Oral Manifestations of HIV Disease

Abstract

The range of manifestations of HIV-infection is extremely broad and may overlap with many diseases of the oral
mucosa of different origin. These diseases can be divided into 2 groups: infectious diseases of the oral mucosa and
tumour diseases of the oral mucosa (the diseases of unspecified origin such as recurrent aphthae could be included in the
third group, respectively). Infectious diseases of the oral mucosa can occur within the ARC (the AIDS-related complex)
and are common in patients with manifested AIDS. However, none of these manifestations is among the clinical criteria
for the determination of HIV infection. The disease of the oral mucosa can manifest itself several months earlier than
other HIV manifestations. Respective changes in the oral cavity can be the first clinical symptoms of the disease, none
of them being specific only for HIV infection! This poses a problem from both the diagnostic and epidemiological point
of view. Diseases with different etiologies may occur in one patient at the same time (mostly at a level of CD4+ Tlymphocytes below 200/mm3); patients with elevated levels of CD4+ T-lymphocytes (but still below 400/mm3) usually
show only one kind of intraoral affliction in the oral cavity. Generally, infectious diseases of the oral mucosa can be
divided into viral infections, bacterial infections and fungal infections. Since the clinical symptoms of the disease may
appear long after the contact with the HIV virus (even laboratory tests may not give a reliable result for a certain period
of time - 3-6 months), the medical staff should observe basic hygienic precautions and use protective gloves and a
mouthpiece, when treating HIV patients. Most HIV-positive patients and patients with AIDS symptoms are treated in
specialized clinics for infectious diseases. The patient is scheduled to have a dental treatment at the end of working
hours. a) Tools for single use should be used as much as possible. b) The assisting nurse must decontaminate and wash
the used tools after use, avoiding the formation of aerosol. Dry tools are sterilized in an autoclave or hot-air sterilizer.
c) The attending physician and other medical staff should use a mouthpiece, cap, safety glasses, full-face shield,
disposable clothing and two pairs of gloves (surgical and non-sterile protective!). d) The use of a turbine should be
limited (aerosol) during preparation. e) After prosthetic treatment, all materials which were placed in the patient’s
mouth are transported in a closed container to the laboratory and disinfected and sterilized prior to further processing
(the laboratory technician should be protected in the same manner as the medical staff), f)X-ray images must be sealed
in a plastic foil and submerged into an alcohol solution for disinfection, prior to development, g) All materials intended
for disposal must be labelled as infectious (including clothing unless it is intended for single use only).