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ORAL HEALTH IN WOMEN ORAL MANIFESTATIONS OF HIV INFECTION

ORAL HEALTH IN WOMEN ORAL MANIFESTATIONS OF HIV INFECTION. dr shabeel pn. DENTAL HEALTH CARE PROVIDER TEAM APPROACH. EPIDEMIOLOGY OF HIV-RELATED ORAL MANIFESTATIONS IN WOMEN. Epidemiology of HIV-Related Oral Manifestations in Women: A Review. Oral Lesions in 15% of HIV-Infected Women

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ORAL HEALTH IN WOMEN ORAL MANIFESTATIONS OF HIV INFECTION

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  1. ORAL HEALTH IN WOMENORAL MANIFESTATIONS OF HIV INFECTION dr shabeel pn

  2. DENTAL HEALTH CARE PROVIDER TEAM APPROACH

  3. EPIDEMIOLOGY OF HIV-RELATED ORAL MANIFESTATIONS IN WOMEN

  4. Epidemiology of HIV-Related Oral Manifestations in Women: A Review • Oral Lesions in 15% of HIV-Infected Women • Most Common Oral Lesion - Candidiasis • Prevalence of Hairy Leukoplakia and Kaposi's Sarcoma Significantly Less Common in Women Oral Dis1997 Sep;3(3):206.

  5. Many Manifestations of HIV Disease are Similar in Men & Women • Other Conditions Differ In Frequency: • HIV-Infected Men 8 X’s More Likely to Develop Kaposi's Sarcoma • Women Have Higher Rates of Esophageal Candidiasis & Herpes Simplex Infections

  6. CHANGINGPREVALENCE OF ORAL MANIFESATIONS

  7. Overall Prevalence of Oral Lesions Has Decreased (47.6%-37.5%) • Hairy Leukoplakia (25.8%-11.4%) & Necrotizing Periodontal Diseases (4.8%-1.7%) Decreased

  8. HIV Salivary Gland Disease Increased (1.8%-5.0%) • Candidiasis (20.3%-16.7%), Aphthae (3.7%-3.0%), Oral Warts (2.2%-4.0%), Herpes Simplex Virus Lesions (1.8%-2.0%) and Kaposi’s Sarcoma (1.1%-0.3%) Unchanged

  9. HIV/AIDS Women's Health: Oral Lesions in HIV-Positive Women Reduced in HAART Therapy • 503 HIV+ women over 6 years • Incidence of EC fell to 2.99 percent from 5.48 percent • PC fell to 2.85 percent from 6.70 percent • No changes were seen in HL or warts Women's Health Weekly (03.25.04)

  10. CANDIDIASIS

  11. Reported in 7-93% of HIV+ /AIDS Patients

  12. FOUR MAJOR TYPES • Pseudomembranous • Hyperplastic • Erythematous (Atrophic) • Angular Cheilitis

  13. PSEUDOMEMBRANOUS • White or Yellow Patches • Easily Removed w/ Scraping Yielding Bleeding Surface • Any Mucosal Surface (Palate, Buccal or Labial Mucosa, Tongue)

  14. HYPERPLASTIC CANDIDIASIS • White Plaques Can’t Be Removed w/ Scraping • Buccal Mucosa Most Common Site in HIV+ Patients

  15. ERYTHEMATOUS (ATROPHIC) • Fiery Red Surfaces to Hardly Discernible Pink Spots • Most Common Location - Palate & Dorsum of Tongue • Spotty Areas in Buccal Mucosa

  16. ANGULAR CHEILITIS • Common in Elderly • Fissures Radiating From Angles of Mouth

  17. PREDISPOSING FACTORS

  18. SYSTEMIC FACTORS • Age • Use of Antibiotics • Xerostomia • Nutritional Deficiencies • Immunosuppression • Gastric Reflux

  19. LOCAL FACTORS • Ill-Fitting Dentures • Poor Prosthesis Hygiene • Heavy Smoking • Topical Medications

  20. CANDIDIASIS TREATMENT • Nystatin Oral Susp • 480 ml • Rinse w/ One Tablespoonful QID • Clotrimazole (Mycelex) Troches • 10 mg Troches • 3-5 Times a Day for 7-14 Days

  21. Ketoconazole (Nizoral) • 200 mg • 200-400 mg Daily for 7-14 Days • Fluconazole (Diflucan) • 100 mg Tabs • 2 Tabs First Day, Then 1 Tab Daily for 14 Days • Itraconazole (Sporanox) • 100 mg Tablets • 1 tablet B.I.D. for 14 days

