trimethoprim--sulfamethoxazole-drug-combination and Oral-Ulcer

Despite a large amount of research of periodontal health seen in HIV infection, much remains to be learned. Very few large controlled studies of infected people at settings not self-selected for oral disease have been reported, and few have investigated the necrotising periodontal diseases described in HIV infection. In this paper we present a brief review of three approaches to identify periodontal changes associated with HIV infection and identify possible aetiological factors for them. First, we summarise the methods and findings of a controlled blinded study of the periodontal health of homosexual men attending a genito-urinary medicine clinic. Second, we precis a case-control study of gingival ulceration among patients at a dedicated dental clinic. Finally, we outline how the validity of diagnostic criteria for HIV-associated periodontal changes were tested against the data collected in the controlled study.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Candidiasis, Oral; Case-Control Studies; CD4 Lymphocyte Count; Gingival Diseases; Gingivitis, Necrotizing Ulcerative; HIV Infections; Humans; Male; Oral Ulcer; Periodontal Diseases; Prognosis; Research Design; Trimethoprim, Sulfamethoxazole Drug Combination

Gingival pathology is a daily presentation, however a small number of systemic conditions can manifest similar to a common gingival condition and have fatal results. Dentist referred 56-year-old woman to Oral and Maxillofacial Surgery department with a 2-week medical history of gingival bleeding not responding to local measures. Biopsy showed eosinophilic infiltrate and vasculitis, and blood tests showed positive markers including cytoplasmic antineutrophil cytoplasmatic antibodies. Granulomatosis with polyangiitis is a rare disease affecting the respiratory tract, blood vessels and kidneys. Oral lesions are rarely the primary presenting feature. When left untreated, most cases are fatal within a year of diagnosis. The diagnosis can only be made when certain criteria are found, including granular oral lesions exhibiting an eosinophilic inflammatory infiltrate on biopsy. With 5% of cases showing intraoral lesions as the primary feature, it is essential that dentists have the knowledge of this rare disease to refer and not to treat as a common gingival condition.

Topics: Aftercare; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Biopsy; Dentists; Diagnosis, Differential; Eosinophils; Female; Giant Cells, Foreign-Body; Gingival Diseases; Glucocorticoids; Granulomatosis with Polyangiitis; Hemorrhage; Humans; Middle Aged; Oral Ulcer; Prednisolone; Rare Diseases; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Bacterial Agents; Antiretroviral Therapy, Highly Active; Combined Modality Therapy; Debridement; Drug Therapy, Combination; Female; Gingivitis; Gingivoplasty; Heroin Dependence; HIV Infections; Humans; Mandible; Methadone; Necrosis; Oral Ulcer; Pain; Stomatitis; Substance Abuse, Intravenous; Tooth Extraction; Tooth Loss; Treatment Refusal; Trimethoprim, Sulfamethoxazole Drug Combination

All cases of HIV-associated gingival ulceration seen at a dedicated dental clinic in a 5-year period were reviewed and compared against other patients attending the clinic. 94 (7.1%) of 1308 patients had 146 episodes of gingival ulceration. 89 patients had 140 episodes similar to acute necrotising ulcerative gingivitis (ANUG) and responded well to conventional treatment for ANUG. The cases were compared with 269 controls in logistic regression. Gingival ulceration was associated with oral candidiasis, lower age and lack of AIDS diagnosis possibly due to a protective effect of co-trimoxazole medication. 5 patients with neutropenia had extensive ulceration without the microflora of ANUG. Histopathology, viral and bacterial culture revealed non-specific changes. The ulcers did not respond to the treatment regimen for ANUG but responded to treatment of their neutropenia. Gingival ulceration is not common in HIV infection. Most cases resemble severe ANUG. It is more frequent in younger people, those with oral candidiasis and without AIDS. Co-trimoxazole may be protective. A minority of cases with ulceration and associated neutropenia resembled the non-specific oral ulceration associated with HIV.

Topics: Adult; Analysis of Variance; Anti-Infective Agents; Candidiasis, Oral; Case-Control Studies; Chi-Square Distribution; Female; Gingivitis, Necrotizing Ulcerative; HIV Infections; Humans; Male; Neutropenia; Oral Ulcer; Regression Analysis; Trimethoprim, Sulfamethoxazole Drug Combination