Oral Pathology 1

Front 1

Molluscum Contagiosum

Back 1

- Caused by pox virus
- Many more lesions develop compared to non-immunocompromised patient
- Facial skin is usually affected
- Lesions tend not to regress, unlike their normal course in immune competent person

Front 2

Persistent Lymphadenopathy

Back 2

- Generalized non-tender lymphadenopathy
- Cervical lymph nodes are frequently affected, including post cervical nodes
- Other causes of lymphadenopathy may have to be ruled

Front 3

Infections of Probable Bacterial Etiology (4)

Back 3

1- Linear gingival erythema
2- NUG
3- HIV-related periodontitis
4- Necrotizing stomatitis

Front 4

Linear Gingival Eythema

Back 4

- Red, linear band at the marginal gingiva
- Spontaneous bleeding may be noted
- Not improved by oral hygiene

Front 5

NUG

Back 5

- Similar to that seen in immunocompetent
- May be seen in a setting of relatively few apparent local factors
- Responds to standard therapy, but requires prophylactic chlorhexidine use with 2x daily rinses for control

Front 6

HIV-Related Periodontitis

Back 6

- Pain and spontaneous gingival bleeding
- Interproximal necrosis and cratering
- Edema and intense erythema
- Extremely rapid bone loss that occurs concurrently with soft tissue destruction; therefore, no pocketing is evident!

Front 7

Necrotizing Stomatitis

Back 7

- Much more severe presentation of NUG or HIV-related periodontitis
- Extensively painful tissue destruction that not only affects gingiva and supporting alveolar bone, but also adjacent soft tissue and deeper osseous structure
- Management includes extensive debridement, topical antiseptics, and systemic antibiotics
- Prognosis is guarded

Front 8

HIV- Related Viral Infections (4)

Back 8

1- Herpes simplex
2- Varicella-zoster
3- Epstein-Barr virus
4- HPV

Front 9

Herpes Simplex Infections

Back 9

- Represent reactivation of virus in most cases
- May affect any oral mucosal surface
- Typically present as persistent painful diffuse shallow ulceration
- Must be treated w/ acyclovir or one of the acyclovir analogues

Front 10

Herpes Zoster Infection

Back 10

- Generally more of a problem from a cutaneous standpoint
- May involve the head and neck area
- Unilateral distribution of vesicles and ulcers is usually a helpful diagnostic clue

Front 11

Hairy Leukoplakia

Back 11

- Most are HIV-infected (other immunocompromised ppl)
- Non-removable white plaques of the lateral tongue
- Caused by Epstein-Barr virus; often superimposed candidiasis
- No Tx necessary

Front 12

HPV

Back 12

- Seen w/ increased frequency intraorally compared w/ non-immunocompromised pop.
- Exophytic lesions, solitary or multiple, that may resemble routine squamous papilloma, condyloma or focal epithelial hyperplasia

Front 13

AIDS-Related Kaposi Sarcoma

Back 13

- Usually affects homosexual males
- Etiology seems linked to HHV-8
- Of patients who develop KS, half will have oral involvement, usually palate or gingiva
- Tx typically only for cosmetic or functional problem
- Patients usually expire due to infectious causes, rather than KS
- Managed w/ excision, local radiation therapy or intralesional vinblastine injections

Front 14

AIDS-Related Lymphoma

Back 14

- Often extra-nodal (CNS or GI tract)
- Clincally may resemble KS, but not as common
- Very poor prognosis in most cases, w/ median survival of 3-4 months typically reported

Front 15

Apthous-Like Ulcerations

Back 15

- Probable immune-mediated etiology
- Painful, persistent- may be solitary or multiple
- May need to rule out infectious etiology by means of culture, exfoliative cytology or biopsy
- Respond to topical corticosteroids