IntroToPerio - 0527 - Gingival Disease II

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  1. Most common one of the four types of oral candidiasis
    Pseudomembranous, aka thrush
  2. Gingival diseases of fungal origin
    • Common in immunocompromised patients caused by disease (HIV etc) or medication (steroids etc).
    • Seen in patients where normal flora is disrupted (opportunistic).
    • Most common oral fungal infection is Candidiasis.
    • a. Common under prosthetic devices.
    • b. White patches on gingiva, tongue, or oral mucous membranes. Can be easily wipe off.
    • c. Diagnosis of candida infection can be made by culture, smear or biopsy.
    • Histoplasmosis.
    • Treat w/ common anti-fungi drugs.
  3. Herpetic gingivostomatitis
    • HSV-1
    • children
    • vesicle formation,
    • fever,
    • gingival inflammation
    • Acute onset (severe or not, depending on the patient and dose of virus exposed to)
    • vesicles are contagious
    • Latency in ganglia
  4. Herpetic gingivostomatitis - oral symptoms
    • Generalized “soreness” of the oral cavity
    • Ruptured vesicles are the focal sites of pain
    • Eating, drinking, oral hygiene affected
  5. Secondary Herpetic gingivostomatitis
    • Stimuli: sunlight, trauma, fever, stress
    • Herpes labialis
    • palate, gingiva , mucosa
    • pain away from the site of stimuli 2 to 4 days later
  6. HIV-related periodontal disease
    • Oral Signs & Symptoms
    • Candidiasis
    • Lymphadenopathy
    • Viral Lesions
  7. Oral Hairy Leukoplakia (HL)
    •  White lesions
    •  Primarily found on lateral border of tongue.
    •  Surface of lesion can be smooth or corrugated & does
    • not rub off.
    •  Most likely a viral induced lesion
  8. Oral Hairy Leukoplakia (HL)
    •  White lesions
    •  Primarily found on lateral border of tongue.
    •  Surface of lesion can be smooth or corrugated & does
    • not rub off.
    •  Most likely a viral induced lesion. 99% HIV related
  9. HIV-related periodontal diseases
    • Viral Lesions
    •  Oral Papillomas
    •  Condyloma acuminatum
    •  Focal eipthelial hyperplasia
  10. HIV-related neoplastic lesions
    • Kaposi Sarcoma
    • Malignant lesion arising from lymphatic or
    • vascular endothelium.
  11. HIV associated gingivitis (HIV-G) or (LGE)
    • Linear Gingival Erythema.
    • 1. Persistent & easily bleeding.
    • 2. Lesions can be localized or generalized.
    • 3. May be limited to marginal tissues.
    • 4. Can also extend into attached gingiva and into alveolar mucosa.
    • 5. Oral candida identified with LGE.
    • 6. Some LGE lesions may undergo spontaneous
    • remission.
  12. HIV associated periodontitis (HIV-P) - Treatment
    • 1. Mechanical debridement.
    • 2. Chemotherapeutic agents.
    • 3. Home care instructions.
    • 4. Routine maintenance care.
  13. Oral lesions strongly associated with HIV-infection
    • 1.Candidiasis
    • 2.HL
    • 3.Kaposi’s sarcoma
    • 4.Non-Hodgkin’s Lymphoma
    • 5.Periodontal Diseases
    • a. LGE
    • b. NUP
    • c. NUG
  14. Muco-cutaneous disorders: desquamative gingivitis
    • Tissue peeling off
    • Lichen Planus - T cells involved
    • BMMP - Benign mucus membrane pemphigoid. Targets B cells
    • Pemphigus Vulgaris
  15. Most common additive in toothpaste is cinnamon flavoring and can cause
    desquamative gingivitis
  16. must do immunofluorescence biopsy on intact tissue to diagnose or differentiate between
    Lichen planus and BMMP
  17. desquamative gingivitis - Treatment:
    • Eliminate etiology
    • Steroids
    • 1.Topical
    • 2.Intra-lesional
    • 3.Systemic
    • Appropriate referral to medical specialist
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IntroToPerio - 0527 - Gingival Disease II
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IntroToPerio - 0527 - Gingival Disease II
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