HIV ORAL Drg.helmin
Transcript of HIV ORAL Drg.helmin
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TUJUAN MATERI INI DIBERIKAN
UNTUK MENGENAL LESI ORAL YANG DISERTAI ADANYA IMUNOSUPRESI
EFEK HIV TERHADAP PREVALENSI LESI ORAL KARENA HIV
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IMMUNOSUPPRESI adalah : hambatan pada fungsi normal respon imun karena adanya penyakit
OPPORTUNISTIC INFECTION adalah infeksi karena suatu mikroorgansme yang akan menyebabkan penyakit pada suatu kondisi tertentu ( kondisi dimana sistim imun seseorang terganggu )
APA YANG BISA KITA LIHAT PADA PASIEN DENGAN HIV-AIDS
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FAKTA-FAKTA YANG LAIN
Sekitar 70- 80 % penderita HIV/AIDS memiliki manifestasi rongga mulut Terapi optimal terhadap masalah-masalah yang rutin akan mengurangi resiko infeksi yang lebih serius hampir semua infeksi yang terlihat muncul pada HIV juga muncul pada bukan penderita HIV tetapi dengan derajat keparahan yang berbeda
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PEMERIKSAAN RONGGA MULUT
•LIPS AND GUMS
•CHEEKS
•TONGUE
•FLOOR OF THE MOUTH
•ROOF OF THE MOUTH
•LYMPH NODES
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Mengenal dan memahami lesi yang biasa munculdi rongga mulut Riwayat penyakit Pemeriksaan Palpasi
PROSES MELAKUKAN DIFFERENSIAL
DIAGNOSIS
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Penyebab-penyebab lesi oral
FUNGAL VIRAL BACTERIAL ULCERATIVE NEOPLASTIC
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FUNGAL
ANGULAR CHELITIS
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Inflammation/irritation Cracking and fissuring Pain upon opening the mouth Susceptible to infection
ANGULAR CHELITIS
TREATMENT• Antifungal medication• Correct vertical dimension
FUNGAL
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FUNGAL
PSEUDOMEMBRANOUS CANDIDIASIS
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PSEUDOMEMBRANOUS CANDIDIASIS
plak lunak multipel (warana putih-kuning) Plak yang mudah dikerokArea sekitar lesi berdarah dan terasa terbakarFungsi pengecapan menurun Xerostomia (dry mouth)
TREATMENT• Antifungal medication
FUNGAL
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FUNGAL
ATROPHIC OR ERYTHEMATOUS CANDIDIASIS
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ATROPIC CANDIDIASIS
Spotty appearance May look like pizza burn sering dikelirukan dengan : trauma, infections, radiation,xerostomia sakit : tidak separah dibanding pseudomembranous candidiasis
TREATMENT• Antifungal medications
FUNGAL
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VIRAL
ORAL HAIRY LEUKOPLAKIA
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ORAL HAIRY LEUKOPLAKIA
Asymptomatic indikator keparahan suatu penyakit Affects the lateral border and ventral tongue, and buccal vestibule bisa disebabkan oleh hiperplasia epitel atau reaktivasi sekunder dari virus
TREATMENT• usually none• occasionally antivirals
VIRAL
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VIRAL
HERPES SIMPLEX VIRUS
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HERPES SIMPLEX VIRUS
Merupakan vesikula yang bercapur dengan bula lalu pecahKadang ada rasa gatal/geli|Muncul pada jaingan yang mengalami keratinisasi dan melekat Nyeri /PainfulKadang merupakan manifestasi penyakit sistemik TREATMENT
• Antivirals• Palliative support
VIRAL
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VIRAL
HUMAN PAPILLOMA VIRUS
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HUMAN PAPILLOMA VIRUS (HPV)
tanda awal : papula dengan permukaan lunak /lembut , kadang permukaan kasar berbentuk jari tangan biasanya muncul pada mukosa yang mengalami keratinisasi Cenderung muncul kembaliTidak sakit,berdarah, Transmissible
VIRAL
TREATMENT• Excision
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PERIODONTAL DISEASEBACTERIAL
