Clinical Manual for Management of the HIV-Infected Adult
2006 Edition

Section 6: Disease-Specific Treatment

Linear Gingival Erythema

Background

Linear gingival erythema is inflammation of the margins of the gingiva. It is characterized by a 2-3 mm band of intense erythema around the necks of the teeth that does not resolve with routine oral hygiene. The erythematous changes usually are generalized, but may be confined to a few teeth. This condition is one of the most common oral manifestations of advanced HIV/AIDS. It also may be referred to as HIV gingivitis or red-band gingivitis.

S: Subjective

The patient may complain of bleeding, tender gums, and a bad taste in the mouth.

O: Objective

Examine the oral cavity carefully for inflamed gingival tissues, which bleed easily upon manipulation (including brushing). This condition is seen most commonly in the buccal area of lower anterior teeth, as a continuous red band around the necks of teeth.

A: Assessment

The differential diagnosis includes necrotizing gingivitis, periodontitis, and Kaposi sarcoma. (See chapters on Necrotizing Ulcerative Periodontitis and Gingivitis and Kaposi Sarcoma for more information.)

P: Plan

The diagnosis is based on clinical features; perform additional testing to rule out other causes, as indicated. Recommend patient education and counseling, meticulous home care, frequent dental visits during treatment phase, and regular recall visits. Refer for nutrition counseling as needed.

Treatment

Linear gingival erythema should be treated aggressively to prevent progression to necrotizing periodontal disease; referral should be made for prompt dental care and the patient should be educated in oral hygiene techniques.

A chlorhexidine gluconate (0.12%) rinse twice daily for 2 weeks will relieve some of the symptoms. Refer to a dentist or dental hygienist for a thorough dental prophylaxis (cleaning). If this combination is not successful, it may be appropriate to add an antibiotic such as:

• Metronidazole 250 mg orally 4 times daily for 7 days
• Amoxicillin-clavulanate (Augmentin) 875 mg orally twice daily for 7 days
• Clindamycin 150-300 mg orally 4 times daily for 7 days

Patient Education

• Good oral hygiene is essential to management, especially with concomitant periodontitis. Advise patients to brush and floss after every meal. Any rinses prescribed by care providers should be used after brushing.
• Advise patients not to eat or drink for 30 minutes after rinsing with chlorhexidine gluconate.
• Urge regular dental checkups and cleaning at least every 3-6 months.
• Patients should not drink alcohol while taking metronidazole, and for at least 48 hours after the last dose.

References

• Bravo IM, Correnti M, Escalona L, et al. Prevalence of oral lesions in HIV patients related to CD4 cell count and viral load in a Venezuelan population. Med Oral Patol Oral Cir Bucal. 2006 Jan 1;11(1):E33-9.
• Coogan MM, Greenspan J, Challacombe SJ. Oral lesions in infection with human immunodeficiency virus. Bull World Health Organ. 2005 Sep;83(9):700-6.
• Kroidl A, Schaeben A, Oette M, et al. Prevalence of oral lesions and periodontal diseases in HIV-infected patients on antiretroviral therapy. Eur J Med Res. 2005 Oct 18;10(10):448-53.
• Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century--the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2003 Dec;31 Suppl 1:3-23.
• Reznik DA. Oral manifestations of HIV disease. Top HIV Med. 2005 Dec-2006 Jan;13(5):143-8.