ORAL HEALTH IN WOMEN ORAL MANIFESTATIONS OF HIV INFECTION - PowerPoint PPT Presentation

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ORAL HEALTH IN WOMEN ORAL MANIFESTATIONS OF HIV INFECTION

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Title: ORAL HEALTH IN WOMEN ORAL MANIFESTATIONS OF HIV INFECTION


1
ORAL HEALTH IN WOMENORAL MANIFESTATIONS OF HIV
INFECTION
dr shabeel pn
2
DENTAL HEALTH CARE PROVIDER TEAM APPROACH
3
EPIDEMIOLOGY OF HIV-RELATED ORAL MANIFESTATIONS
IN WOMEN
4
Epidemiology 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.
5
Many 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

6
CHANGING 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

9
HIV/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)

10
CANDIDIASIS
11
Reported in 7-93 of HIV /AIDS Patients
12
FOUR MAJOR TYPES
  • Pseudomembranous
  • Hyperplastic
  • Erythematous (Atrophic)
  • Angular Cheilitis

13
PSEUDOMEMBRANOUS
  • White or Yellow Patches
  • Easily Removed w/ Scraping Yielding Bleeding
    Surface
  • Any Mucosal Surface (Palate, Buccal or Labial
    Mucosa, Tongue)

14
HYPERPLASTIC CANDIDIASIS
  • White Plaques Cant Be Removed w/ Scraping
  • Buccal Mucosa Most Common Site in HIV Patients

15
ERYTHEMATOUS (ATROPHIC)
  • Fiery Red Surfaces to Hardly Discernible Pink
    Spots
  • Most Common Location - Palate Dorsum of Tongue
  • Spotty Areas in Buccal Mucosa

16
ANGULAR CHEILITIS
  • Common in Elderly
  • Fissures Radiating From Angles of Mouth

17
PREDISPOSING FACTORS
18
SYSTEMIC FACTORS
  • Age
  • Use of Antibiotics
  • Xerostomia
  • Nutritional Deficiencies
  • Immunosuppression
  • Gastric Reflux

19
LOCAL FACTORS
  • Ill-Fitting Dentures
  • Poor Prosthesis Hygiene
  • Heavy Smoking
  • Topical Medications

20
CANDIDIASIS 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

22
OROFACIAL VIRAL INFECTIONS IN IMMUNOCOMPROMISED
HOST
23
HAIRY LEUKOPLAKIA
  • First Identified Among HIV Individuals
  • Never Described Before AIDS Epidemic

24
CLINICAL 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

26
HAIRY LEUKOPLAKIA - PATHOGENESIS
  • Epstein-Barr Virus

27
HAIRY LEUKOPLAKIA TREATMENT
  • Appears to Be Little Advantage in Treating
  • Surgical Removal
  • Laser
  • Acyclovir
  • Topical Vitamin A

28
HUMAN PAPILLOMA VIRUS LESIONS
29
HUMAN PAPILLOMA VIRUSES
  • More Than 100 Human Papilloma Virus (HPV) Types
  • 24 Associated with Oral Lesions

30
HPV ORAL LESIONS
  • Warts, Papillomas
  • Condyloma Acuminatum
  • Verruca Vulgaris
  • Focal Epithelial Hyperplasia
  • Dysplasia / Carcinoma

31
HUMAN PAPILLOMA VIRUS LESIONS
32
CONDYLOMA ACUMINATUM
  • Sexually Transmitted
  • Appears 1-3 Months After Exposure
  • Multiple Wart-Like Lesions
  • Lips, Lingual Frenum Tongue

33
TREATMENTCONDYLOMA ACUMINATUM
  • Surgical Removal
  • Cryotherapy
  • Laser Therapy
  • Medications

34
KAPOSIS SARCOMA
35
Originally Described in 1872 - Idiopathic
Multiple Sarcomas of the Skin
36
Previously 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

38
CLINICAL PRESENTATION
  • Angiomatous Malignancy of Skin, Mucosa, and
    Internal Organs
  • Most Common Intraoral Locations
  • Palate
  • Gingiva
  • Non-Elevated Macules, Nodules or Papules
  • Brown, Blue, Purple

