Immunodeficien

cies and their

oralDone by :

manifestations
Mohammad salah qrea
5th year
And presented to
Dr. fahed habash
 Immunity
• A complex interaction of certain types of
cells.
• Innate immunity with born vs. adaptive
immunity along time.
 Innate immunity

Interferons
Phagocytes

Skin Complement system

 IMD disorders
• Part of the body's immune system is
missing or defective.
• impairing the body's ability to fight
infections.
• As a result, the person with an IMD will
have frequent infections that are generally
more severe and last longer than usual.
 Types of IMDs
• Primary or congenital ID.
• Acquired ID.
 Primary IMD
• Congenital disorder of one or more of
immune system.
• T and B cell defects.
• Phagocytes defects.
• IgA deficiency.
 Acquired IMD
• Infections (HIV, chicken pox, German
measles, measles, tuberculosis, chronic
hepatitis, lupus, bacterial and fungal
infections).
• Malnutrition (vitamins, iron, and zinc).
• Some cancers.
• Some drugs.
• Some metabolic diseases.
• Alcoholism.
 Prevention of AIMDs
• Good nutrition.
• Avoiding responsible infections.
• And safe sex “ for AIDS prevention,
IF YOU DON’T KNOW YOUR PARTNER
USE CONDOM”
• Illegal intravenous drugs.
Oral manifestations of IMD
disorders
JANE C. ATKINSON, D.D.S., ANNE O’CONNELL, B.DENT.SC., M.SC. and DORON
AFRAMIAN, D.M.D., M.SC.
 General rule
Candidal infections +
T-cell deficiency herpetic infections

B-cell deficiency Bacterial infections

Phagocyte Periodontitis +
deficiency candidal
 T- CELL DEFICENCY

Severe pseudomembranous candidiasis in a young man with Job’s syndrome.

phagocyte function
leukocyte adhesion deficiency
leukocyte adhesion deficiency
 Treatment modalities
• Bone marrow transplantation.
• Prophylactic antibiotic regimens.
• Aggressive preventive dental care.
Secondary immunodeficiency oral
manifestations
 Acquired immunodeficiency
syndrome
 Causative agent: HIV

 Target cells: CD4+ T cells, monocytes,

macrophages, dendritic cells, etc.

 Importance of gp120
• Diagnosis: detection of viral Ag, anti-
viral Ab
• Prognosis: CD4/CD8 ratio, skin tests
(DTH), Lymphocyte transformation
test
• Treatment:
• 1. Treatment of microbial infections
• 2. Anti-viral drugs
• 3. Immunorestoration: BM
transplantation, Ig injections,
cytokines
Oral manifestations of

AIDS
• Fungal
Candidiasis Pseudomembranous Erythematous
Angular cheilitis Histoplasmosis
Cryptococcosis.
• Viral Herpes simplex Herpes zoster Human
papillomavirus lesions Cytomegalovirus ulcers
Hairy leukoplakia
• Bacterial Linear gingival erythema Necrotizing
ulcerative Periodontitis Mycobacterium avium
complex Bacillary angiomatosis
• Neoplastic Kaposi's sarcoma Non-Hodgkin's
lymphoma
• Other Recurrent aphthous ulcers Immune
thrombocytopenic purpura HIV salivary gland
disease.
 CANDIDIASIS
• Exfoliative cytology, biopsy for
diagnosis.
• TREATED BY:
• Topical antifungal (e.g., nystatin [Mycostatin].
• Suspension, clotrimazole [Mycelex] troches,
fluconazole [Diflucan] suspension.
• Or systemic antifungal (e.g., fluconazole,
ketoconazole [Nizoral], itraconazole [Sporanox])
 Pseudomembranous candidiasis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA,

CHARLESTON, SOUTH CAROLINA
 Median rhomboid glossitis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA,

CHARLESTON, SOUTH CAROLINA
 Angular cheilitis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA,

CHARLESTON, SOUTH CAROLINA
Histoplasmosis
Oral thrush
 Recurrent aphthous stomatitis
• Yellowish white pseudomembrane
surrounded by erythematous zone.

• Treated by:
• Fluocinonide gel (Lidex) or triamcinolone
acetonide (Kenalog in Orabase), amlexanox
paste (Aphthasol), chlorhexidine gluconate
(Peridex) mouthwash.
 Recurrent aphthous stomatitis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA,

CHARLESTON, SOUTH CAROLINA
Multiple canker sores
 Erythema migrans
• Migrating, central erythema surrounded by
white- to-yellow elevated borders; typically
on tongue.

• TREATED BY:
• Symptomatic cases may be treated with
topical corticosteroids, zinc supplements,
or topical anesthetic rinses.
 Erythema migrans
waxes and wanes

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA,

CHARLESTON, SOUTH CAROLINA
 Hairy tongue
• Elongated filiform papillae.
• Predisposing factors, smoking, poor oral
hygiene, antibiotics and psychotropics.

• TREATED BY:
• Regular tongue brushing or scraping;
avoidance of predisposing factors
 Hairy tongue

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA,

CHARLESTON, SOUTH CAROLINA
VIRUSES
 Recurrent herpes labialis
• Prodrome, 12 to 36 hours, rupture vesicles.
• Reactivation triggers: ultraviolet light,
trauma, fatigue, stress, menstruation.

• TRAETED BY:
• Topical agents include 1% penciclovir cream
(Denavir)
• Systemic agents (e.g., acyclovir [Zovirax],
valacyclovir [Valtrex], famciclovir [Famvir]) are
most effective if initiated during prodrome.
 Recurrent herpes labialis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA,

CHARLESTON, SOUTH CAROLINA
Herpes zoster
Human papilloma virus
 Cytomegalovirus
• Ulcers confused with aphthous ulcers.
• necrotizing ulcerative periodontitis and
lymphoma.
Hairy leukoplakia EBV
Kaposi's Sarcoma
Lymphoma
Idiopathic Thrombocytopenic
Purpura
 Immunosuppresive drugs
• glucocorticoids
• cytostatics
• antibodies
• drugs acting on immunophilins
• other drugs.
And thanks