4 HIV Oral Manifestations

Question 1

What does HAART stand for?

Answer 1

Highly Active Antiretroviral Therapy

Question 2

Which HIV patients get HAART?

Answer 2

Some MDs suggest only giving it to severely compromised pts

Question 3

What happens to the prevalence of oral manifestations in HIV patients on HAART?

Answer 3

reduction of hairy leukoplakia, NUP, and oral lesions.

Increase in salivary gland diseases, oral warts.

Question 4

Oral manifestations occur in approximately what percentage of HIV patients?

Answer 4

30-80%

Question 5

What are 5 predisposing factors for oral lesions in HIV patients?

Answer 5

CD4 count 3000 copies/mL, xerostomia, poor oral hygiene, smoking

Question 6

What is the commonly the first lesion a HIV patient can present with?

Answer 6

Hairy leukoplakia

Question 7

How do you treat hairy leukoplakia?

Answer 7

No real Tx, but can treat associated candida or prescribe acyclovir in severe cases

Question 8

Where in the mouth is hairy leukoplakia seen?

Answer 8

On the tongue

Question 9

What are three major presentations of candidiasis in HIV infected patients?

Answer 9

pseudomembranous (thrush), erythematous (atrophic), and angular chelitis (corners of mouth)

Question 10

Where can candidiasis be seen?

Answer 10

anywhere in the mouth

Question 11

What is the most common symptom seen with candidiasis?

Answer 11

burning painful sensation and changes in taste

Question 12

What can you use to treat candidiasis?

Answer 12

Nystatin cream, Clotrimazole cream, Amphotericin B

Question 13

Opportunistic tumors occur in which HIV patients?

Answer 13

Pts that have end-stage HIV disease (really really sick)

Question 14

What are two examples of opportunistic tumors seen in HIV pts?

Answer 14

kaposi’s sarcoma, and non-hodgkin lymphoma

Question 15

How does Kaposi’s sarcoma present in the mouth?

Answer 15

gingival overgrowth

Question 16

What is the probable cause of Kaposi’s sarcoma?

Answer 16

Human Herpes Virus 8

Question 17

What can make removing a pappiloma difficult?

Answer 17

The pappiloma can be much larger and spread out underneath the epithelium than what it appears on the surface - like an iceberg

Question 18

How would you treat a pappiloma?

Answer 18

They can be removed through surgery, freezing them, or doing nothing

Question 19

Was there an increase or decrease in pappiloma cases in the HAART era?

Answer 19

dramatic increase

Question 20

What are some associated reasons why a person can have oral ulcers?

Answer 20

lymphoma, mycobacterial infection, CMV, neutropenia, HSV, HZV, apthous ulcers, trauma, or Stevens Johnson’s syndrome

Question 21

What are two things you can administer to a pt to treat their apthous ulcer?

Answer 21

Lidex or Thalidomide

Question 22

Do you need to take a biopsy to diagnose non-hodgkin’s lymphoma?

Answer 22

Yes of course

Question 23

What are some things that can cause xerostomia?

Answer 23

anti-HIV meds, antidepressants, analgesics, salivary gland disease, candidiasis, or nutritional problems

Question 24

How can a Pt manage xerostomia?

Answer 24

Have sugarless candies, use artificial saliva, administer pilocarpine, decrease smoking

Question 25

What are clinical features of HIV-associated gingivitis (HIV-G) and Linear gingival erythema (LGE)?

Answer 25

red linear band involving the free gingival margin, spontaneous bleeding, erythema of attached and unattached mucosa, unusual response to therapy

Question 26

What are some clinical features of NUP, NUG, and HIV-associated periodontitis (HIV-P)?

Answer 26

painful and spontaneous bleeding, necrosis, cratering, intense erythema, extremely rapid bone loss

Question 27

Are implants a short term success in HIV patients?

Answer 27

Yes

Question 28

Are we more concerned about CD4 count changing or about how low it is?

Answer 28

Changing - that will tell us how unstable they are

Question 29

In HIV patients, the viral load represents _______ and the CD4 count represents _________.

Answer 29

viral load represents speed/rate of their disease, and the CD4 count represents how far the disease can progress until its fatal.

Question 30

What is a normal CD4 count?

Answer 30

800-1200 cells/mm^3

Question 31

What CD4 count must you be under to be considered having AIDS?

Question 32

What total white cell count must you be under to be diagnosed with leukopenia?

Question 33

A neutrophil count under ____ calls for the use of systemic antibiotics concurrent with invasive procedures?

Question 34

All dental procedures are contraindicated when platelet counts are under _____.

Question 35

Having a hematocrit under ____% should refer Pt to MD prior to invasive dental procedures.

Question 36

Hemoglobin under ___ should send the Pt to an MD before sedating or doing invasive procedures.

Question 37

T or F: Routine dental care including surgical interventions are safe and predictable in HIV infected individuals.

Answer 37

True