Seasonal variation of acute necrotising ulcerative gingivitis in South Africans.

OBJECTIVES: To examine seasonal variations in the presentation of acute necrotising ulcerative gingivitis (ANUG) in a previously unstudied population in Cape Town, South Africa. DESIGN: A descriptive study of all presenting cases of ANUG at a health center over 6 years; patients were examined at one point in time. SETTING: A clinic-based cross-sectional study was carried out among patients presenting routinely to the oral medicine clinic at the University of the Western Cape. Patients at this clinic were mostly colored and black people, and were of low socioeconomic status. SUBJECTS AND METHODS: All patients presenting to the periodontal clinic were examined during the period from 15 March 1992 to 15 March 1998 and interviews were conducted. A comprehensive clinical intra-oral and peri-oral examination was carried out using a dental mirror and blunt probe by three trained calibrated dental examiners. The minimum criteria for inclusion as an ANUG patient were painful, bleeding gums with irreversible destruction of the interdental papillae (cratering) and marginal gingiva. Patients with multiple small ulcerations not restricted to the gingiva, but including other oral sites such as the tongue and buccal mucosa were diagnosed as herpetic stomatitis. Other distinguishing characteristics of ANUG included presence of a pseudomembrane, odor, a strange taste in the mouth, and hypersalivation. Swabs and biopsies taken to verify the diagnosis when necessary. If there was any doubt as to the diagnosis of the lesion it was not included among the ANUG cases. MAIN OUTCOME MEASURE: Presence of ANUG. RESULTS: Among the 19944 patients presenting for periodontal treatment, 684 were found to have ANUG. The ANUG patients consisted of 58% males; 73% of the ANUG patients were between the ages of 5 to 12 years. The majority of ANUG patients presented during the summer (55.4%), 27.7% in autumn and 8.4% during both winter and spring. Significant differences were evident between the numbers seen during the different seasons. CONCLUSIONS: This study demonstrated a significant seasonal variation in the occurence of ANUG in Cape Town, South Africa.

Oral manifestations of HIV infection in 600 South African patients.

Oral lesions associated with HIV infection, as classified by the EC-Clearinghouse on Oral Problems related to HIV infection and the WHO Collaborating Centre on Oral manifestations of the immunodeficiency virus, were studied in 600 consecutive HIV-infected patients in Cape Town, South Africa. One or more lesions were seen in 60.4% of cases. Combined candidal lesions were evident in 37.8%, hairy leukoplakia in 19.7% and combined gingival/periodontal lesions in 8.5% of patients seen. Lesions less commonly recorded include oral ulceration (2.9%) and Kaposi's sarcoma (1.5%). The clinical range of lesions seen is similar to those reported elsewhere, but socio-cultural differences allowed no reliable comparison. More than a quarter of our patients had oral soft tissue discomfort necessitating treatment; in 3.3% these were the presenting symptom. This indicates a potential major public health concern requiring education in recognition and appropriate referral and management.

PIP: The prevalence and clinical appearance of oral manifestations of HIV were investigated in 600 consecutive HIV patients examined at health care facilities in Cape Town, South Africa, in 1993-96. At least 1 oral lesion was present in 362 patients (60.4%). 160 oral manifestations (26.7%) were symptomatic and required treatment. The majority of lesions (37.8%) were candidosis, primarily pseudomembranous and erythematous types. Oral hairy leukoplakia was present in 19.7% of patients, while HIV-related peridontal disease was noted in 8.5%. 20 HIV-positive patients (3.3%) presented with an oral manifestation of HIV infection before HIV was diagnosed. Classifications were based on guidelines developed by the EC-Clearinghouse on Oral Problems Related to HIV Infection and the World Health Organization Collaborating Center on Oral Manifestations of the Immunodeficiency Virus. These findings, which are similar to those reported in other developed and developing countries, indicate a need for education on the recognition and appropriate management and referral of oral manifestations of HIV infection.