Timothy M. Durham

Oral histoplasmosis in a patient infected with HIV. A case report

Histoplasmosis is a frequent complication of HIV infection and is usually the result of reactivation. In the immunocompromised host, histoplasmosis may cause a chronic pulmonary infection or disseminated disease. In the setting of disseminated disease, oral lesions are present in 30% to 50% of patients and may occur in almost every part of the oral mucosa. The most common sites are the tongue, palate, and buccal mucosa. In some cases, oral lesions appear to be the primary or only manifestation of disease. We have been able to find only five case reports in the literature of histoplasmosis in HIV infection with oral lesions. In two of the cases, histoplasmosis was apparently localized to the oral cavity, whereas two cases also had evidence of disseminated disease, the fifth was undetermined. We report one such case of apparently localized oral histoplasmosis in a patient with HIV infection.

Facial nerve paralysis related to HIV disease: Case report and dental considerations

Neurologic manifestations of human immunodeficiency virus disease have been well documented and include peripheral neuropathy of the facial nerve. HIV-related peripheral facial nerve paralysis may be of predictive value in endemic populations, and it may be associated with acute HIV infection. It may herald the onset of seroconversion, and it is more common in the later stages of HIV disease. Treatment is palliative in nature and, although self-limiting, the condition may be of an extended duration and result in increased patient morbidity. The nutritional impact of HIV-related peripheral facial nerve paralysis on the patient and associated exacerbation of oral manifestations of HIV disease resulting from the presence of oral dryness are addressed. Early dental intervention is essential to reduce patient morbidity.

Oral health outcomes in an adult dental population: the impact of payment systems

This study compared the effect of payment systems on recall visits and oral health outcomes for four patient payer groups. The authors reviewed recall audit data obtained over a 4-year period. Dental payer groups in the study population differed with respect to dental outcomes. Patients who had recall visits at 1 year or longer had worse outcomes than patients seen more frequently. A Medicaid subgroup with the greatest number of risk factors displayed improved oral health outcomes when seen on a more frequent recall schedule. Study findings suggest that, given the increased risks to maintaining oral health, patients being supported by public-funded programs would benefit from more frequent recalls. Such an emphasis would appear to provide the opportunity to improve outcomes in disadvantaged populations and increase the quality of care offered.