ORAL

MANIFESTATI
ON IN
PATIENT WITH
HIV
 bacterial

HIV etiology Fungal

viral
HIV oral
Manifestation
classification Strongly
associated

EC- less commonly

Clearinghouse associated

possibly
associated
 Oral manifestation in patient with HIV disease are most likely to appear when the
CD4 cell count is low and are often controlled by antiretroviral treatment.

The most common manifestation is oral candidosis (usually thrush or erythematous

disease) and manifestation seen in 50% of the patient.
Oral Candidiasis Candida Albicans

• Oral candidiasis is the most common oral manifestation of HIV

infection.

• Oral candidiasis is often observed as four clinical forms:

erythematous (atrophic) candidiasis, pseudomembranous
candidiasis, hyperplastic candidiasis, and angular cheilitis.

• Treatment for oral candidiasis is with topical and systemic

antifungal agents
Erythematous (atrophic) candidiasis appears clinically as multiple small or large patches, most
often localized on the tongue and/or palate

Pseudomembranous candidiasis (oral thrush) is characterized by the presence of multiple

superficial, creamy white plaques that can be easily wiped off , revealing an erythematous
base. they are usually located on the buccal mucosa, oropharynx, and/or dorsal face of the
tongue

Hyperplastic candidiasis lesions appear white and hyperplastic and cannot be removed by
scraping. is form of oral candidiasis is rare in HIV infected individuals.

Angular cheilitis is characterized by the presence of erythematous fissures at the corners of

the mouth. It is usually accompanied by another form of intraoral candidiasis.
Oral Hairy Leukoplakia EpsteinBarr virus

• Oral hairy leukoplakia (OHL) is more common among HIV infected

adults than among HIV infected children.

• OHL presents as white, thick patches that cant be wipe away and
may exhibit with a hairlike appearance the lesions usually start on
the lateral margins of the tongue

• OHL usually does not require any treatment, but in severe cases
systemic antivirals are recommended
HIV-Associated Periodontal
Disease

• Periodontal (gum) disease is characterized by bleeding

gums, bad breath, pain/discomfort, mobile teeth, and some-
times sores
• Four forms of HIV associated periodontal disease: linear
gingival erythema, necrotizing ulcerative gingivitis (NUG),
necrotizing ulcerative periodontitis (NUP), and necrotizing
stomatitis.
• Management and control of HIV associated periodontal
disease begin with good daily oral hygiene.
Linear gingival erytema is characterized by the presence of a 2-3 mm
red band along the marginal gingiva, associated with diffuse erythema
on the attached gingiva and oral mucosa.

NUG is characterized by the presence of ulceration, sloughing, and

necrosis of one or more interdental papillae, accompanied by pain,
bleeding, and fetid halitosis.

NUP is characterized by the extensive and rapid loss of soft tissue and
teeth

Necrotizing stomatitis is thought to be a consequence of severe,

untreated NUP. It is characterized by acute and painful ulceronecrotic
lesions on the oral mucosa that expose underlying alveolar bone.
Herpes Simplex Virus

• The prevalence of oral HSV infection varies between

10% and 35% in HIV infected adults and children
• HSV infection appears as a crop of vesicles usually
localized on the keratinized mucosa (hard palate,
gingiva) and/or vermillion borders of the lips and
perioral skin. The vesicles rupture and form irregular
painful ulcers.
• Systemic therapy with antiviral agents is recommended
Recurrent Aphtous Ulcers

• Severe recurrent aphthous lesions usually occur when the CD4+ lymphocyte count is
less than 100 cells/μL. is result may be suggestive of HIV disease progression.

• RAU may present as minor, major and herpetiform aphtae.

• The first line of management of RAUs is pain control and prevention of superinfection.
Depending on the severity of the ulcers, topical and/or systemic steroid agents are
recommended
Minor aphtous ulcers are ulcers less than 5 mm in diameter covered by
pseudomembrane and surrounded by halo erythematous

Major aphtous ulcers resemble minor aphtous ulcers but fewer and larger in
diameter (1-3 mm). Presence interferes with mastication, swallowing, and
speaking. Healing occurs over 26 weeks. Scarring is common.

Herpetiform aphthous ulcers occur as a crop of many small lesions (12 mm)
disseminated on the soft palate, tonsils, tongue, and/or buccal mucosa.
Parotid Enlargement and
Xerostomia

• Parotid enlargement is commonly associated with HIV infection in children

(10%30%) and less commonly in adults.

• Parotid enlargement occurs as unilateral or bilateral swelling of the parotid

glands.it is usually asymptomatic and may be accompanied by decreased
salivary low (xerostomia or dry mouth).

