperplastic
• white areas are due to hyperkeratosis
• Non scrapable
• Confused with hairy leukoplakia.
26. • Diagnostic modalities: based on clinical appearance and
response to empirical antifungal therapy.
• Microscopic Examination : swab - budding yeast cells,
pseudohyphae, or filaments
• KOH & PAS - improve Visualization of Fungal elements in
cytologic specimens.
• Culture on Sabouraud dextrose agar medium for 24 to 48
hours
27. 2. Oral hairy leukoplakia
• 2nd most common hiv associated mucosal lesion
• Caused by EBV virus
• latently infects 90% of the population worldwide
without causing disease.
• OHL occurs in pts with CD4+ T cell counts < 400
• Used as a marker of disease activity
• affects men more than women
28. Clinical features :
• Site : lateral borders of tongue,
dorsum
• Rarely FOM, buccal mucosa
• Bilaterally as painless, faint white vertical streaks/
thickened & furrowed areas with shaggy keratotic
surface ( hyper keratotic hair like projections)
• Vertical striations imparts a corrugated appearance.
• Non scrapable lesion
• Asymptomatic
29. • PROVISIONAL DIAGNOSIS : clinical characteristics
• PRESUMPTIVE DIAGNOSIS : HISTOPATHOLOGY
• hyperkeratosis & acanthosis leading to corrugations,
Koilocytosis, Nuclear beading, chromatin
margination
• DEFINITIVE DIAGNOSIS : VIRAL DEMONSTRATION
• Fluorescent In Situ Hybridisation
• IHC, PCR, EM
30. 3. KAPOSI SARCOMA
• Angiogenic disorder in which multi centric neoplastic
proliferation of vascular, spindle cell components
occurs in response to circulating growth factors.
• Wahman et.al. cofactor model : inf, host, env
• Chang et.al., moore et.al. – HHV 8, KSHV
• Four types : Classic,
• African type
• Transplant associated, AIDS related
31. AIDS RELATED
• seen in 55% homosexual pts
• Represents 1st sign of progression of AIDS
• Many cutaneous lesions are seen
• Oral lesions can occur on any mucosal surface
• Mainly on hard palate, maxillary gingiva,
• Also – tongue, uvula, tonsils, pharynx
• Associated with cervical lymphadenopathy
• Salivary gland enlargement
32. Multiple Flat,
blue/red/purpl
e patches
Coalesce to
form plaques
Surface papules
/ nodules
develop
Lesion becomes
exophytic,
ulcerate and
bleed
Asymptomatic initially
• May cause discomfort during speech, eating
• on palate, alv . Ridge : resorption - tooth loss
• compromise airways
Diagnosis : biopsy
Patch stage
Plaque stage
Nodular stage
33. NON HODGKINS LYMPHOMA
• Second most common neoplasm associated with
AIDS
• HIV pts are 60 times at risk
• Lesions tend to present as large, painful, ulcerated
mass on palate, gingival tissues.
• Biopsy – for definitive diagnosis
34. 4.A. Linear gingival erythema
• As distinctive fiery red band of marginal gingival tissue
without ulceration or attachment loss, prone to
bleeding
• Some times extend beyond the MGJ.
• The lesion redness is disproportional to the amount of
plaque and persists after removal of plaque
• HP : reveals little inflammation
• Clinical redness represents vascular reponse with no
lymphocytic infiltration.
35.
36. 5.B. Necrotising ulcerative gingivitis
• Fusospirochaetal infection
• Involves primarily free gingiva , crest of gingiva, id
papilla
• Rarely soft palate, tonsil
• Occurs at any age, middle age – common
• Stress, immunosuppression, malnutrition, trauma,
smoking
37. • Painful , hyperemic gingiva & sharply punched out
crater like erosions of id papilla of sudden onset
• Ulcerated remanants bleed when touched
• Covered by greyish pseudomembrane
• Ulcers tend to spread to all margins
• Pt c/o inability to eat, fetid odour
• Excessive salivation, metallic taste
• Systemic manifestations
38.
39. 5.C.Necrotising ulcerative periodontitis
• characterized by recession and increased attachment
loss with shallow probing depths, bleeding, tissue
sloughing, loss of id papillae, fetid odor, and moderate
pain.
• Periods of activity (tissue necrosis and loss) may be
followed by
• periods of quiescence (healing with no signs of
inflammation, but evidence of permanent residual
tissue loss)
40.
41. • Typical : P. gingivalis, P. intermedia, T.denticola,
Actinobacillus actinomycetemcomitans
• Atypical bacteria seen in NUP ( HIV PTS) : Bulleidia
Extructa, Dialister, fusobacterium, selenomonas,
peptostreptococcus, veillonella
• Condition may be exacerbated by Candida, herpes like
viruses & by an HIV disease–related increased
inflammatory cytokine response
• Fusobacterium necrophorum plays a major role in
progression of NUP to noma.
