ORAL LESIONS ASSOCIATED WITH HIV DISEASE DR. VALLI MEEKS - - PowerPoint PPT Presentation

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ORAL LESIONS ASSOCIATED WITH HIV DISEASE DR. VALLI MEEKS - - PowerPoint PPT Presentation

Feb 21, 2024 333 likes •780 views

ORAL LESIONS ASSOCIATED WITH HIV DISEASE DR. VALLI MEEKS UNIVERSITY OF MARYLAND BALTIMORE COLLEGE OF DENTAL SURGERY VI Meeks, DDS, U Md Dental School ORAL LESIONS ASSOCIATED WITH HIV DISEASE Oral Candidiasis (Thrush) pseudomembranous -

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VI Meeks, DDS, U Md Dental School

ORAL LESIONS ASSOCIATED WITH HIV DISEASE

  • DR. VALLI MEEKS

UNIVERSITY OF MARYLAND BALTIMORE COLLEGE OF DENTAL SURGERY

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Oral Candidiasis (Thrush)

  • pseudomembranous -

white or yellow plaques on mucosa; leaves raw, bleeding surface upon wiping plaque away.

ORAL LESIONS ASSOCIATED WITH HIV DISEASE

VI Meeks, DDS, U Md Dental School

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Oral Candidiasis (Thrush)

  • erythematous - mucosal

erythema (red macules or patches); cytology smear or culture is + for Candida/yeast.

VI Meeks, DDS, U Md Dental School

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Oral Candidiasis (Thrush)

  • hyperplastic - white plaques

which cannot be wiped away.

VI Meeks, DDS, U Md Dental School

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Oral Candidiasis (Thrush)

  • angular cheilitis - erythema,

fissures at labial commissures.

VI Meeks, DDS, U Md Dental School

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Periodontal Disease

  • linear gingival erythema -

fiery, red band along free gingival margin; also punctate areas of erythema; spontaneous bleeding may be present.

VI Meeks, DDS, U Md Dental School

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Periodontal Disease

  • necrotizing ulcerative

gingivitis (including ANUG) - psuedomembrane of interdental papillae (necrosis); ulceration; fetor oris; pain.

VI Meeks, DDS, U Md Dental School

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Periodontal Disease

  • necrotizing ulcerative gingivitis
  • after 7 days of antibiotics.

VI Meeks, DDS, U Md Dental School

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Periodontal Disease

  • necrotizing ulcerative

periodontitis - extremely rapid and progressive destruction of periodontal attachment and bone; fetor oris; pain.

VI Meeks, DDS, U Md Dental School

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Periodontal Disease

  • necrotizing ulcerative

periodontitis

VI Meeks, DDS, U Md Dental School

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CASE PRESENTATION:

Acute Necrotizing Ulcerative Periodontitis - psuedomembrane of interdental papillae (necrosis); ulceration; fetor oris; pain.

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Healing after periodontal therapy

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Kaposi’s Sarcoma

  • malignant neoplasm of blood

vessels; a reactive lesion.

VI Meeks, DDS, U Md Dental School

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Kaposi’s Sarcoma

VI Meeks, DDS, U Md Dental School

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Non-Hodgkin’s Lymphoma

  • B-cell lymphoma; can appear

as necrotic, ulcerated mass or nonulcerated, normal color or erythematous mucosa; diagnosis by biopsy.

VI Meeks, DDS, U Md Dental School

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Melanotic Pigmentation

  • hyperpigmented, macular

lesions; asymptomatic; clinically can be mistaken for Kaposi’s Sarcoma.

VI Meeks, DDS, U Md Dental School

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Mycobacterium Tuberculosis

  • usually pulmonary infection;

extrapulmonary lesions appear as painful, indurated, nonhealing ulcerated lesions.

VI Meeks, DDS, U Md Dental School

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Necrotizing Stomatitis

  • extensive soft tissue necrosis

exposing underlying bone; often no etiologic agent found.