• Treatment is required only in severe cases and may consist of systemic

analgesics, anti in ammatories, antibiotics, and/or steroids
Human Papillomavirus Infection
(Oral Wartz)

• The lesions are more prevalent in adults (1%-4% of cases) than in children.

• Oral warts may appear cauliflower like, spiked, or raised with a at surface. they
are asymptomatic. the most common location is the labial and buccal mucosa.
the most common clinical presentation is multifocal at lesions resembling focal
epithelial hyperplasia (Heck’s disease).
• Treatment may be required for patients with multiple lesions.
CONTROL
INFECTIONS
PATIENT WITH
HIV
Infections of
• The presence of a susceptible host
HIV are • The presence of pathogenic micro-organisms
spread if the • A portal of entry via which the organisms invade and
colonize the susceptible host
following
criterias are
present : Absence of any one of these requisites will prevent
the transmission of an infectious disease. Therefore,
the goal of infection control is to eliminate one, two,
or all of these criteria.
Transmission of infection within the setting of dentistry:
 precutaneous
inoculation
Major Routes of
Transmission
contact with an
open wound
 Protective Measures
2. Protective
1. Coverings:
Immunisation
 4. First aid and inoculation
3. Sharp Instruments and
injuries
needles
In the event of a skin puncture
Needles should never be
by a contaminated
recapped by using both
instrument, the wound should
hands, indirect contact or by
be encouraged to bleed and
any other technique that
washed thoroughly with
involves moving the point of a
running water. All incidents
used needle towards any part
should be reported to the
of the body.
officer of the clinic.
Instrumen Sterilization
Items which will penetrate tissues must be sterilized in and autoclave or hot
air steriliser. Items which will touch mucous membrane but not penetrate
tissues should similarly be heat or if not possible, disinfected by immersion in
2% glutaraldehyde solution

Handpieces, ultrasonic scaler inserts/tips and air-water syringe tips where

detachable should be flushed for 30 seconds, dismantled, cleaned,and
autoclaved between patients.

Following sterilization, all instruments should be

stored in clean containers to prevent
recontamination.
Surface Disinfection
Between clinical sessions, work surfaces should be thoroughly cleaned
and decontaminated with ethyl alcohol (70%). If there is visible blood
or pus, the surface should be cleaned and disinfected with sodium
hypochlorite (0.5%)

Aspiration and ventilation

The use of high volume aspiration will reduce any risk of
cross-infection from aerosols. The risk is further reduced
by good ventilaton.
Laboratory items
Sharp items including needles and scalpels and local anaesthetic cartridges,
should be placed into puncture proof containers which should be securely sealed.
Non infective waste should be disposed of in thick black plastic bags securely
fastened. Liquid waste should be carefully poured into a drain and then flushed
with water. Spatter and splash should be avoided.

Disposal of waste
Impressions and appliances
should be rinsed thoroughly to
remove all visible blood and
debris.
Certain types of impression material
(silicone, polysulphur) can be disinfected
by total immersion in glutaraldehyde (2%)
or sodium hypochlorite (0.1%).
PROPHYLAXIS
FOR THE
HEALTHWORKE
RS INFECTED
WITH HIV
Steps in The event of Accidental
Exposures
Use soap and water to wash the areas exposed.

Healthcare workers have to report to the Authorised Medical

Attendant (AMA) to record the circumstances and details of injury.
Then starts post-exposure prophylaxis (PEP) in consultation with
the physician. Date, time and details of exposure; type and amount
of biological material, severity of exposure and details about the
exposure source should be recorded.
3. Evaluation of The exposures  The HCW must be
evaluated for potential to acquire HIV based on the type of
biological material involved, route of injury and severity of
exposures.

4. Specific Management by Post-Exposures Prohpylaxis 

PEP for HIV should be commenced as soon as possible after
the incident and ideally within the next one to two hours and
should continue for 28 days. When PEP is initiated, baseline
serum creatinine, liver function tests with enzymes and
complete blood counts must be done.
5. Follow up Healthcare Workers  HIV exposed Healthcare workers should have repeat HIV
antibody testing at six weeks, three and six months post-exposure. Complete blood counts, serum
creatinine, LFT including enzymes should be repeated two weekly.

PEP adverse Reaction: Nausea, vomitting, diarrhea and

fatique
References 1. Scully C. Medical problems in dentistry. China: Elsevier
Limited; 2010: 451-471
2. Kapila, K., Gupta, R. M., & Sm, G. S. C. (2011). Post-
exposure Prophylaxis : What Every Health Care Worker
Should Know. Medical Journal Armed Forces India, 64(3),
250–253.
3. Kamiru, H., & Kabue, M. (2016). Oral Manifestations of
HIV Infection. University of the Western Cape, 184–193.