BACTERIAL DISEASES

Oral Manifestations of HIV infection
By Drs. Deborah Greenspan and John S. Greenspan

Periodontal Disease

Although conventional periodontal disease is seen in this population, a much more rapid and severe form occasionally occurs. Formerly called HIV-periodontal disease, this is now known as necrotizing ulcerative periodontitis (NUP). The associated and possible precursor lesion, formerly called HIV-gingivitis, is now known as linear gingival erythema (LGE). LGE may be difficult to distinguish from conventional gingivitis. It appears as a red band along the marginal gingiva and may be associated with complaints of occasional bleeding. NUP is associated with severe pain and bleeding; rapid loss of bone and soft tissue, sometimes leading to exposure and sequestration of bone; loosening and even loss of teeth. No unique microorganisms have been identified. Rather, the condition seems to involve an anaerobic periodontal flora similar to that which causes conventional periodontal disease. The role, if any, played by host factors is equally poorly defined. Management of NUP requires care by a dental professional familiar with this condition. Effective treatment depends on the immediate application of local measures, including removal of plaque and necrotic soft tissue by scaling and curettage, and irrigation with agents such as 10% betadine. Where bone is exposed, sequestration may occur, sometimes without tooth loss. Home care is very important. Affected areas need to be irrigated locally with povidone iodine and the mouth rinsed with chlorhexidine. Antibiotics effective against gram-negative flora may be needed in cases of severe disease, but these must be used in conjunction with the local measures described above.
Metronidazole (one 250-mg tablet taken four times a day) is useful against this condition. Alternatives include clindamycin (one 300-mg tablet taken three times a day) or augmentin (one 250-mg tablet taken three times a day).

Tuberculosis

Oral lesions in people with tuberculosis are seen only rarely. These lesions have been reported as ulcers on the tongue secondary to pulmonary tuberculosis.

Mycobacterium avim complex (MAC)

Oral lesions are not a common finding in people with MAC. MAC has been reported to occur as a palatal ulcer and was in fact the first presentation of MAC in that patient.