VI Meeks, DDS, U Md Dental School

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Necrotizing Stomatitis

  • 10 days after treatment

VI Meeks, DDS, U Md Dental School

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Ulceration Not Otherwise Specified

  • ulceration with a predilection for

the pharynx; characteristics of ulceration is not recognized as any pattern similar to aphthous ulceration; may be related to specific medications like ddC.

VI Meeks, DDS, U Md Dental School

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Salivary Gland Enlargement

  • unilateral or bilateral

enlargement of salivary (parotid) gland.

VI Meeks, DDS, U Md Dental School

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Thrombocytopenia Purpura

  • dramatic decrease in platelet

count

  • hemorrhage/spontaneous

bleeding of gingiva; bruises on extremities.

VI Meeks, DDS, U Md Dental School

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Herpes Simplex

  • vesicular lesions which rupture

becoming painful, irregular ulcerations; intraorally, usually found on tissue bound to bone, e.g. palate

  • herpetic lesion lasting longer

than 30 days is an AIDS defining lesion

VI Meeks, DDS, U Md Dental School

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Papilloma; Focal Epithelial Hyperplasia (FEH)

  • “wart”; clinical appearance may

be flat (FEH) or spiky, cauliflower- like; human papilloma virus

VI Meeks, DDS, U Md Dental School

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Papilloma; Focal Epithelial Hyperplasia (FEH)

VI Meeks, DDS, U Md Dental School

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Papilloma; Focal Epithelial Hyperplasia (FEH)

VI Meeks, DDS, U Md Dental School

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Herpes Zoster (Shingles)

  • activation of Varicella zoster

virus which has been dormant in sensory nerve; unilateral, often vesicular lesions.

VI Meeks, DDS, U Md Dental School

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Bacterial Infections

  • A. israelii; E. coli; K. pneumoniae etiological agents

cultured from oral ulcerative or granulomatous lesions; possible cause of slow/poor wound healing.

VI Meeks, DDS, U Md Dental School

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Bacillary (epithelioid) Angiomatosis

  • bacterial infection; causative

agent: Bartonella henselae / Rochalimaea henselae; clinical appearance can be mistaken for Kaposi’s sarcoma.

VI Meeks, DDS, U Md Dental School

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Erythema Multiforme

  • hypersensitivity reaction; acute, self-limiting process affecting skin

(target lesion) or mucous membranes - orally seen as ulcerations or vesicular/bullous lesions.

VI Meeks, DDS, U Md Dental School

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Lichen Planus

  • cell mediated immune response;

white keratotic lines (striae); atrophic or erosive lesion (desquamative).

VI Meeks, DDS, U Md Dental School

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Recurrent Aphthous Stomatitis

  • raised, red border with necrotic,

depressed center

  • minor

VI Meeks, DDS, U Md Dental School

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Recurrent Aphthous Stomatitis

  • major

VI Meeks, DDS, U Md Dental School

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Recurrent Aphthous Stomatitis

  • major, healed with scarring

VI Meeks, DDS, U Md Dental School

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Recurrent Aphthous Stomatitis

  • herpetiform

VI Meeks, DDS, U Md Dental School

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Molluscum Contagiosum

  • viral wart; spread via direct

contact

VI Meeks, DDS, U Md Dental School

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Cytomegalovirus

  • usually causes eye

complications (CMV retinitis); also can have intraoral ulceration associated with the cytomegalovirus; spread via direct contact

  • CMV is found in virtually all

body fluids; crosses transplacental barrier; caution - pregnant dental providers.

VI Meeks, DDS, U Md Dental School

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Xerostomia (dry mouth)

VI Meeks, DDS, U Md Dental School

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Vitamin Deficiency & Angular Chelitis

VI Meeks, DDS, U Md Dental School

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Oral hairy leukoplakia (OHL) is a viral infection caused by Epstein-Barr virus (EBV).

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 Treat for cosmetic reasons; otherwise no treatment is warranted  Use of Acyclovir or topical Podophyllum resin has been reported to provide relief

Oral Viral Lesions

Epstein-Barr Virus (EBV)