Periodontal considerations in the patient with HIV.

The HIV-associated periodontal diseases present unique challenges to the dental practitioner. The presence and severity of HIV-associated gingivitis, HIV-associated periodontitis, and possibly necrotizing ulcerative gingivostomatitis, and other oral lesions may indicate the presence and staging of HIV infection. In general, a similar relationship does not appear to exist between adult periodontitis and HIV staging. There is a wide variation in recent reports on the epidemiology of HIV-associated diseases. These variations point to the need for a standard definition for HIV-associated periodontal diseases using both conventional periodontal evaluation criteria and criteria designed specifically for the characteristics of HIV-associated gingivitis and HIV-associated periodontitis. HIV staging, geographic location of the study, antiviral and antimicrobial therapies, and oral habits may also account for many of these differences. Both the HIV-associated gingivitis and periodontitis lesions have similar microbiologic profiles to adult periodontitis lesions for previously identified periodontopathic bacteria. In addition, these lesions may have a unique opportunistic microflora. The pathogenesis of HIV-associated periodontal diseases may be due to the microflora, the effects of HIV and other viral agents, or alterations in the host response. These factors should be taken into consideration in the treatment and prevention of these HIV-associated periodontal lesions.