42. • Diagnostic modalities : clinical appearance
Measurements of recession, periodontal probing
depths, attachment levels, and mobility
• Imaging : of areas of NUP involvement may show loss
of crestal cortication associated with rapid alveolar
bone loss.
43. GROUP II
A) Mycobacterial infections
• MAC, M.TB
• Approx 1/3rd of AIDS-related deaths worldwide are due to
TB
• increased reactivation of latent TB infections as well as
higher primary rates of TB
• Pulmonary TB is the most common
• Extrapulmonary disease affecting the liver, spleen,or
kidney may occur in patients with CD4 < 100 cells/mm3
44. ORAL MANIFESTATIONS :
• Primary TB : gingiva, tooth extraction sockets, buccal
folds
• Sec. TB : tongue, palate, lips, alveolar mucosa & jaw
bones
• present as ulcers or nodules, vesicles, fissures,,
plaques, granulomas and verrucous proliferations.
• single or multiple, painful or painless
45. • Ulcer – irregular, ragged, undermined edges,
minimal induration , with yellowish granular base
• Tongue : lateral border, ant. Dorsum, base of tongue
• Painful, grayish-yellow, firm well demarcated
• Palate : Small granulomas or ulcerations
• Lips : shallow granulating ulcers
• TB OSTEOMYELITIS
• TB SIALADENITIS
46.
47. B) MELANOTIC HYPERPIGMENTATION
• HIV pts hyperpigmentation of oral mucosa , skin, nails
occurs suddenly
Due to
• Direct result of HIV infection
• Adrenocortical destruction due to several infections
associated with hiv
• Medication intake : ketoconazole, zidovudine
48. C) NECROTISING ULCERATIVE STOMATITIS
• NUG, NUP, NUS – different clinical stages of same disease (
robinson et.al)
• Collectively – necrotising gingivostomatitis
• NUS is an outcome of NUG/P progressing beyond mucogingival
demarcation
• Sometimes arise on mucosa seperately
• NUS involves mainly soft tissues, may extend into underlying
bone causing massive tissue destruction.
• If NUS extends from oral mucosa to involve facial skin, it will
result in noma
49. Hiv
infects lc
cells
Depletion
of lc cells
Decreased
local
immune
response
Increased
susceptibility
to infections
NPD,
NUS
STIMULATES
CYTOTOXIC T-
CELL RESPONSE
PATHOGENESIS
50. D)UNI/BILATERAL SWELLING OF MAJOR SALIVARY GLANDS
• HIV-associated lymphoepithelial lesions which are
known as hiv associated salivary gland lesions ( HIV
SGD)
• Hyperplastic reactive lymphadenopathy,
• Benign lymphoepithelial cysts,
• Malignant : lymphoma, ks
• benign neoplasms
• Bacterial , mycobacterial , and viral infections
51. • Diffuse Infiltrative Lymphocytosis Syndrome (Dils)
• In 3% of hiv pts multiple lymphoepithelial cysts
proliferate in parotid gland
• Painful enlargement of gland
• Lesion involves entire parotid parenchyma, so presents
as localised mass
• Not moveable, Tender on palpation
• Tense , due fluid accumulation in multiple cysts
• Reduced salivary gland function : xerostomia, sicca
symptoms
52. • In HIV +ve, CT scan showing multiple hypodense areas
is suggestive of DILS .
Histopathology :
• Characterized by persistent infiltration of CD8 cells that
have the ability to destroy HIV-infected cells
• lymphocytic infiltration involving the salivary glands (~
to Sjogren syndrome)
• Differentiation : DILS also involves lungs, kidney, git
• Sj autoab’s will be absent in pts with DILS
53. • Fine-needle aspirates can be useful in differential
diagnosis of salivary gland masses
• Confirmatory - histopathologic diagnosis
• If ct shows a defined mass, then superficial
parotidectomy
• If no defined mass is seen in ct then incisional biopsy
• Immunohistochemical analysis from a biopsy are
essential to determine the nature of the salivary gland
enlargement.
54. E) THROMBOCYTOPENIC PURPURA
• HIV related immune thrombocytopenic purpura
• Immune mediated destruction
• Circulating immune complexes are non specifically
deposited on platelet membrane, resulting in
reticuloendothelial clearance.
• Us studies , HIV directly infects megakaryocytes , leading
to impaired production
55. • Thrombotic thrombocytopenic purpura is also
seen in HIV pts.
