Atypical periodontal disease

Periodontal disease is a common problem in both asymptomatic & symptomatic HIV infected patients.

Classification of periodontal disease associated with HIV infection:-

1. HIV- associated gingivitis- now it is called linear gingivitis
2. HIV associated periodontitis, now called necronizing ulcerative periodontistis
3. HIV- necrotising gingivitis now called Necronizing ulcerative gingivitis
4. Necrotizing stomatitis

Clinical features

• It often occurs in clean mouth where there is very little plaque or calculus to account for the gingivitis.
• The onset is often sudden, with rapid loss of bone & soft tissue. In linear gingival erythema, the gingival may be reddened & edematous.
• Patients sometimes complain of spontaneous bleeding.In acute onset ulcerative gingivitis, ulcers occurs at the tip of the interdental paipilla & along the gingival margin & often elicit complaints of severe pain .The ulcers heal, leaving the gingival papillae with characteristic cratered appearance.
• Necrotizing ulcerative periodontitis may present as rapid loss of supporting bone & soft tissue. Typically, these losses occur simultaneously with no formation of gingival pocket,sometimes involving only isolated areas of the mouth.Teeth may loosen & eventually fall out, but uninvolved sites can appear healthy.
• Necrotising stomatitis may develop and areas of necrotic bone nmay appear along the gingival margin.The bone may eventually sequestrate. Patients with necrotizing ulcerative  periodontitis & necrotizing stomatitis frequently complain  of extreme pain & spontaneous bleeding.
• It will produce severe pain.

Differential Diagnosis

It is some times difficult to distinguish this type of periodontal disease from non-HIV related periodontal problems.However, the complaints of severe pain, rapid onset & rapid destruction in an often extremely clean mouth are unusual for non-HIV related periodontal disease.

Management

Following protocol has achieved reasonable success:-

• Plaque removal,Irrigation with povidine iodine, scaling & root planning & maintenance with a chlorhexidine mouth rinse(0.12 %) once or  twice daily
• In case of necrotizing ulcerative periodontistis Metronidazole (250mg tablet four times daily), amoxicillin/clavulanate (augmentin 250 mg TDS), or clindamycin (300mg tablet TDS) should be added to the treatment regimen.
• Systemic analgesics can be prescribes in the case of necrotizing ulcerative periodontitis