Necrotising Stomatitis in a HIV-Seropositive Patient: Report of a Case and a Review of the Literature

Necrotizing gingivitis (NG) and necrotizing periodontitis (NP) are collectively referred to as necrotizing periodontal diseases (NPD) (International Workshop for the Classification of Periodontal Diseases and Conditions. Consensus Report, 1999). NPDs are considered to be more common in HIV-seropositive subjects compared to immunocompetent individuals, and might be the first clinical manifestation of HIV infection or an indication of immune deterioration in these subjects (Shangase et al, 2004; Vastardis et al, 2003; Laskaris et al, 1992). NG is characterised by gingival necrosis, bleeding and pain. Secondary clinical signs may include fetid breath, pseudomembrane formation, lymphadenopathy, fever and malaise (Horning and Cohen, 1995), and the main predisposing factors are poor oral hygiene, smoking, stress, poor nutrition and immunosuppression. NP is an extension of NG to include the periodontal attachment apparatus and is most commonly observed in HIV-seropositive subjects and other immunosuppression states (International Workshop for the Classification of Periodontal Diseases and Conditions. Consensus Report, 1999). The prevalence of NP is uncertain, since most studies of necrotic periodontal lesions have failed to differentiate NP from current NG superimposed upon pre-existing periodontal attachment loss and therefore, in the majority of cases, NG and NP should be grouped together under the heading of NDP (Feller and Lemmer, 2005). Smoking is a well-established risk factor for the development and progression of periodontal disease. However, its role in the pathogenesis of NPD in HIV-seropositive subjects is less clear (Shangase et al, 2004; Glick et al, 1994). The clinical signs and symptoms, as well as the microflora of NG in HIV-seropositive subjects are the same as those in HIV-seronegative subjects (Feller and Lemmer, 2005). Dramatic resolution of signs and symptoms occur following conventional periodontal therapy of plaque control instructions, mechanical debridement of plaque and calculus, the Necrotising Stomatitis in a HIV-Seropositive Patient: Report of a Case and a Review of the Literature