Oral disease associated with HIV
Oral diseases are often early warning signs of HIV. Children commonly manifest candidosis, gingivitis and parotid swelling.
Herpes simplex : infections occur intraorally and circumorally; recurrences are frequent. Treatment is with acyclovir.
Aphthous-type ulcers : are persistent and common. Treatment is palliative.
Salivary gland enlargement : is unilateral and bilateral, resulting in xerostomia and pain. Xerostomia can result in candidosis and dental caries. Treatment involves the use of saliva replacements, mouth sprays and salivary stimulants.
Hairy leukoplakia : occurs in adults but is rare in children. It occurs on lateral border of tongue and, occasionally, the buccal mucosa and soft palate. No treatment required.
Oral candidosis : Acute pseudomembranous candidosis is an early sign and suggests other opportunistic infections. It responds well to treatment with systemic antifungals and oral hygienie improvement.
HIV gingivitis : results in red erythematous gingival tissues extending to free gingival margin. There is often spontaneous gingival haemorrhage and petechia at gingival margin, either localised or generalised. Treatment involves improved oral hygiene and 0.2% chlorhexidine mouthwash or gel four times a day.
HIV periodontitis : gives rise to deep pain, spontaneous bleeding, interproximal necrosis and cratering, and intense erythema. Treatment is similar to that for acute necrotising gingivitis, with the use of metronidazole.
Kaposi’s sarcoma : is uncommon in children and adolescents. It affects the palate particularly but can occur on gingivae and tongue. Treatment is by chemotherapy, radiotherapy or laser excision.