Diagnosis and management of HIV-associated periodontal lesions

Abstract

Since 1983, a large number of persons infected with the human immunodeficiency virus (HIV) have sought routine dental treatment at the University of California, San Francisco School of Dentistry, many of them with gingivitis that did not respond to conventional scaling, root planing, and improved oral hygiene. In some instances, the gingivitis progressed to severe and painful periodontitis in a few weeks. Clinically, the periodontitis lesions resembled acute necrotizing ulcerative gingivitis (ANUG) superimposed on rapidly progressive and severe periodontitis. However, many distinct features such as clinical appearance, severity, amount of spontaneous bleeding, type of pain, and rapid rate of periodontal destruction suggested that we were dealing with a difficult to manage form of periodontal lesion associated with HIV infection. This article provides a clinical description of these HIVassociated gingivitis (HIV-G) and HIV-associated peri­ odontitis (HIV-P) lesions that facilitate appropriate diagnosis. An effective treatment regimen for managing these lesions is recommended, based on our experience with more than 400 HIV-positive patients in the past 6 years. Clinical description