The second most frequent malignant neoplasia found in AIDS patients is lymphoma and the vast majority of them are extremely agressive B cell lymphomas which are non Hodgkin's lymphoma (NHL). These lymphomas are extranodal and in AIDS patients about 5% of extranodal NHL are intraoral. It has been estimated than almost 100% of the AIDS associated NHL contain Epstein-Barr virus. In the past NHL were practically non-existent in the oral cavity but now they are the predominant form in AIDS patients. NHL develops as a fast growing mass generally on the palate, tongue or gingiva and soon it ulcerates and presents areas of extensive necrosis. Pain may not be present on the initial stages of the tumor. Clinically the mass may be erythematous or purplish in color with a boggy consistency. Some cases may develop in a pre-existing periodontal disease such as necrotizing ulcerative periodontitis. Therefore, it is imperative that in those cases where the treatment of the periodontal disease is not effective, a biopsy be performed to rule out the possibility of an associated NHL The survival rate for patients with oral NHL has been estimated at an average of 8 months.
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| Large intraoral mass of 30 days evolution in a 30 year-old HIV infected man. The mass grew out of the maxillary left retromolar area and extended to the mandibular retromolar area and gingiva. Biopsy of the lesion established the diagnosis of B-Cell lymphoma which was confirmed by immunoperoxidase studies. |
After the diagnosis is confirmed by biopsy the treatment is in the hands of the oncologist and consists of multidrug chemotherapy and radiation. The dentist's participation in the management of these patients is to maintain an acceptable level of intraoral health. Rinses with chlorhexidine gluconate should be prescribed as antimicrobial prior to radiation therapy to ameliorate glossitis and mucositis which are a consequence to radiation. In case of xerostomia, also as a consequence to the treatment, saliva substitutes should be prescribed.
Other commercially available saliva substitutes (OTC) can also be used, i.e: Xero-Lube, Salivart, Orex, etc.
Other indications to the patient can be:Do you wish to take this course for continuing education credit? Yes
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