• Other causes of thrombocytopenia in HIV :
• Infections / neoplastic conditions involving
bone marrow
• Any medication causing myelosuppression
56. F) ULCERATIONS NOT OTHERWISE SPECIFIED
• single or multiple, well-circumscribed, extremely
painful
• often with a pseudomembrane, > 0.5 cm to 2/ 3 cm
• may have a recurrent pattern/ not
• may last for several weeks, healing with scarring.
• Typically found on nonkeratinized epithelial mucosa
57. • In immune-suppressed patients ulcers are deeper
and devoid of the classic erythematous halo at ulcer
margin
• Biopsy should be obtained for lesions lasting > 3
weeks
58. G) VIRAL
1)HSV : In HIV pts presents
• as an erythematous pruritus that develops into
painful vesicles and ulcerates over a brief period,
accompanied by painful regional lymphadenopathy.
• HSV infection may involve all oral mucosa
• Both keratinised & non keratinised
• can be more prolonged and severe than in HIV-ve
60. • VERRUCA VULGARIS ( COMMON WART)
• cutaneous lesion, less common on mucos memb
• Numerous finger like projections
• Resulting in lesion with rough, verrucous, cauliflower
like surface
• Well circumscribed, pendculated/sessile
• Contagious, capable of spreading to other parts
61. • CONDYLOMA ACCUMINATUM ( veneral wart)
• Soft, pink nodules which proliferate & coalesce rapidly
to form diffuse papillomatous clusters of varying size
• Occurs on moist, intertriginous areas
• Seen on tongue, commissures
• Also present on other mucosal surfaces
62. • FOCAL EPITHELIAL HYPERPLASIA
• Most contagious oral papillary lesion
• Well circumscribed numerous soft, flat,sessile, non
papillomatous papules are distributed throughout oral
mucosa
• Site : labial, buccal, lingual mucosa, Gingiva, tonsil
• Differs from other HPV infections : extreme acanthosis,
hyperplasia, but minimal production of surface
projections
• Mucosa is 8-10 times thicker than normal.
63. 3) VARICELLA ZOSTER:
• Acute ubiquitous extremely contagious disease occuring in
children, young adults
• Maculopapular rash, vesicular eruptions which begins on
trunk, spreads centrifugally ( face & extremities)
• Occurs in successive crops.
• Skin lesions rupture , form superficial crusting , heals by
desquamation
• Can occur anywhere on oral mucosa
• Vesicles rupture to form eroded ulcers with red margins.
64. • HERPES ZOSTER
• In HIV latent VZV is reactivated by
Immunocompromised state
• Lymphomas like Hodgkins , T Cell Leukemia
• Prodrome : Deep aching / burning pain
• Dermatomatic/ zosteriform distribution of vesicles
• Unilateral, clustered distribution of vesicles, ulcers
• Thoracic > lumbar> craniofacial areas
• V1 is most commonly involved
65. • Post herpetic neuralgia :
• Pain that persists for 30/120 days after onset of rash.
• Occurs at any age
• More common in elderly pts
• Cli. Features: persistent pain, hyperesthesia,
parasthesia, allodynia for months or yrs after zoster
lesions have healed.
68. ACTINOMYCOSIS
• Actinomyces – filamentous bacteria
• living as commensal organisms in the human oral
cavity and respiratory and digestive tracts
• Becoming invasive when, through a mucosal lesion,
they gain access to the subcutaneous tissue.
• Infection is always endogenous. Doesnot occur by
person to person contact.
69. • Presents as a chronic, fluctuant mass
• Located at the border of the mandible
• Pain is rare, slight fever
• Initially, the mass may be surrounded by
induration or erythema; later, it may become
tender to palpation, on account of a central
necrosis process
• Becoming progressively larger within weeks or
months
70. • Mass breaks down and abscess, sinuses are formed
• Discharging pus contain typical yellow sulphur
granules
• Skin overlying abscess is purplish,red indurated has
appearance of wood.
• Infection may extend into adjoining soft tissue as well
as bone
• Leads actinomycotic osteomyelitis
71.
72. Epitheloid (bacillary) angiomatosis
• Vascular proliferation that ~ ks
• First described in 1983 in HIV pts
• Occurs when CD4 count < 100/cumm
• Rarely seen in immunocompetent pts
• Mucocutaneous disorder
• Lesions – vascular papules that grow to form nodules
• Diagnosis : hp
• Which demonstrate presence of causative bacteria
74. 4)Fungal other than candidiasis
• cryptococcus neoformans
• Geotrichum
• Histoplasma
• Mucoracea
• Aspergillus flavus
75. Cryptococcosis:
• Cryptococcus neoformans
• Meningoencephalitis
• Symptoms include headache, nausea, irritability,
and diminished cognitive function
• physical findings include cranial nerve palsies,
hyperreflexia, and papilledema.