39
KAPOSIS SARCOMAPATHOGENESIS
  • Sexually Transmitted Cofactor
  • Human Herpes Virus 8 (HHV 8)

40
TREATMENT
  • Treatment Reserved for Lesions Which Interfere w/
    Function or Esthetics
  • Laser Excision
  • Cryotherapy
  • Radiation
  • Intralesional Injection w/ Vinblastine

41
CANCER IN PATIENTS WITH AIDS
42
AIDS 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

43
RECURRENT ORAL ULCERATIONS
44
RECURRENT APHTHOUS STOMATITIS
45
EPIDEMIOLOGY
  • Prevalence in General Population 10-20
  • 67-85 Develop Prior
  • to Age 30
  • Familial Disposition

46
MINOR 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

47
MAJOR APHTHAE
  • Large Painful Ulcerations
  • Single or Multiple Lesions
  • Persists Up to 6 Weeks
  • Heal w/ Scarring

48
GENERAL RULE
  • Aphthae Occur on Mobile Mucosa
  • Herpetic Lesions Occur on Tissue That is Firmly
    Bound Down

49
FACTORS ASSOCIATED WITH APHTHAE
  • Psychological (Stress) Trauma
  • Socio-Economic S. sanguis
  • Endocrine
  • Immunosuppression
  • Hereditary
  • Hypersensitivity
  • Chemicals in Food

50
TREATMENT
  • Chlorhexidine
  • Topical Steroids
  • Lidex Gel .05
  • Aphthasol Cream 5

51
HERPES SIMPLEX INFECTIONS
52
RECURRENT HERPETIC STOMATITIS
  • Attenuated Form of Primary Infection
  • Tissue Firmly Bound Down
  • Vesicles Burst to Form Ulcers
  • Coalesce
  • Heals in 7-10 Days

53
HERPES LABIALIS
54
SYSTEMIC 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

55
TOPICAL ANTIVIRALS
  • Zovirax (Acyclovir) Ointment 5
  • 15 Gram Tube
  • Apply TID
  • Denavir (Penciclovir) Cream 1
  • 2 Gram Tube
  • Apply Every Two Hours

56
AIDS RELATED PERIODONTAL DISEASE
  • Linear Gingival Erythema
  • Necrotizing Ulcerative Gingivitis
  • Necrotizing Ulcerative Periodontitis
  • Necrotizing Ulcerative Stomatitis

57
LINEAR GINGIVAL ERYTHEMA
  • A Persistent, Linear Erythematous Gingivitis
    Which Bleeds Easily
  • Resistant to Treatment
  • Spontaneous Remission

58
NECROTIZING ULCERATIVE GINGIVITIS
  • Also Known as ANUG
  • Acute Gingivitis Characterized by Ulceration
    Necrosis of the Gingival Margin Destruction of
    the Interdental Papilla
  • Gingival Pain

59
NECROTIZING ULCERATIVE GINGIVITIS
  • Profuse Gingival Bleeding
  • Fetid Odor
  • No Involvement of Osseous Tissues
  • Associated w/ Stress, Anxiety, Malnutrition
    Smoking

60
NECROTIZING ULCERATIVE PERIODONTITIS
  • Severe Deep Pain
  • Spontaneous Gingival Bleeding
  • Extensive Soft Tissue Necrosis
  • Severe Loss of Periodontal Attachment

61
NECROTIZING ULCERATIVE PERIODONTITIS
  • Rapid Onset Progression
  • Bone May Be Exposed
  • Associated with Low CD4 Counts

62
NECROTIZING ULCERATIVE STOMATITIS
  • Necrosis of Significant Areas of the Oral Soft
    Tissue Underlying Bone

63
INTRAORAL PIGMENTATION
  • Racial Pigmentation Smoking
  • Amalgam Tattoo Addisons Disease
  • Heavy Metal Poisoning Puetz-Jeger Syndrome
  • Medications
  • Birth Control Pills
  • Minocycline
  • AZT

64
SALIVARY 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

65
Thanks for Coming!
Jacqueline M. Plemons DDS, MS 6031 Sherry
Lane Dallas, TX 75225 (214)369-8585 drplemons_at_yah
oo.com
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