4 HIV Oral Manifestations Flashcards
What does HAART stand for?
Highly Active Antiretroviral Therapy
Which HIV patients get HAART?
Some MDs suggest only giving it to severely compromised pts
What happens to the prevalence of oral manifestations in HIV patients on HAART?
reduction of hairy leukoplakia, NUP, and oral lesions.
Increase in salivary gland diseases, oral warts.
Oral manifestations occur in approximately what percentage of HIV patients?
30-80%
What are 5 predisposing factors for oral lesions in HIV patients?
CD4 count 3000 copies/mL, xerostomia, poor oral hygiene, smoking
What is the commonly the first lesion a HIV patient can present with?
Hairy leukoplakia
How do you treat hairy leukoplakia?
No real Tx, but can treat associated candida or prescribe acyclovir in severe cases
Where in the mouth is hairy leukoplakia seen?
On the tongue
What are three major presentations of candidiasis in HIV infected patients?
pseudomembranous (thrush), erythematous (atrophic), and angular chelitis (corners of mouth)
Where can candidiasis be seen?
anywhere in the mouth
What is the most common symptom seen with candidiasis?
burning painful sensation and changes in taste
What can you use to treat candidiasis?
Nystatin cream, Clotrimazole cream, Amphotericin B
Opportunistic tumors occur in which HIV patients?
Pts that have end-stage HIV disease (really really sick)
What are two examples of opportunistic tumors seen in HIV pts?
kaposi’s sarcoma, and non-hodgkin lymphoma
How does Kaposi’s sarcoma present in the mouth?
gingival overgrowth
What is the probable cause of Kaposi’s sarcoma?
Human Herpes Virus 8
What can make removing a pappiloma difficult?
The pappiloma can be much larger and spread out underneath the epithelium than what it appears on the surface - like an iceberg
How would you treat a pappiloma?
They can be removed through surgery, freezing them, or doing nothing
Was there an increase or decrease in pappiloma cases in the HAART era?
dramatic increase
What are some associated reasons why a person can have oral ulcers?
lymphoma, mycobacterial infection, CMV, neutropenia, HSV, HZV, apthous ulcers, trauma, or Stevens Johnson’s syndrome
What are two things you can administer to a pt to treat their apthous ulcer?
Lidex or Thalidomide
Do you need to take a biopsy to diagnose non-hodgkin’s lymphoma?
Yes of course
What are some things that can cause xerostomia?
anti-HIV meds, antidepressants, analgesics, salivary gland disease, candidiasis, or nutritional problems
How can a Pt manage xerostomia?
Have sugarless candies, use artificial saliva, administer pilocarpine, decrease smoking
What are clinical features of HIV-associated gingivitis (HIV-G) and Linear gingival erythema (LGE)?
red linear band involving the free gingival margin, spontaneous bleeding, erythema of attached and unattached mucosa, unusual response to therapy
What are some clinical features of NUP, NUG, and HIV-associated periodontitis (HIV-P)?
painful and spontaneous bleeding, necrosis, cratering, intense erythema, extremely rapid bone loss
Are implants a short term success in HIV patients?
Yes
Are we more concerned about CD4 count changing or about how low it is?
Changing - that will tell us how unstable they are
In HIV patients, the viral load represents _______ and the CD4 count represents _________.
viral load represents speed/rate of their disease, and the CD4 count represents how far the disease can progress until its fatal.
What is a normal CD4 count?
800-1200 cells/mm^3
What CD4 count must you be under to be considered having AIDS?
What total white cell count must you be under to be diagnosed with leukopenia?
A neutrophil count under ____ calls for the use of systemic antibiotics concurrent with invasive procedures?
All dental procedures are contraindicated when platelet counts are under _____.
Having a hematocrit under ____% should refer Pt to MD prior to invasive dental procedures.
Hemoglobin under ___ should send the Pt to an MD before sedating or doing invasive procedures.
T or F: Routine dental care including surgical interventions are safe and predictable in HIV infected individuals.
True
