Diagnosis and management of HIV-associated periodontal lesions

Article Abstract:

Two problems seen in patients who are HIV positive are HIV-associated gingivitis (HIV-G) and HIV-associated periodontitis (HIV-P). Clinical descriptions of these lesions and treatments are outlined. HIV-G are lesions confined to the soft tissue; the gingiva, or gums, are red and loose gingiva is seen in all zones. The redness, which may be band-like or diffuse, is usually associated with spontaneous bleeding. HIV-P lesions have the characteristics of HIV-G, except that there is also severe soft tissue loss and rapid breakdown of the periodontal (area surrounding the teeth) attachment and bone. In addition, HIV-P is associated with severe pain which is localized in the jaw bone and characterized as a deep aching pain. HIV-G usually involves the entire mouth whereas HIV-P is usually more localized. Conventional gingivitis responds to treatment. However, HIV-G does not respond to usual treatment and rapidly progresses to HIV-P. After the diagnosis is made, periodontal therapy is begun. Plaque and other causative agents, and surrounding necrotic or dead tissue must be removed. During this debridement process, the authors found povidone iodine to be helpful because of is anesthetic effect. Local pain control during debridement is often difficult to obtain. Oral hygiene is essential. Pain management and healing are aided by the antibiotic metronidazole for short periods of time; chlorhexidine can be used for long-term maintenance. Antifungal agents may be necessary for candidiasis. Immediate follow-up for HIV-P and HIV-G is essential. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects

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Radiation therapy for treatment of palatal Kaposi's sarcoma: report of case

Article Abstract:

Kaposi's sarcoma (KS) is a malignant condition of the retroendothelial system of the body, which is important in fighting infection. KS is a common cancer among patients with AIDS (acquired immunodeficiency syndrome), and is most commonly found in young homosexual or bisexual men. This sarcoma often begins as brown or purple papules and may occur in different locations on the body. KS can eventually spread to the lymph nodes and internal organs. Frequently in AIDS patients KS lesions initially occur in the mouth, particularly on the palate and gums. One form of treatment is radiation therapy; this is most effective in relatively healthy patients who have localized lesions. A case is presented of a 24-year-old homosexual man. He sought treatment for a growth in his mouth. Upon biopsy of this tissue, the diagnosis of AIDS was made. The dental team was involved in the diagnosis and treatment of the lesion. The patient also received treatment from internal medicine and oncology specialists. The use of radiation therapy produced dramatic regression of the lesion, and there were few complications from the therapy. At one year post-treatment there had been no recurrence of the patient's oral sarcoma, although some nonaggressive KS lesions had developed in other areas. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, AIDS patients, Kaposi's sarcoma, Mouth cancer

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Clinical management of HIV-related periodontitis: report of case

Article Abstract:

Patients who have HIV (human immunodeficiency virus) often develop a progressive form of periodontal disease, which affects the areas surrounding the teeth. HIV-related periodontitis causes destruction of the papilla (projection of gum tissue between the teeth), rapid loss of bone, spontaneously bleeding gums and severe pain. This form of periodontal disease usually does not respond to conventional treatment. The case is presented of a 30-year-old white man who was referred for severe gum pain. X-rays showed bone loss only in the anterior or front teeth. Dead tissue around the front teeth was debrided, or removed. The patient was placed on a chlorhexidine gluconate antibiotic mouthwash and a systemic antibiotic, metronidazole. Within one week the patient's mouth pain had subsided and the gums were pink and more firm. Aggressive therapy combined with conventional treatment, such as removing dead tissue, scaling of plaque, root planing and gentle scraping of soft tissue, and the use of mouthwashes and antibiotics were essential to the management of this case. (Consumer Summary produced by Reliance Medical Information, Inc.)

Gum diseases

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