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Home , Noma (disease)

ORAL MANIFESTATIONS OF HIV and the IMMUNOCOMPROMISED PATIENT

Oral Manifestations of HIV

• Candidiasis • Oral hairy • Kaposi’s sarcoma • • Squamous cellcarcinoma

Oral Manifestations of HIV

• Bacterial infections • Mycotic infections • Viral infections • Non-specific ulcerations • NOMA-like lesions

1 Oral Manifestations of HIV

• Papilloma viral lesions • Autoimmune • • Idiopathic thrombocytopenia •

Candidiasis

Yeast, C albicans, globrata

• Pseudomembraneous • Atophic • Hyperplastic • Angular

Causes of

• Candidiasis • Decreased vertical dimension • Anemia • Malnutrition • Vitamin deficiency

2 Management of Mild/Moderate Candidiasis

• Clotrimazole Troches • Nystatin Suspension • Gentian Violet • Dairy products with acidophilus

Management of Angular Cheilitis

• Clotrimazole Cream/Ointment • Nystatin-Triamcinolone Cream • Clotrimazole-Betamethasone Cream

Management of Moderate/Severe Candidiasis • Itraconazole Solution/ Capsules • Fluconazole

For resistant cases: • Add Amphotericin Suspension • Add Nystatin Suspension • Caspofungin acetate IV • Amphotericin IV

3 Oral

Treatment for Oral Hairy Leukoplakia

• Podophyllin resin 25% • Podophyllotoxin • Retinoic acid • Acyclovir

White lesions - Differential Diagnosis

• Pseudomembraneous candidiasis • Hyperplastic candidiasis • Hairy leukoplakia • White hairy tongue • • • Hyperkeratosis • Leukoplakia

4 Kaposi’s Sarcoma

Differential Diagnosis for Kaposi’s Sarcoma •Hematoma • Hemangioma • Bacillary angiomatosis • Lyphoma • • Hyperplastic

Lymphoma

5 Squamous Cell Carcinoma

Bacterial Infections

• Syphillis • Gonorrheae • Atypical tuberculosis • Bacillary angiomatosis

Deep Mycotic Infections

• Candidal ulcers • Invasive candidiasis • Histoplasmosis • Mucormycosis

6 Management of Deep Mycotic Infections

• Itraconazole 200-400mg qd • Amphotericin B IV • Caspofungin acetate IV

Oral Ulcerations

• Aphthous major • Drug Induced • • Cytomegalovirus

Management of Aphthous Ulcers

• Fluocinonide gel/ointment 0.05% • Clobetasol ointment 0.05% • Dexamethasone elixir 0.5mg/5ml • Prednisone 60mg qd for 10 days • Intralesional dexamethasone 4mg/ml

7 Viral Infections

• Herpes simplex –labialis – folliculitis – intraoral • Cytomegalovirus – ulceration – intrabony

Management of HSV and HZV

• Acyclovir 1-4gm qd • Acyclovir ointment 5% • Penciclovir ointment • Valacyclovir 1gm tid • Famciclovir 0.5gm tid • Foscarnet IV

Management of CMV

• Acyclovir 4gm qd • Ganciclovir IV or PO • Foscarnet IV

• may need concomitant steroid tx

8 NOMA-Like Lesions

Necrotizing Cancrum oris

Management of NOMA-Like Lesions

• Biopsy to exclude viral/fungal etiology • Antibiotic therapy – Metronidazole – Amoxicillin/clavulanate – Clindamycin – Tobramycin – Floxin

Management of NOMA-Like Lesions

• Prednisone • Intralesional steroid therapy – Dexamethasone 4mg/cc • Thalidomide • Surgical debridement • Nutrional supplementation

9 Papillomavirus Lesions

• Condyloma acuminatum • Focal epithelial hyperplasia • Verruca vulgaris • Verruca plana

•

Management of Papillomavirus Infections

• Podophyllin resin 25% • Laser ablation • Surgical excision • Intralesional interferon • Intraleisonal cidofovir • Cimetidine 400mg tid • Levamisole

HIV-Associated Periodontitis

• (LGE) • Necrotizing Ulcerative Gingivitis (NUG) • Necrotizing Ulcerative Periodontitis (NUP)

10 Periodontal Treatments

• Subgingival scaling and debridement • Antibiotic therapy – Metronidazole – Clindamycin • Oral hygiene instructions • Clorhexidine mouthrinse

Periodontal Treatments

• Root planing and scaling • Removal of sequestrae • Osseous recontouring • Gingival grafts

Immune Dysfunction

• Lichenoid reactions • Lichen planus •Psoriasis

11 Allergic of Drug Reactions

• – Candidiasis – Herpes simplex • Chemical Burns

Salivary Gland Disease

• Diffuse infiltrative lymphocytosis • Obstructive salivary gland disease • Sialendenitis • Mucocele

• Xerostomia

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