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Common Gum Diseases in HIV and AIDS

Acquired immunodeficiency syndrome (AIDS) is a condition of by profound impairment of the immune system. Various types of mouth lesions such as candidiasis, hairy cell leukoplakia and a range of gum diseases are prevalent in patients infected with human immunodeficiency virus (HIV). In fact in some cases the oral manifestations itself can act as an indicator of a human immunodeficiency virus infection.

Gum diseases are common throughout the world and even in people who not living with HIV. However, in the backdrop of HIV and AIDS, these conditions can be very severe and there may be extensive damage to the oral cavity. The inability of the immune system to stop or at least minimize the extent of the condition can have serious, life threatening and disfiguring consequences.

Types of HIV Gum Diseases

The following are the most commonly encountered gum related disease seen in human immunodeficiency virus infected individuals. However, it is important to bear in mind that these gum diseases are not unique to HIV/AID. Although it may be present in people who are not immuncompromised, it is uncommon as compares to  HIV positive and AIDS patients.

  • Linear gingival erythema
  • Necrotizing ulcerative gingivitis
  • Necrotizing ulcerative periodontis
  • Necrotizing ulcerative periodontis

Linear Gingival Erythema in HIV

A persistent, linear, easily bleeding erythmatous inflammation of the gums has been reported in many HIV-positive cases. The disease can also serve as precursor to rapidly progressing necrotizing ulcerative periodontis. The lesion of linear gingival erythema can be localized or generalized in nature. It may be limited to marginal gums or may extend in to the attached gum margins and lining of the oral mucous membrane covering the alveolar bones.

Treatment

Linear gingival erythema can be effectively managed by periodontal therapy including scaling and polishing adjacent to affected areas. Irrigation with chlorhexidine or 10% povidone-iodine may also be used to provide relief. The condition should be reevaluated after 2 to 3 weeks of initial therapy as the disease is of a refractory nature.

Necrotizing Ulcerative Gingivitis in HIV

Necrotizing ulcerative gingivitis is a rapidly progressing gum disease caused by bacteria. It causes significant destruction of the gum and teeth supporting tissues. It is associated with discomfort, pain and fetid odor from the gums. These may be widespread ulceration on the gums and the teeth corresponding to the affect portions of the gum appear extruded.

Treatment

The treatment for necrotizing ulcerative gingivitis includes cleaning and debridement of the affected areas after the application of a topical anesthetic agent. The patient is advised to avoid tobacco, alcohol and condiments. Chlorhexidine mouthwashes are generally prescribed for topical use. Systemic antibiotics such as metronidazole may also be administered.

Necrotizing Ulcerative Periodontis in HIV

Necrotizing ulcerative periodontitis is a severe and rapidly progressing form of periodontitis seen more frequently in patients suffering with HIV infection. The disease may occur as a sequelae of necrotizing ulcerative gingivitis causing rapid destruction of supporting structures of the teeth. The periodontal ligament and alveolar bone forming the tooth socket are mainly affected.

Treatment

The treatment for necrotizing ulcerative periodontis includes local debridement, scaling and root planning. Local irrigation with antimicrobial agents can also be incorporated in the treatment regime. The patient suffering from necrotizing ulcerative periodontis is advised to maintain strict oral hygiene to avoid its recurrence.

Necrotizing Ulcerative Stomatitis in HIV

Necrotizing ulcerative stomatitis is an occasional finding in HIV-infected patients but is relatively rare in people who are not immunocompromised. It is a severe destructive and acutely painful condition affecting the entire oral cavity. The condition can affect the soft tissues, inner lining of the mouth and the bone underlying the teeth. The condition is very similar to cancrum oris (noma) a rare destructive process reported in malnourished individuals mainly in African countries.

Treatment

Treatment of necrotizing ulcerative stomatitis includes antibiotics such as metronidazole in systemic and topical forms. If the bone tissue is necrosed (dead) the affected bone is excised by surgical means to promote wound healing.


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