Principles of Oral Health Management for the HIVAIDS Patient

1
Principles of Oral HealthManagement for the
HIV/AIDS Patient

• A Course of Training for the Oral Health
  Professional

Made possible from a grant to the New York State
Department of Health AIDS Institute from the
HIV/AIDS Bureau, Division of Community Based
Programs, Health Resources and Services
Administration, DHHS
2
Oral Manifestations Of HIV Infection Clinical
Characteristics, Diagnosis, And Treatment
Recommendations
Joan A. Phelan, DDS
3
Diagnosis Of HIV Related Oral Lesions

• Oral examination procedures are the same for HIV
  patients as for all dental patients
• Diagnostic procedures must be appropriate to the
  identified problem
• Treatment should be based on either a provisional
  or definitive diagnosis
• Diagnosis should be re-evaluated if treatment is
  not effective

4
Oral Manifestations Of HIV Infection

• Opportunistic diseases--manifestations of immune
  deficiency or derangement.
• Not caused directly by HIV.
• The same lesions occur in association with other
  immune deficiency disorders.

5
HIV-related Oral Lesions

• Infections
• Fungal, Viral, Bacterial
• Neoplasms
• Kaposis Sarcoma, Non-Hodgkins Lymphoma
• Other
• Non-specific or Aphthous-like Ulcers, Lichenoid
  or Drug Reactions, Salivary Gland Disease

6
Oral Candidiasis

• Pseudomembranous
• Erythematous
• Hyperplastic
• Accompanying angular cheilitis

7
(No Transcript)
8
(No Transcript)
9
Pseudomembranous Candidiasis

• Appearance white curd-like material that wipes
  off revealing an underlying erythematous mucosa
• Clinical Diagnosis generally made on the basis
  of appearance

10
Erythematous Candidiasis

• Appearance mucosal erythema and/or
  patchy-depapillation of the dorsal tongue
• Definitive diagnosis requires
• Identification of fungal hyphae in the lesion
• Response of the lesion(s) to antifungal therapy

11
(No Transcript)
12
(No Transcript)
13
Hyperplastic Candidiasis

• Appearance as a leukoplakia (a white lesion that
  does not rub off)
• Definitive diagnosis requires
• Identification of fungal hyphae in the lesion
• Response of the lesion(s) to antifungal therapy
• If unresponsive to antifungal therapy, biopsy
  must be considered

14
(No Transcript)
15
Angular Cheilitis

• Appearance erythema and/or fissuring at the
  corners of the mouth
• Frequently accompanies intraoral candidiasis

16
(No Transcript)
17
Treatment Of Oral Candidiasis

• Topical Antifungal Therapy
• Systemic Antifungal Therapy

18
Hairy Leukoplakia

• Appearance white corrugated lesion on the
  lateral border of the tongue
• Clinical Diagnosis
• known seropositive patients
• patients with unknown HIV status
• definitive diagnosis requires identification of
  Epstein-Barr virus infected epithelial cells

19
(No Transcript)
20
(No Transcript)
21
Hairy Leukoplakia

• Treatment and Management
• Generally does not require treatment
• Antiviral treatment and topical podophyllum resin
  have been used to treat --the result is temporary
• May wax and wane without treatment

22
Oral Ulcers

• Herpes simplex infection
• Varicella zoster infection (Shingles)
• Cytomegalovirus infection
• Aphthous ulcers

• Histoplasmosis
• Lymphoma
• Necrotizing ulcerative gingivitis (NUG)
• Necrotizing ulcerative periodontitis (NUP)
• Necrotizing stomatitis (NS)

23
Herpes Simplex Infection

• Atypical herpes simplex ulceration is a frequent
  cause of mucosal ulceration
• Diagnosis may be confirmed using mucosal smear,
  viral isolation (culture) or biopsy
• Ulcers generally respond to systemic anti-viral
  treatment

24
(No Transcript)
25
Low Incidence Infections

• Viral
• Varicella-Zoster
• Cytomegalovirus
• Fungal
• Histoplasmosis
• Bacterial
• Tuberculosis
• Syphilis

26
(No Transcript)
27
(No Transcript)
28
Major Aphthous-like Ulcers

• Appearance persistent, nonspecific ulcers
• Biopsy and histologic examination may be
  necessary to exclude other causes
• Systemic and topical corticosteroid therapy have
  been successful management
• Topical tetracycline application and systemic
  thalidomide have also be used

29
(No Transcript)
30
(No Transcript)
31
Non-Hodgkins Lymphoma

• Appearance necrotic, ulcerated or nonulcerated
  masses, when occurring in the oral cavity
• Diagnosis biopsy and histologic examination

32
(No Transcript)
33
Necrotizing Ulcerative Periodontal Disease

• Characterized by painful gingival ulceration and
  may result in loss of alveolar bone
• Management
• antibiotic therapy
• debridement of necrotic tissue
• meticulous home care

34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
Lesions Caused By Human Papilloma Virus (HPV)

• Appearance exophytic, papillary, oral mucosal
  lesions
• Several different types of HPV have been reported
  to cause lesions
• May be multiple
• Often difficult to treat due to a high risk of
  recurrence

38
(No Transcript)
39
Pigmented And Erythematous Lesions

• Kaposis sarcoma
• Mucosal melanin pigmentation
• Linear gingival erythema

40
Kaposis Sarcoma

• Appearance Oral lesions appear as reddish
  purple, raised or flat
• Size ranges from small to extensive
• Behavior is unpredictable
• Definitive diagnosis biopsy and histologic
  examination
• No curative therapy--radiation treatment,
  chemotherapy and sclerosing agents have been,
  used to control oral lesions

41
(No Transcript)
42
(No Transcript)
43
Mucosal Melanin Pigmentation

• Single and multiple oral mucosal melanotic
  macules have been report to occur in HIV infected
  individuals
• Significance is not known
• Some have been associated with zidovudine therapy
• Treatment is not indicated

44
(No Transcript)
45
Linear Gingival Erythema

• Appearance a distinct band of erythema of the
  gingival margin
• Erythema does not respond to removal of local
  factors
• Cause is not known

46
(No Transcript)
47
(No Transcript)
48
Salivary Gland Disease

• Bilateral parotid gland enlargement occurs in HIV
  infected individuals
• Histology has been described as resembling
  autoimmune salivary gland disease with cystic
  changes

49
(No Transcript)
50
Surgeon Generals Report Oral Health
Oral Health In America A Report of the Surgeon
General, Executive Summary, June 2000 Oral
diseases and disorders in and of themselves
affect health and well-being throughout life. The
burden of oral problems is extensive and may be
particularly severe in vulnerable populations. It
includes the common dental diseases and other
oral infections, such as cold sores and
candidiasis, that can occur at any stage of life,
as well as birth defects in infancy, and the
chronic facial pain conditions and oral cancers
seen in later years. Many of these conditions and
their treatments may undermine self-image and
self-esteem, discourage normal social
interaction, and lead to chronic stress and
depression as well as incur great financial cost.
They may also interfere with vital functions such
as breathing, eating, swallowing, and speaking
and with activities of daily living such as work,
school, and family interactions.