Title: ORAL HEALTH IN WOMEN ORAL MANIFESTATIONS OF HIV INFECTION
1ORAL HEALTH IN WOMENORAL MANIFESTATIONS OF HIV
INFECTION
dr shabeel pn
2DENTAL HEALTH CARE PROVIDER TEAM APPROACH
3EPIDEMIOLOGY OF HIV-RELATED ORAL MANIFESTATIONS
IN WOMEN
4Epidemiology of HIV-Related Oral Manifestations
in Women A Review
- Oral Lesions in 15 of HIV-Infected Women
- Most Common Oral Lesion - Candidiasis
- Prevalence of Hairy Leukoplakia and Kaposi's
Sarcoma Significantly Less Common in Women
Oral Dis 1997 Sep3(3)206.
5Many Manifestations of HIV Disease are Similar in
Men Women
- Other Conditions Differ In Frequency
- HIV-Infected Men 8 Xs More Likely to Develop
Kaposi's Sarcoma - Women Have Higher Rates of Esophageal Candidiasis
Herpes Simplex Infections
6CHANGING PREVALENCE OF ORAL MANIFESATIONS
7- Overall Prevalence of Oral Lesions Has Decreased
(47.6-37.5) - Hairy Leukoplakia (25.8-11.4) Necrotizing
Periodontal Diseases (4.8-1.7) Decreased
8- HIV Salivary Gland Disease Increased (1.8-5.0)
- Candidiasis (20.3-16.7), Aphthae (3.7-3.0),
Oral Warts (2.2-4.0), Herpes Simplex Virus
Lesions (1.8-2.0) and Kaposis Sarcoma
(1.1-0.3) Unchanged
9HIV/AIDS Women's Health Oral Lesions in
HIV-Positive Women Reduced in HAART Therapy
- 503 HIV women over 6 years
- Incidence of EC fell to 2.99 percent from 5.48
percent - PC fell to 2.85 percent from 6.70 percent
- No changes were seen in HL or warts
- Women's Health Weekly (03.25.04)
10CANDIDIASIS
11Reported in 7-93 of HIV /AIDS Patients
12FOUR MAJOR TYPES
- Pseudomembranous
- Hyperplastic
- Erythematous (Atrophic)
- Angular Cheilitis
13PSEUDOMEMBRANOUS
- White or Yellow Patches
- Easily Removed w/ Scraping Yielding Bleeding
Surface - Any Mucosal Surface (Palate, Buccal or Labial
Mucosa, Tongue)
14HYPERPLASTIC CANDIDIASIS
- White Plaques Cant Be Removed w/ Scraping
- Buccal Mucosa Most Common Site in HIV Patients
15ERYTHEMATOUS (ATROPHIC)
- Fiery Red Surfaces to Hardly Discernible Pink
Spots - Most Common Location - Palate Dorsum of Tongue
- Spotty Areas in Buccal Mucosa
16ANGULAR CHEILITIS
- Common in Elderly
- Fissures Radiating From Angles of Mouth
17PREDISPOSING FACTORS
18SYSTEMIC FACTORS
- Age
- Use of Antibiotics
- Xerostomia
- Nutritional Deficiencies
- Immunosuppression
- Gastric Reflux
19LOCAL FACTORS
- Ill-Fitting Dentures
- Poor Prosthesis Hygiene
- Heavy Smoking
- Topical Medications
20CANDIDIASIS TREATMENT
- Nystatin Oral Susp
- 480 ml
- Rinse w/ One Tablespoonful QID
- Clotrimazole (Mycelex) Troches
- 10 mg Troches
- 3-5 Times a Day for 7-14 Days
21- Ketoconazole (Nizoral)
- 200 mg
- 200-400 mg Daily for 7-14 Days
- Fluconazole (Diflucan)
- 100 mg Tabs
- 2 Tabs First Day, Then 1 Tab Daily for 14 Days
- Itraconazole (Sporanox)
- 100 mg Tablets
- 1 tablet B.I.D. for 14 days
22OROFACIAL VIRAL INFECTIONS IN IMMUNOCOMPROMISED
HOST
23HAIRY LEUKOPLAKIA
- First Identified Among HIV Individuals
- Never Described Before AIDS Epidemic
24CLINICAL PRESENTATION
- Painless White Patches
- Do Not Rub Off
- Lateral Borders of the Tongue
- Surface May Be Smooth, Corrugated or Markedly
Folded - Thick, Hair-Like Projections
25 DIFFERENTIAL DIAGNOSIS
- Hyperplastic Candidiasis
- Geographic Tongue
- Lichen Planus
- Frictional Keratosis
- Leukoplakia
26HAIRY LEUKOPLAKIA - PATHOGENESIS
27HAIRY LEUKOPLAKIA TREATMENT
- Appears to Be Little Advantage in Treating
- Surgical Removal
- Laser
- Acyclovir
- Topical Vitamin A
28HUMAN PAPILLOMA VIRUS LESIONS
29HUMAN PAPILLOMA VIRUSES
- More Than 100 Human Papilloma Virus (HPV) Types
- 24 Associated with Oral Lesions
30HPV ORAL LESIONS
- Warts, Papillomas
- Condyloma Acuminatum
- Verruca Vulgaris
- Focal Epithelial Hyperplasia
- Dysplasia / Carcinoma
31HUMAN PAPILLOMA VIRUS LESIONS
32CONDYLOMA ACUMINATUM
- Sexually Transmitted
- Appears 1-3 Months After Exposure
- Multiple Wart-Like Lesions
- Lips, Lingual Frenum Tongue
33TREATMENTCONDYLOMA ACUMINATUM
- Surgical Removal
- Cryotherapy
- Laser Therapy
- Medications
34KAPOSIS SARCOMA
35Originally Described in 1872 - Idiopathic
Multiple Sarcomas of the Skin
36Previously Uncommon in USA
