1. a i d s
dr shabeel pn

2. ORAL MANIFESTATION OF HIV INFECTIONS
What is the importance ?
Oral cavity can be easily examined
Common
Early recognition diagnosis and treatment may reduce morbidity
Early diagnostic indicator
May change the staging
Predictor of progression of HIV done

3. Fungal lesions
Viral
Bacterial
Neoplastic
Minor oral ulcers

4. FUNGAL LESIONS Oral Candidiasis Candida albicani
Candida glabrata and C.tropicalis
Common oral manifestation of acute stage of HIV infection

5. Occur with falling CD4 + T cell count in middle and late stages of HIV
Other predisposing factors, are infancy, old age, antibiotic therapy, steroids and other immunosuppressive drugs, xerostamia, anaemia, endocrine disorders, primary and acquired immunodeficiency.

6. CLINICAL FEATURES
Burning mouth, problems eating spicy food and changes in taste.
Clinical appearance varies
Common are pseudomembranous and erythematous candidiasis

7. HISTOPLASTOMIES Appear as oral ulcers Diagnosis requires biopsy
Cryptococcus neoformans
Ulcerated mass in the hard palate. Biopsy of palatal ulcer is diagnostic.

9. VIRAL LESIONS Painful persistent large intraoral ulcers
Buccal/ labial mucosa 27%, tongue 25%, gingiva – 18%

10. Recurrent herpes simplex (H.Labialis, cold sores)
Develop on the lips
Intraorally in the keratinised mucosa of palate and gingiva.
Begins as a burning sensation followed by small coalseing vesicles.
Ulcer surrounded by erythematous halo
No scan formation
Importance – Patients with advanced HIV disease may present several recurrence a year especially characterized by large confluent and extremely painful ulceration.

12. HERPES ZOSTER Painful oral lesion or tooth ache Usually unilateral
Follow the distribution of maxillary and /or mandibular branches of trigeminal nerve.

13. Human Papilloma
Oral wart
Papilloma

14. CYTOMEGALOVIRUS
Confused with aphthous ulcers, necrotizing ulcerative periodontitis and lymphoma
Aphthous ulcer
CMV Diagnosis by biopsy and immunohistochemistry

16. HAIRY LEUKOPLAKIA
Non movable corrugated or hairy white lesion on the lateral margins of tongue.
Occurs in 20% of person with asymptomatic HIV infection
Becomes more common as the CD4+T cell count falls
Non HIV patients who are affected are recipients of bone marrow, cardiac and renal transplants

18. BACTERIAL INFECTION Periodontal Disease
Necrotising ulcerative periodontitis
- Rapid and severe course
Linear gingival erythema – relative mild form

19. MYCOBACTERIUM AVIUM INTRACELLULARE
Palatal and gingival granulomatous masses
Diagnosed by AFB staining of biopsy specimens

20. NEOPLASTIC LESION
This may occur intraorally either alone or association with skin and disseminated lesion.
Common in men
First manifestation of late stage of HIV

21. DIFFERENTIAL DIAGNOSIS
Vascular lesion – haematoma, haemangioma
Pyogenic granuloma
Bacillary angiomatosis
Oral melanotic macules
No bleeding associated with a biopsy of oral KS aspiration prior to biopsy may be useful to rule out haemangioma. Sudden appearance is characteristic.

22. LYMPHOMA Firm painless swelling that may be ulcerated
Occur anywhere in the oral cavity
Soft tissue involvement
Bony involvement

23. DIFFERENTIAL DIAGNOSIS
Confusion with major aphthous ulcers and rarely pericoronitis associated with an erupting third molar
Diagnosis made by histologic examination of biopsy specimen.

24. OTHER ORAL LESIONS Recurrent Aphthous ulcers (RAU)
Cause unknown – Stress and unidentified infectious agents
Minor RAU – Well circumscribed with erythematous margin.
Solitary lesion of cm
Herpetiform type RAU- Clusters of small ulcers

25. Major RAU – Extremely large necrotic ulcer 2-4cm
Idiopathic thrombocytopenic purpura may first manifest as oral lesion in HIV infected patients
Xerostomia

26. Oral manifestation in children with AIDS
Children infected with HIV develop severe immunosuppression very early
Earlier than adults
Fungal infections are more

27. DIAGNOSIS Detection of antiviral protein
CD4+ T Cell count – oral abnormalities result from changes in the immune status of HIV carrier – Due to reduction in the number of CD4 + T cells and / or modification of CD4 / CD8 ratio.
Increased T8 cells in germinal centres.

28. TREATMENT
Most of the opportunistic infections are incurable. But by aggressively treating the acute disease, the infection can be controlled and suffering of patient decreased.

29. Cryptococcus – Amphotericin B 0.5- 0.8mg/kg/d iv
Bacterial- Ampicillin
Trimethoprim- Sulphamethoxazole
Chloramphenicol
Ceftriaxone
Viral - Ganciclovir IV

30. PREVENTION Teach ABC of AIDS prevention Abstrain Be faithful
Use Condom
Dental Surgeons – High risk category - use gloves, Goggles, Facemask.
Every patient is HIV positive until other wise proved.

31. THANK YOU