Clinical Manual for Management of the HIV-Infected ... - myCME.com

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
Section 6—Disease-Specific Treatment | 6–109
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.