  22. OROFACIAL VIRAL INFECTIONS IN IMMUNOCOMPROMISED HOST

  23. HAIRY LEUKOPLAKIA • First Identified Among HIV+ Individuals • Never Described Before AIDS Epidemic

  24. CLINICAL PRESENTATION • Painless White Patches • Do Not Rub Off • Lateral Borders of the Tongue • Surface May Be Smooth, Corrugated or Markedly Folded • Thick, Hair-Like Projections

  25. DIFFERENTIAL DIAGNOSIS • Hyperplastic Candidiasis • Geographic Tongue • Lichen Planus • Frictional Keratosis • Leukoplakia

  26. HAIRY LEUKOPLAKIA - PATHOGENESIS • Epstein-Barr Virus

  27. HAIRY LEUKOPLAKIA TREATMENT • Appears to Be Little Advantage in Treating • Surgical Removal • Laser • Acyclovir • Topical Vitamin A

  28. HUMAN PAPILLOMA VIRUS LESIONS

  29. HUMAN PAPILLOMA VIRUSES • More Than 100 Human Papilloma Virus (HPV) Types • 24 Associated with Oral Lesions

  30. HPV ORAL LESIONS • Warts, Papillomas • Condyloma Acuminatum • Verruca Vulgaris • Focal Epithelial Hyperplasia • Dysplasia / Carcinoma

  31. HUMAN PAPILLOMA VIRUS LESIONS

  32. CONDYLOMA ACUMINATUM • Sexually Transmitted • Appears 1-3 Months After Exposure • Multiple Wart-Like Lesions • Lips, Lingual Frenum & Tongue

  33. TREATMENTCONDYLOMA ACUMINATUM • Surgical Removal • Cryotherapy • Laser Therapy • Medications

  34. KAPOSI’S SARCOMA

  35. Originally Described in 1872 - Idiopathic Multiple Sarcomas of the Skin

  36. Previously Uncommon in USA • Elderly Jewish Men of Eastern European or Mediterranean Descent • Usually Involved Lower Extremities • Indolent Course • 1981 - Fulminant, Aggressive Form Occurring in Young Homosexual Men w/ AIDS

  37. >50% of AIDS Patients w/ KS Display Oral Lesions • Remains Significant Cause of Morbidity & Mortality in HIV Infected Patients

  38. CLINICAL PRESENTATION • Angiomatous Malignancy of Skin, Mucosa, and Internal Organs • Most Common Intraoral Locations • Palate • Gingiva • Non-Elevated Macules, Nodules or Papules • Brown, Blue, Purple

  39. KAPOSI’S SARCOMAPATHOGENESIS Sexually Transmitted Cofactor Human Herpes Virus 8 (HHV 8)

  40. TREATMENT • Treatment Reserved for Lesions Which Interfere w/ Function or Esthetics • Laser Excision • Cryotherapy • Radiation • Intralesional Injection w/ Vinblastine

  41. CANCER IN PATIENTS WITH AIDS

  42. AIDS AND CANCER • Roche et al, NJ Med2001,Jan;98(1);27-36 • 2460 Persons w/ AIDS and Cancer • 2159 Males, 301 Females • 50% Kaposi’s Sarcoma • 33% Non-Hodgkins Lymphoma • Lung, Oral, Cervical, Hodgkins Lymphoma, Other Digestive

  43. RECURRENT ORAL ULCERATIONS

  44. RECURRENT APHTHOUS STOMATITIS

  45. EPIDEMIOLOGY • Prevalence in General Population 10-20% • 67-85% Develop Prior to Age 30 • Familial Disposition

  46. MINOR APHTHAE • Superficial Erosion with Fibrinous Coating & Red Halo • Single or Multiple Lesions • 2-3 mm’s to Over 10 mm’s in Diameter • Persists for 7-10 Days • Painful

  47. MAJOR APHTHAE • Large Painful Ulcerations • Single or Multiple Lesions • Persists Up to 6 Weeks • Heal w/ Scarring

  48. GENERAL RULE • Aphthae Occur on Mobile Mucosa • Herpetic Lesions Occur on Tissue That is Firmly Bound Down

  49. FACTORS ASSOCIATED WITH APHTHAE • Psychological (Stress) Trauma • Socio-Economic S. sanguis • Endocrine • Immunosuppression • Hereditary • Hypersensitivity • Chemicals in Food

  50. TREATMENT • Chlorhexidine • Topical Steroids • Lidex Gel .05% • Aphthasol Cream 5%

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