Oral Pathology in HIV-infected Individuals and Osteomyelitis

Oral Pathology in HIV-infected Individuals and Osteomyelitis

I. Oral Pathology in HIV-infected Individuals

1. Candida Infection

• Pseudomembranous Candidiasis:

• Characteristics: White or yellow membrane, bleeding when scraped.

• Location: Palate, buccal mucosa, lips and dorsum of the tongue.

• Hyperplastic Candidiasis:

• Characteristics: White membrane that cannot be scraped off.

• Location: Buccal mucosa, extending inward.

• Note: The angular cheilitis is commonly found in people who are not infected with HIV.

• Erythematous or Atrophic Candidiasis:

• Characteristics: Prominent or inconspicuous deep red color, a hallmark of HIV infection.

• Location: Palate, dorsum of the tongue (loss of papillae).

• Types of Candida Infection:

• Pseudomembranous

• Hyperplastic

• Erythematous/Atrophic

• Angular Cheilitis

• Treatment of Fungal Infection:

• Tim Genian mouthwash, Clotrimazole lozenges, Nystatin.

• Fluconazole 100mg/2 days initially, then 1 tablet/day for 14 days.

2. Periodontal Disease

• Linear Gingivitis:

• Characteristics:

• A red line at the gingival margin.

• Red spots on the alveolar mucosa.

• Gums easily bleed even with good hygiene.

• Less plaque accumulation.

• Chronic Periodontitis:

• Characteristics:

• Rapid destruction of periodontal tissue.

• Severe pain.

• Loose teeth.

• Shallow periodontal pockets.

• Necrotizing Ulcerative Gingivitis (NUG):

• Characteristics:

• Necrotizing ulceration of the gingiva, extending across both jaws.

• Severe pain.

• Halitosis.

• Treatment of Periodontal Disease:

• Thorough oral hygiene.

• Betadine/Chlorhexidine mouthwash.

• Metronidazole 500mg/2 times a day for 7-10 days.

• Clindamycin/Amoxicillin.

3. Viral Infection

• Herpes infection, Shingles: More severe in HIV-infected individuals.

• Hairy Leukoplakia: Commonly seen in the late stage, white patches, location: both sides of the tongue, ventral surface of the tongue.

• Kaposi’s Sarcoma: Vascular proliferation stimulated by HIV.

4. Manifestations of Kaposi’s Sarcoma:

• The first sign of the AIDS stage.

• Location: Face (tip of the nose), mouth (palate on one side, gingiva, tongue).

• Characteristics:

• Reddish-bluish patches, rough, dark, raised, ulcerated surface or with multiple lobes.

• Feels firm before surface ulceration.

5. Dry Mouth: Tooth decay pain, periodontal inflammation.

II. Osteomyelitis

• Pathology: Increased pressure in the bone causing severe pain.

• Symptoms of Acute Osteomyelitis (Characteristic):

• Wide-ranging facial pain, episodic, severe.

• Clenching of the jaw, numbness of the lips and chin.

• Loose teeth, very painful percussion (infected area).

• Symptoms of Chronic Suppurative Osteomyelitis:

• Skin/mucosal fistula with pus discharge.

• Occasional expulsion of dead bone fragments through the fistula.

• X-ray image of chronic osteomyelitis of the jaw: Bone resorption = moth-eaten appearance.

• X-ray image of osteomyelitis with periosteal proliferation: Onion-skin periosteal reaction.

• X-ray image of osteomyelitis with sclerosis: Radiopaque area with clear boundaries, not around the tooth apex, no bone expansion.

• Common location of chronic diffuse sclerosing osteomyelitis: Edentulous areas.

• Which jaw is more commonly affected by radiation-induced osteonecrosis: The mandible.

• Types of osteomyelitis of the jaw commonly found in young people:

• Osteomyelitis of the jaw with periosteal proliferation.

• Sclerosing osteomyelitis.

• Osteomyelitis commonly found in the elderly: Chronic diffuse sclerosing osteomyelitis of the jaw.

III. Neoplasms

1. Reactive Fibroma

• Etiology: Trauma.

• Histology: Dense fibrous tissue.

• Special type: Arborescence fibroma.

• Basic lesion: Nodular, not encapsulated, painless, normal surface.

2. Giant Cell Fibroma

• Location accounts for 50%: Gingiva.

• Special lesion: Papilloma behind the canine.

• Lesion: Small nodule on the gingiva behind the lower canine, usually bilateral.

3. Gingival Fibroma

• Etiology: Trauma from denture borders.

• Type of lesion: Mass-like, painless, not lobulated.

• Location: Vestibular sulcus, anterior floor of the mouth.

• Histology: Fibrous tissue whorl.

4. Denture-Induced Papilloma

• Cause: Repeated trauma from wearing dentures during sleep.

• Characteristics:

• Associated with Candida infection.

• Multiple papillomas scattered on the hard palate, painless, concentrated in the midline.

5. Juvenile Aggressive Fibroma

• Lesion: Firm nodule, painful, usually lobulated, may destroy the underlying bone.

• Treatment: Wide excision including affected bone.

• Recurrence: 25% recurrence rate.

6. Fibrosarcoma

• Neoplasm: Malignant form of fibroblasts.

• Type:

• Pleomorphic cell.

• Encapsulated.

• Multiple pseudo-mitosis.

7. Fibrohistiocytic Tumor

• Lesion: Nodular, firm, painless, not encapsulated.

• Malignant form: Malignant fibrous histiocytoma, may: have many spindle-shaped cells with open nuclei.

• Histological features: May be very benign on histology.

• Recurrence: Low recurrence rate.

• Recurrence of the malignant form: 40% recurrence rate, 5-year survival rate of 30%.

• Other names: Fibrous xanthoma/Dermatofibroma.

Note: This article provides general information about oral pathology in HIV-infected individuals and osteomyelitis. For accurate diagnosis and treatment, you should consult a qualified specialist.