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paling sering karena infeksi bakteri oral pada pasien yang terinfeksi HIV
faktor yang berperan : diet buruk, oral hygiene yang buruk dan saliva yang kental
Terutama berhubungan dengan pertumbuhan flora normal yang berlebih
PERIODONTAL DISEASEBACTERIAL
TREATMENT
• Deep scaling and root planning
•Good home care
•Antimicrobial rinses
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BACTERIAL
LINEAR GINGIVAL ERYTHEMA
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LINEAR GINGIVAL ERYTHEMA (LGE) keradanganPeradarahan spontan Tidak selalu sakit Muncul tanpa disertai adanya plak gingivaProfil mikrobiologi pada cairan gusinya sama dengan profil kelainan periodontalManifestasi awal dari HIV
TREATMENT• Periodontal scaling• Peridex
BACTERIAL
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ULCERATIVE
APTHOUS ULCER
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APTHOUS ULCER
bentuk : seperti kawah pada ermuaan membran mukosa,nyeri, berbentuk seperti nanah, sering muncul pada : stress, makanan asam,trauma dan medikasi klinis : mirip CMV (Cytomegalovirus)bentuk
TREATMENT• Topical steroids mixed with Orabase
ULCERATIVE
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BACTERIAL
NECROTIZING ULCERATIVEPERIODONTITIS (NUP)
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NEOPLASM
KAPOSI’S SARCOMA (KS)
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KAPOSI’S SARCOMA (KS)NEOPLASM
awalnya : lesi tidak menonjol/datar,tidak sakit kemudian berkembang menjadi papula dan nodula paling sering ( terutama ) pada pria dengan HIV AIDS Studi terbaru menunjukkan bisa disebabkan herpes virus-HHV 8yang ditularkan secara sexual
TREATMENT•Radiation therapy•Chemotherapy•Immuno-modulator drugs
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NEOPLASM
NON-HODGKIN’S LYMPHOMA
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NON-HOGKIN’S LYMPHOMA
NEOPLASM
keganasan urutan kedua yang paling sering diemui pada AIDS Tumor muncul introral sebagai massa jaringan lunak Tumbuh lebih cepat dan menyebar keluar menuju sistem limfenodi jika disertai AIDS
TREATMENT•Radiation therapy•Chemotherapy•Immuno-modulator drugs
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APA YANG TELAH KITA LIHAT SETELAH HAART (HIGHLY ACTIVE ANTI-RETROVIRAL
THERAPY) TELAH DIBERIKAN ?
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MANIFESTASI ORAL AKIBAT TERAPI HAART YANG LAMA
Salivary HypofunctionSalivary Hypofunction
Increase in Salivary Gland Disease Increase in Salivary Gland Disease
Increase of Oral Warts (HPV) for those on a ProteaseIncrease of Oral Warts (HPV) for those on a Protease
InhibitorInhibitor
Decrease in Oral CandidiasisDecrease in Oral Candidiasis
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SALIVARY GLAND HYPOFUNCTION
DIHUBUNGKAN DENGAN : HAART and other medications Karena pertumbuhan yang berlebih organnisme rongga mulut Periodontal disease and root caries sulit mengunyah dan hilang nya fungsi pengecapan sulit memakai gigi tiruan karena retensi gigi berkurang dan injuri pada jaringan
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SALIVARY HYPOFUNCTION
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SALIVARY GLAND ENLARGEMENT
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ORAL LESIONS AND USE OF ANTIRETROVIRAL THERAPY
Greenspan, D et alThe Lancet Vol 357 May 5, 2001
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WHAT DO WE NEED?
MORE PROSPECTIVE RESEARCHIN THIS AREA
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WHAT HAVE WE SEEN?
Oral lesions are important indicators for HIV diagnosis and disease progression
HAART has changed the prevalence of specific types of lesions
The oral cavity can be a window to overall health
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QUESTIONS
OR
COMMENTS?