Oral & Respiratory Diseases – Key Vocabulary

Oral Manifestations of AIDS

• Definition

  • “Oral manifestation” = a sign that appears in the mouth but reflects a systemic condition.

  • In AIDS the immune system is severely compromised, allowing opportunistic infections and neoplasms to flourish intra-orally.

• Classic lesions/infections

  • Oral candidiasis (thrush) – overgrowth of Candida albicans producing a white pseudomembrane.

  • Herpes simplex reactivation – recurrent cold sores or intra-oral lesions.

  • Bacterial disease – severe gingivitis, periodontitis.

  • Kaposi sarcoma – vascular cancer appearing as red-purple patches or nodules.

• Clinical significance

  • Early recognition can prompt HIV testing or staging.

  • Requires collaborative management with physicians due to systemic nature.

HIV Transmission

• HIV is a blood-borne pathogen.

• Principal routes

  • Unprotected sexual contact with an infected partner.

  • Parenteral exposure to contaminated blood or needles (e.g., IV drug use, reused syringes).

  • Perinatal: trans-placental, during delivery, or via breastfeeding.

  • Occupational exposure (needle-stick, instrument puncture, splash to non-intact skin or mucosa).

• Quantitative/clinical points

  • Virus viability outside the body is low → rapid loss of infectivity after desiccation.

  • Dental setting: no documented cases of patient-to-provider HIV transmission to date.

Occupational Exposure & Risk Management

• Risk is "extremely low" but not zero; vigilance required.

• Psychological aspect

  • Even seasoned clinicians feel extra caution when a known HIV(+) medical history is present.

  • Must consciously override bias because many carriers remain undiagnosed.

• Instructor’s mental checklist/metaphor

  • "Treat EVERY patient as if the next patient is the person you love most."

  • Ensures meticulous adherence to cleaning, disinfection, and sterilization even under time pressure.

Standard Precautions (Universal Precautions)

• Treat all blood, saliva, and body fluids as potentially infectious.

• Key practices

  • Personal Protective Equipment (PPE): gloves, masks, eyewear/face shields, gowns.

  • Two-step operatory wipe-down ("wipe–wipe" technique).

  • Instrument reprocessing: cleaning → packaging → sterilization → storage.

  • Proper sharps handling, immediate disposal, never passing hand-to-hand.

Oral–Systemic Links Beyond HIV

• Discussion tangent highlighted flossing & periodontal health.

• Poor oral hygiene ↔ elevated systemic inflammation → cardiovascular disease risk.

• Reinforces that intra-oral findings can reflect or influence systemic status.

Oral & Respiratory Viral/Bacterial Diseases of Interest

Overview of Human Herpes Viruses (HHV)

• Eight known HHV types; dentistry focuses on Types 1–3.

HHV-1 & HHV-2 (Herpes Simplex Virus, HSV)

• HSV-1

  • Primary cause of oral/labial lesions (“cold sores,” "sun blisters").

  • Seroprevalence ≈ 90\% among adults.

• HSV-2

  • Traditionally genital, but oral lesions possible via orogenital contact.

• Biological behavior

  • Establishes lifelong latency in trigeminal or sacral ganglia.

  • Reactivation triggers: stress, UV light, illness, tissue manipulation.

Herpes Labialis – Clinical Stages

1. Prodrome: tingling, burning.

2. Vesicular: clustered, fluid-filled blisters — MOST contagious.

3. Ulceration/Weeping.

4. Crusting: scab forms; less infectious, may be considered safe to treat.

5. Healing.

Dental Office Protocol

• Active weeping lesions = automatic postponement.

• Document, educate, reschedule once crusted/healed.

• Rationale: prevents spread to

  • Other oral sites (autoinoculation).

  • Operator’s skin → Herpetic Whitlow (painful digital infection).

  • Eyes → ocular herpes; face shields now reduce splash risk.

HHV-3 (Varicella-Zoster Virus, VZV)

• Primary infection = chickenpox (varicella) in children.

• Reactivation = shingles (herpes zoster) typically >50 years.

• Transmission: saliva, nasal secretions, direct contact with lesions.

• Oral manifestation: vesicles or ulcers—generally posterior palate/tonsillar pillars.

Oral Candidiasis (Thrush)

• Etiology: overgrowth of C. albicans (commensal yeast).

• Predisposing factors

  • Immunosuppression (HIV, chemo, steroids).

  • Long-term/wide-spectrum antibiotics.

  • Xerostomia, trauma, continuous denture wear.

• Forms

  • Pseudomembranous: white curd-like plaques; wipe → red/bleeding base.

• Symptoms: burning, taste alteration, discomfort.

• Treatment: topical or systemic antifungals; address underlying cause.

Oral Syphilis & Gonorrhea

• Causative agents: Treponema pallidum (syphilis), Neisseria gonorrhoeae (gonorrhea).

• Oral presentation

  • Chancre (syphilis) or purulent ulcers (gonorrhea) on lips, tongue, palate.

  • Occur as primary lesions in 5\text{–}10\% of systemic cases.

• Highly contagious; seldom seen in developed regions but possible with global travel.

• Mandatory referral and deferral of dental treatment until cleared.

Hand, Foot, and Mouth Disease (HFMD) / Herpangina

• Etiology: Coxsackie A viruses.

• Oral findings

  • Numerous small vesicles/ulcers, predominately on soft, movable mucosa (posterior palate, faucial pillars).

  • Pain often severe—"hundreds of tiny canker-sore-like lesions."

• Differential: HSV intra-oral lesions favor bound-down keratinized tissue; HFMD favors non-keratinized.

• Highly contagious; reschedule until resolution.

Practical / Ethical Take-Aways for Dental Professionals

• Always balance empathy with infection control.

• Avoid stigmatizing known carriers; the unknown carriers pose equal or greater risk.

• Continuous patient education builds trust (e.g., explaining why a cold-sore visit is postponed).

• Staying current on PPE and sterilization protocols protects the team AND the “person you love the most” who might sit in that chair next.

Quick Reference Numbers & Facts (Exam-Friendly)

• 90\% of adults exposed to HSV-1.

• 5\text{–}10\% of syphilis/gonorrhea cases debut orally.

• No documented patient-to-provider HIV transmissions in dentistry to date.

• VZV reactivation risk spikes >50 years old; vaccine available.