- Elderly Jewish Men of Eastern European or
Mediterranean Descent - Usually Involved Lower Extremities
- Indolent Course
- 1981 - Fulminant, Aggressive Form Occurring in
Young Homosexual Men w/ AIDS
37- gt50 of AIDS Patients w/ KS Display Oral Lesions
- Remains Significant Cause of Morbidity
Mortality in HIV Infected Patients
38CLINICAL PRESENTATION
- Angiomatous Malignancy of Skin, Mucosa, and
Internal Organs - Most Common Intraoral Locations
- Palate
- Gingiva
- Non-Elevated Macules, Nodules or Papules
- Brown, Blue, Purple
39KAPOSIS SARCOMAPATHOGENESIS
- Sexually Transmitted Cofactor
- Human Herpes Virus 8 (HHV 8)
40TREATMENT
- Treatment Reserved for Lesions Which Interfere w/
Function or Esthetics - Laser Excision
- Cryotherapy
- Radiation
- Intralesional Injection w/ Vinblastine
41CANCER IN PATIENTS WITH AIDS
42AIDS AND CANCER
- Roche et al, NJ Med 2001,Jan98(1)27-36
- 2460 Persons w/ AIDS and Cancer
- 2159 Males, 301 Females
- 50 Kaposis Sarcoma
- 33 Non-Hodgkins Lymphoma
- Lung, Oral, Cervical, Hodgkins Lymphoma, Other
Digestive
43RECURRENT ORAL ULCERATIONS
44RECURRENT APHTHOUS STOMATITIS
45EPIDEMIOLOGY
- Prevalence in General Population 10-20
- 67-85 Develop Prior
- to Age 30
- Familial Disposition
46MINOR APHTHAE
- Superficial Erosion with Fibrinous Coating Red
Halo - Single or Multiple Lesions
- 2-3 mms to Over 10 mms in Diameter
- Persists for 7-10 Days
- Painful
47MAJOR APHTHAE
- Large Painful Ulcerations
- Single or Multiple Lesions
- Persists Up to 6 Weeks
- Heal w/ Scarring
48GENERAL RULE
- Aphthae Occur on Mobile Mucosa
- Herpetic Lesions Occur on Tissue That is Firmly
Bound Down
49FACTORS ASSOCIATED WITH APHTHAE
- Psychological (Stress) Trauma
- Socio-Economic S. sanguis
- Endocrine
- Immunosuppression
- Hereditary
- Hypersensitivity
- Chemicals in Food
50TREATMENT
- Chlorhexidine
- Topical Steroids
- Lidex Gel .05
- Aphthasol Cream 5
51HERPES SIMPLEX INFECTIONS
52RECURRENT HERPETIC STOMATITIS
- Attenuated Form of Primary Infection
- Tissue Firmly Bound Down
- Vesicles Burst to Form Ulcers
- Coalesce
- Heals in 7-10 Days
53HERPES LABIALIS
54SYSTEMIC ANTIVIRALS
- Acyclovir (Zovirax) 200 mg CapsulesOne Capsule 5
Times a Day - Valacyclovir (Valtrex) 1 gm CapletsTwo Caplets
Twice a Day - Famciclovir (Famvir) 125 mg TabletsOne Tablet
Twice Daily
55TOPICAL ANTIVIRALS
- Zovirax (Acyclovir) Ointment 5
- 15 Gram Tube
- Apply TID
- Denavir (Penciclovir) Cream 1
- 2 Gram Tube
- Apply Every Two Hours
56AIDS RELATED PERIODONTAL DISEASE
- Linear Gingival Erythema
- Necrotizing Ulcerative Gingivitis
- Necrotizing Ulcerative Periodontitis
- Necrotizing Ulcerative Stomatitis
57LINEAR GINGIVAL ERYTHEMA
- A Persistent, Linear Erythematous Gingivitis
Which Bleeds Easily - Resistant to Treatment
- Spontaneous Remission
58NECROTIZING ULCERATIVE GINGIVITIS
- Also Known as ANUG
- Acute Gingivitis Characterized by Ulceration
Necrosis of the Gingival Margin Destruction of
the Interdental Papilla - Gingival Pain
59NECROTIZING ULCERATIVE GINGIVITIS
- Profuse Gingival Bleeding
- Fetid Odor
- No Involvement of Osseous Tissues
- Associated w/ Stress, Anxiety, Malnutrition
Smoking
60NECROTIZING ULCERATIVE PERIODONTITIS
- Severe Deep Pain
- Spontaneous Gingival Bleeding
- Extensive Soft Tissue Necrosis
- Severe Loss of Periodontal Attachment
61NECROTIZING ULCERATIVE PERIODONTITIS
- Rapid Onset Progression
- Bone May Be Exposed
- Associated with Low CD4 Counts
62NECROTIZING ULCERATIVE STOMATITIS
- Necrosis of Significant Areas of the Oral Soft
Tissue Underlying Bone
63INTRAORAL PIGMENTATION
- Racial Pigmentation Smoking
- Amalgam Tattoo Addisons Disease
- Heavy Metal Poisoning Puetz-Jeger Syndrome
- Medications
- Birth Control Pills
- Minocycline
- AZT
64SALIVARY GLAND DISEASE
- Xerostomia
- Bilateral Parotid Gland Enlargement Occurs in HIV
Infected Individuals - Histology Has Been Described as Resembling
Autoimmune Salivary Gland Disease w/ Cystic
Changes
65Thanks for Coming!
Jacqueline M. Plemons DDS, MS 6031 Sherry
Lane Dallas, TX 75225 (214)369-8585 drplemons_at_yah
oo.com