Frequent Oral Diseases in HIV Positive and AIDS Patients

Dr. Heddie O. Sedano, DDS

Necrotizing Stomatitis (NS)

Necrotizing stomatitis also called necrotizing ulcerative stomatitis is very difficult to differentiate from necrotizing ulcerative periodontitis (NUP). NS as a rule is a generally localized, very rapidly destructive disease of the alveolar bone and overlying gingiva. It is considered less severe than NUP and is accompanied by severe deep pain. Ns also may invove the palatal mucosa. The rapid destruction will lead to bone sequestration if NS is not treated promptly.

NS Case #1 - This is 29 year old HIV+ man with this gingival appearance and a history of intense intraoral pain for the last four days. The gingiva presents atrophy and necrosis between teeth #23 and #24 and between #24 and #25. The interdental papilla between teeth #25 and #26 is markedly hyperplastic. This lesion is highly erythematous. There was intense halitosis. This lesion is treated with careful debridement aided by local irrigation with 10% Betadine.

NS Case #2 - Another example of NS in a 37 year old HIV+ man. Note the combination of atrophy, necrosis, hyperplasia and erythema of this gingiva. Non HIV associated ANUG is, as a rule, is a necrotizing ulcerative gingivitis with horizontal atrophy of the interdental papillae and without gingival hyperplasia.

The treatment for NS is identical to that utilized to treat NUP

• Gentle debridement of affected areas to minimize bleeding and pain.
• Irrigation with 10% Betadine (providone-iodine) to aid debridement.
• If possible root planning and scaling under local anesthesia again with 10% Betadine as irrigant.
• Instruct patient to maintain a methodical and careful oral hygiene regimen.

• Rx: Metronidazole (Flagyl) 250 mg tablets
• Disp: 24 Tablets
• Sig: 1 Tab. 4 times a day NOTE: Refill if needed for one more week

When severe pain, necrosis and fever are present, then penicillin need to be prescribed (either of the two prescriptions below):

• Rx: Amoxicillin (Amoxil) 500 mg Tablets
• Disp: 24 Tablets
• Sig: 1 Tab. 4 times a day

• Rx: Clindamycin (Cleocin) 300 mg capsules
• Disp: 24 Capsules
• Sig: 1 Cap. 4 times a day

If the patient is allergic to penicillin, then prescribe:

• Rx: Erythromycin enteric coated 500 mg Tablets
• Disp: 24 Tablets
• Sig: 1 Tab. 4 times a day

The patient should be reevaluated after one week of treatment and the medication should be reinstated if the response is not satisfactory. Recalls every four weeks are recommended until total stabilization, then control check-ups every three to four months.

• Rx: Chlorexidine gluconate (Peridex), 0.12%
• Disp: 2 x 16 oz bottle
• Sig: 15 or 20 ml, 30 seconds oral rinse 2 times per day

The patient should be warned that Chlorexidine gluconate will stain the teeth and also the tongue.