• Rarely, intraoral ulcerations may occur in mucosal
tissues with dissemination of cryptococcosis
76. • Histoplasmosis
• Primary infection – self limiting pulmonary infection.
• Heals with fibrosis, calcification
• In HIV PTS progressive disseminated form
• Predilection for RE SYSTEM
• Involves liver, spleen, lymphnodes, bone marrow
• Oral histoplasmosis in HIV occurs alone/ as a part of
disseminated infection.
77. • Oral : nodular / ulcerative/ vegetative lesions
• Ulcerated areas covered by pseudomembrane
• Indurated margins
• Dissemination of histoplasmosis to the oral mucosa
may occur primarily on the gingival, tongue, palate,
and buccal mucosa.
• Gingival lesions will appear as diffuse granulomatous
inflammation with progressive alveolar bone erosion
and loosening of teeth
78. ASPERGILLOSIS
• Aspergillus spore is found in decaying vegetation and
in the immunocompromised host may cause acute
invasive pulmonary aspergillosis.
• Aspergillus species have also been isolated from the
air and environmental surfaces of hospital settings
• Hospitalized immunosuppressed individuals may be at
increased risk.
79. • Invade blood vessels causing thrombosis and infarction
of the perivascular tissues.
• Less commonly Aspergillus invades the sinuses and can
progress through the underlying soft tissue and bone to
cause palatal and oral lesions, typically described as
black or yellow necrotic lesions of the soft tissue
80. Recurrent aphthous stomatitis
• Most commonly reported type of ulcers in HIV +ve
pts
• Etiology remains undetermined
• Ulcers appear clinically as painful, round-to-oval,
yellow or white, & are surrounded by a halo of
erythema.
• HIV-positive patients usually experience increased
frequency and severity of typical minor aphthous
ulcers
81.
82. CYTO MEGALO VIRUS :
• May cause oral ulceration in HIV-positive pts with
• disseminated cytomegalovirus (CMV) disease
• Ulcers may occur anywhere in the oral cavity
• Resemble MAU in size.
• Instead of an erythematous margin, CMV ulcers
appear necrotic with a white halo.
• Deep tissue biopsy with biopsy punch or scalpel is
used to confirm diagnosis
• .
83. • large intracellular inclusion bodies are characteristic of
infection.
• Patients may develop CMV retinitis, esophagitis, colitis,
pneumonitis, and neurological disease
84. Molluscum contagiosum
• Infection of skin caused by pox virus
• Shiny, white, skin coloured dome shaped papules that
often demonstrate a central depressed crater.
• In pts with AIDS numerous lesions may be present
• No tendency to undergo spontaneous resolution
• Hp : large intracytoplasmic inclusions are seen
• Molluscum bodies
85.
86. CONCLUSION
• Dentists play an important role in managing
the oral health of patients with HIV disease
• Knowledge of HIV oral lesion clinical
appearance, lesion symptoms and behavior,
various treatment approaches, and anticipated
response to treatment are important for oral
disease control and oral health maintenance
87. REFERENCES
• Lauren L Patton, Oral Lesions Associated With Human
Immunodeficiency Virus Disease. Dent Clin N Am 57
(2013) 673- 698
• Nicholas G Mosca, Alicia Rose Hathorn , HIV Positive
Patients : Dental Managent Considerations. Dent Clin
N Am 50 (2006) 635-657
• Charles E Barr, Michael Glick , Diagnosis And
Management Of Oral & Cutaneous Lesions In HIV -1
Disease. Dent Clin N Am 10 (1998)25-45
88. • Burkets Oral Medicine , 11th Edition, Bc Decker Inc
Hamilton 2008
• Robert E Marx, Diane Stern Oral And Maxillofacial
Pathology: A Rationale For diagnosis & Treatment.
1st edition, Quintessence.2003
• R Rajendran B Sivapathasundharam Shafer’s
Textbook Of Oral Pathology. 5th Edition, Elsevier,
2008
89. HIV does not make people dangerous
to know, so you can shake their
hands and give them a hug: Heaven
knows they need it !!
Editor's Notes
AIDS CAUSED BY HIV….
European – listed out 3o lesions
Mc occurs in 3 forms in hiv : opc, vv, eso….candida are normal inhabitants…1/3rd in normal, 2/3rd in aids
Only apparent azole refractory strains warrant antifungal sensitivity testing.
1985 – greenspan……type of human herpes virus
Asymp….becomes symp when super infected with candida.
1872…..ARE, MIHSK
Dd : ecchymosis, vascular lesions, low grade mucoepidermoid ca
Vincents, trench mouth…in 1999 am ac of perio reclass nug nup as necrotising perio disease….
OSTEO : difficulty in eating, trismus, paraesthesia of lower lip, lymphadenopathy , Loosening of teeth