18 Oral manifestations of AIDS - Sheet1

Question 1

Define Acquired Immune Deficiency Syndrome.

Answer 1

Acquired - result of infection with HIV
Immune - T-cells specifically targeted
Deficiency - Incapable of normal immune repsonse and defenese and surveillance systems both affected
Syndrome - multiple clinical features and any combination possible.

Question 2

Compare the oral lesions of AIDS to those seen in other immune deficient states like autoimmune disease, widespread malignant disease, and medically-induced immune supression

Answer 2

Similar to lesions of these other immune deficient states
More complete deficiency:More florid manifestations, accelerated clinical course
Less effective treatment: Prolonged treatment often required

Question 3

Describe the frequency of oral sequelae in AIDS and pre-AIDS patients.

Answer 3

Seen in 70% of AIDS and pre-AIDS patients. Opportunistic infections - viral, bacterial, fungal and neoplastic

Question 4

What are some important considerations for those in the dental community?

Answer 4

Establishing the initial diagnosis of AIDS in patients unaware they are infected
Treatment planning considerations
Most important in the pre-AIDS patients
Time interval for treatment completion
Preparation for the immunodeficient state
Recognition and management of the specific oral manifestations

Question 5

Describe the opportunistic viral infections seen in AIDS patients, the characteristics, symptoms and treatment: (Herpes virus - Simplex)

Answer 5

• Recurrent labialis or recurrent intraoral, lesions begin as vesicles - rupture to ulcers, larger lesions, longer duration, increased number of lesions.
  Treatment - Antiviral therapy, supportive care - fluids, analgesics

Question 6

Describe the opportunistic viral infections seen in AIDS patients, the characteristics, symptoms and treatment: (Herpes virus - Varicella-zoster)

Answer 6

• Lesions begin as vesicles, progress to ulcers, more florid manifestations, more severe pain, longer duration, strict unilateral involvement, skin lesions often accompany oral lesions.
  Treatment - antiviral therapy, topical ointment for skin lesions, supportive care

Question 7

Describe the opportunistic viral infections seen in AIDS patients, the characteristics, symptoms and treatment: (Herpes virus - Epstein-Barr)

Answer 7

Etiologic factor in oral hairy luekoplakia

Question 8

Describe the opportunistic viral infections seen in AIDS patients, the characteristics, symptoms and treatment: (HPV-papilloma)

Answer 8

Cauliflower-like appearance, often pedunculated, normal to pink color, multiple lesions mor commonly, larger lesions possible.
Treatment - Antiviral agents of little value, surgical excision.

Question 9

Describe the opportunistic viral infections seen in AIDS patients, the characteristics, symptoms and treatment: (HPV-condyloma acuminata)

Answer 9

Cauliflower or papillary surface, broad based rather than pedunculated, usually white in color, multiple lesions more commonly, larger lesions possible
Treatment - antiviral agents of little value, surgical excision

Question 10

Describe the opportunistic viral infections seen in AIDS patients, the characteristics, symptoms and treatment: (HPV-oral hairy leukoplakia)

Answer 10

Predictor for progression to full blown AIDS, Lateral border of tongue, bilateral, white, non-whipeable plaques in vertical/linear pattern, “shaggy” surface most often, occasionally smooth.
Treatment - Necessary? Anti-fungal therapy? Anti-viral therapy? Lesions may regress with treatment and anti-AIDS drug regime. ** Positive association with Epstein Barr Virus (HHV4) **

Question 11

Describe the opportunistic viral infections seen in AIDS patients, the characteristics, symptoms and treatment: (HIV-associated periodontal disease: linear gingival erythema)

Answer 11

Gingival erythema spreading to involve movable mucosa, increased bleeding on brushing, spontaneous bleeding (sometimes nocturnal), soft tissue necrosis, local/multifocal or diffuse, painful gingivitis!!, progress to HIV associated periodontitis in short time.

