Oral Aspects of HIV and AIDS and How to Treat Them as a Dentist

### Introduction

HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immunodeficiency Syndrome) are both severe worldwide health issues that highly affect the immune system. The oral manifestations have been one of the earliest and most significant symptoms of HIV infection. Oral lesions may act as diagnostic markers and indicate disease stage and immune condition. Proper treatment of these manifestations is important to enhance the quality of life among HIV/AIDS patients.

### Oral Features of HIV and AIDS

The oral features of HIV and AIDS can be divided into various categories depending on their etiology:

#### 1. Fungal Infections

- Oral Candidiasis: The most frequent fungal infection among HIV patients, usually presenting as:

- Pseudomembranous Candidiasis (Thrush): White, curd-like plaques that can be removed, leaving erythematous tissue underneath.

- Erythematous Candidiasis: Atrophic, red patches typically on the dorsum of the tongue and palate.

- Hyperplastic Candidiasis: White lesions which cannot be rubbed off, often looking like leukoplakia.

- Angular Cheilitis: Cracks and fissures at the mouth corners with pain and burning.

#### 2. Viral Infections

- Herpes Simplex Virus (HSV): Recurrent and chronic ulcers, typically on the lips or intraoral.

- Human Papillomavirus (HPV): Triggers oral warts, papillomas, and condyloma acuminatum.

- Cytomegalovirus (CMV): Produces painful ulcerations, most commonly observed in immunocompromised patients.

- Epstein-Barr Virus (EBV): Causes Oral Hairy Leukoplakia, with white, corrugated lesions on the lateral tongue.

#### 3. Bacterial Infections

- Necrotizing Ulcerative Gingivitis (NUG) and Necrotizing Ulcerative Periodontitis (NUP): Advanced forms of gum disease with deep pain, bleeding, and rapid tissue loss.

- Mycobacterial Infections (Tuberculosis and Atypical Mycobacteria): Can lead to oral ulcerations and enlarged lymph nodes.

#### 4. Neoplastic Lesions

- Kaposi’s Sarcoma: A vascular tumor presenting as purple, red, or brown plaques or nodules on the oral mucosa, especially the palate.

- Non-Hodgkin’s Lymphoma: Appears as rapidly growing ulcerative masses, often involving the gingiva or palate.

#### 5. Immune-Mediated Lesions

- Recurrent Aphthous Ulcers: Painful, round or oval ulcers with a yellowish base and erythematous border.

- Xerostomia (Dry Mouth): Due to salivary gland dysfunction or side effects of medication, leading to an increased risk of caries and infections.

### Management of Oral Manifestations of HIV/AIDS as a Dentist

The management of oral manifestations in HIV/AIDS patients involves a multidisciplinary approach with symptom relief, prevention, and improvement in overall health.

1. Diagnosis and Monitoring

- Comprehensive Oral Examination: Regular screenings help in early detection of lesions.

- Saliva and Blood Tests: May be used to confirm fungal or viral infections.

- Biopsy and Histopathology: Essential for suspicious lesions like Kaposi’s Sarcoma or Non-Hodgkin’s Lymphoma.

2. Antifungal Therapy

- Topical Treatments: Clotrimazole troches, nystatin suspensions, and miconazole gels.

- Systemic Antifungals: Fluconazole and itraconazole for severe or recurrent candidiasis.

3. Antiviral Therapy

- HSV Infections: Acyclovir, Valacyclovir, and Famciclovir.

- CMV Lesions: Ganciclovir and foscarnet for systemic involvement.

- HPV-related Warts: Surgical removal, cryotherapy, or laser therapy.

4. Antibacterial and Periodontal Management

- Debridement and Scaling: Reduces bacterial load in NUG and NUP cases.

- Antibiotics: Metronidazole or amoxicillin-clavulanate for severe infections.

- Chlorhexidine Mouthwash: Helps control plaque and bacterial growth.

5. Management of Neoplastic Lesions

- Kaposi’s Sarcoma: Requires a combination of antiretroviral therapy (ART), intralesional chemotherapy, or radiation therapy.

- Lymphomas: Chemotherapy and radiotherapy.

6. Management of Pain and Ulcers

- Topical Anesthetics: Lidocaine gel or benzocaine lozenges.

- Corticosteroids: Hydrocortisone or triamcinolone for aphthous ulcers.

7. Control of Xerostomia

- Salivary Substitutes and Stimulants: Pilocarpine or cevimeline.

- Hydration and Sugar-Free Gum: Stimulates natural saliva secretion.

8. Preventive Care and Patient Education

- Oral Hygiene Reinforcement: Brushing, flossing, and mouth rinses on a regular basis.

- Nutritional Counseling: Promoting healthy eating to optimize immune function.

- Smoking and Alcohol Cessation: Minimizing irritants that exacerbate oral status.

- Patient Counseling and Support: Managing psychological effects and promoting ART adherence.

Conclusion

Oral symptoms of HIV/AIDS are important predictors of disease. Dentists have an active role to play in early detection, symptomatic treatment, and prevention. An active approach, including regular oral check-ups, proper drugs, and patient counseling, greatly enhances the quality of life of people with HIV/AIDS.