Immunocompromised Px

Down syndrome

Trisomy 21

Incidence of Down’s syndrome

1:600 births, risk increases w/maternal age

Appearance of Downs Syndrome

1. Brachycephaly

2. Mid face recursion, small nose w/flattened nasal bridge

3. Upward sloping palpebral fissures

4. macroglossia

5. Delayes eruption

6. abnormal teeth shape, size and alignment

Dhx of Down Syndorm

1. poor OHi

2. Mouth breathing

3. poor diet

4. resistance to regular brushing

Grave’s Disease

1. Specific hyperthyroidism

2. Antibody binding to TSH receptor on thyroid cells, stimulating it

3. commonly affects women 30-50yrs

Oral manifestation of Graves

1. increased caries

2. enlarged thyroid tissue

3. accelerated dental eruption

4. BMS

Gardner’s Syndrome

Characterised by multiple osteomas (esp in jaw, clonic polyps & skin tumours)

Dental abnormalities in Gardner’s Syndrome

1. impacted teeth other than 8s

2. supernumerary/mussing teeth

3. abnormal root formation

Papillon-lefevre syndrome

1. Autosomal recessive

2. diffuse palmar-planar hyperkeratosis

3. severe generalised perio

4. Occurs before puberty w/early loss of dentition

Congenital immunodeficiencies

1. Downs

2. Grave’s

3. Gardner’s

4. Papillon lefevre

Acquired immunodeficiencies

1. HIV

2. Kaposi’s sarcoma

3. Erythermatous candidosis

CT diseases

1. Rheumatoid arthritis

2. SLE

3. Sjogrens

HIV

1. retrovirus directly infecting lymphocytes & macrophages carrying CD4 markers

2. HIV 1 & 2

3. Progression of HIV to aids, CD4 T lymphocyte count drops

Strongly associated oral manifestation of HIV

1. Kaposi’s saecoma

2. Hairy leukoplakjia

3. Oral thrush

4. gingivitis & Perio

HIV related gingivitis

similar to ANUG

Oral Hairy Leukoplakia

1. Not potentially malignant, needs no tx

2. Opportunistic EBV infection

3. infect keratinocytes with/in mucosa

4. Mostly L tongue border

Aetiology of Kaposi’s Sarcoma

1. HHV8

2. interfere w/cell signalling

3. Loss of cell regulation

Kaposi’s sarcoma presentation

1. Vascular lesion containing factor 8 & many capillaries

2. resembles granulation tissue

3. Necrosis can occur centrally = bone loss

Management of Kaposi’s sarcoma

1. Controlled, not cured

2. HAART

3. excision of localised lesions

4. oral radiation avoided bc complication

Erythematous candidiasis presentation

1. flat, red, subtle lesion(s) on dorsal tongue ± palate

2. depappilated red mucosal areas on dorsal tongue

Causes of Erythematous candidiasis

1. broad spectrum Abx

2. Xerostomia

3. Smoking

4. HIV

Abx therapy in immunocompromised px

1. poor healing risk & systemic involvement from dento-alveolar infection

2. to tx active dental infection to avoid risks

Absolute Neutrophil count (ANC)

1. severity of suppression

2. not appropriate for meds impacting immune system

Autoimmune diseases often associated with

1. HLA-B8

2. DR3

Rheumatoid Arthritis

1. Multisystem disease frequently affect TMJ

2. associated w/sjogrens

3. tend to be anaemic as well bc of gastric blood loss by analgesia

RA medication effects

1. methotrexate & anti rheumatic agents - stomatitis

2. Minocycline - hyperpigmentation intraorally

3. Ciclosporin - gingival hyperplasia

4. Prednisolone/TNF alpha blocking therapy - opportunistic infection

SLE Features

1. autoantibodies - antinuclear factors

Tx for SLE

1. Corticosteroids

2. immunosuppressants

3. antimalarials - LP

SLE Oral manifestation

1. resemble LP

2. May not respond to systemic corticosteroids

3. painful oral lesions

4. sjogrens

5. Bleeding tendency - anti platelet antibodies/anticoags

6. anaemia

7. CVD & IE risk