Question 12

What is the etiology of HIV associated periodontal disease?

Answer 12

Differences in the percentages of causative organisms when compared with routine periodontal disease
Increased % of:
Eikenella species
Wolinella species
Bacteroides species
Candidiasis mediated?

Question 13

HIV-associated gingivitis

Answer 13

Gingival erythema spreading to involve movable mucosa
Increased bleeding on brushing
Spontaneous bleeding, sometimes nocturnal
Soft tissue necrosis
May be local, multifocal, or diffuse
Painful!!
May progress to HIV associated periodontitis in a short time interval

Question 14

HIV-associated periodontal disease

Answer 14

Severe loss of periodontal attachment
Ulceration
Minimal pocket formation
Interproximal cratering
Bone destruction:
Loss of crestal alveolar bone
Sequestration
Very rapid progression
Severe pain
Often described by the patient as “deep” pain or “bone” pain

Question 15

HIV-associated periodontal disease: necrotizing stomatitis

Answer 15

Most severe form of the disease, involvement of soft tissue, and bony outside the alveolar process

Question 16

Describe the opportunistic fungal infections seen in AIDS patients, the characteristics, symptoms and treatment: candidiasis-pseudomembranous

Answer 16

Creamy white or yellow plaques (resembles milk curd), usually has erythematous background, wipeable. Found commonly on palate, buccal mucosa, labial mucosa, dorsum tongue
Treatments: Antifungal medications, may require longer duration of therapy, more potent agents.

Question 17

Describe the opportunistic fungal infections seen in AIDS patients, the characteristics, symptoms and treatment: candidiasis-hyperkeratotic

Answer 17

White plaque, often has irregular surface texure, non-whipeable, normal colored mucosal background most often. Found most common in the buccal mucosa.
Treatments: Antifungal medications, may require longer duration of therapy, more potent agents.

Question 18

Describe the opportunistic fungal infections seen in AIDS patients, the characteristics, symptoms and treatment: candidiasis-erythematous (atrophic)

Answer 18

Red to pink color, often diffuse area of involvement, may have distinctly “velvety” surface texture. Commonly found on palate, buccal mucosa, dorsum tongue.
Treatments: Antifungal medications, may require longer duration of therapy, more potent agents.

Question 19

Describe the opportunistic fungal infections seen in AIDS patients, the characteristics, symptoms and treatment: angular cheilitis

Answer 19

Radiating fissures from commissure areas, may spread to adjacent skin and lip vermillion, diffuse erythematous background, cracking, crusting, and bleeding on wide opening, difficult healing due to location, often accompanied by other intraoral clinical forms of candidiasis.
Treatments: Antifungal medications, may require longer duration of therapy, more potent agents.

Question 20

What are some other common fungal infections in addition to candidiasis?

Answer 20

Histoplasmosis, cryptococcosis (oral lesions usually accompany widespread involvement)

Question 21

Describe the opportunistic neoplasms seen in AIDS patients, the characteristics, symptoms and treatment: Non-Hodgkin’s lymphoma

Answer 21

Second most common malignancy of AIDS, very aggressive, soft tissue enlargement, any area of mucosa, palate & gingiva most common site, firm to palpation, painless most often, ulceration due to trauma, may be first presentation of systemic disease.

Question 22

Describe the opportunistic neoplasms seen in AIDS patients, the characteristics, symptoms and treatment: Kaposi’s sarcoma

Answer 22

Diffuse, uncontrolled angiogenesis in an immune deficient host, Herpes Virus VIII, oral lesions precede skin lesions, aggressive, resistant to therapy, red to purple lesions, macular, may ulcerate, commonly on hard palate & gingiva.
Treatment - surgical excision, laser removal for larger areas.

Question 23

Describe the opportunistic neoplasms seen in AIDS patients, the characteristics, symptoms and treatment: Squamous cell carcinoma

Answer 23

Questionable increased incidence in AIDS patients.