Book Review

Oral Manifestations of HIV Infection

N Engl J Med 1995; 333:328-329August 3, 1995

Article

Oral Manifestations of HIV Infection
Edited by John S. Greenspan and Deborah Greenspan. 381 pp., illustrated. Carol Stream, Ill., Quintessence, 1995. $64. ISBN: 0-86715-286-9

It can be argued that the historical accident whereby medicine and dentistry became separate realms has been detrimental to patient care. This is particularly true for patients with conditions that straddle the line between the two realms (i.e., systemic illnesses with serious oral manifestations or oral conditions that take on special importance in medically compromised patients). In the past decade and a half, human immunodeficiency virus (HIV) infection has superseded infective endocarditis as the example par excellence of this phenomenon. The publication of Oral Manifestations of HIV In- fection is a service to both the medical and dental communities, at least in part because it represents a concerted interdisciplinary effort to shed light on aspects of HIV infection and AIDS that have tended to fall between the two disciplines of medicine and dentistry.

The participants in the Second International Workshop on the Oral Manifestations of HIV Infection, who have contributed the chapters in this book, represent a broad spectrum of clinical and scientific disciplines, educational backgrounds, institutions, and countries. The chapters range from descriptions of the specialized dental facilities that have been established for the treatment of patients with AIDS to formal reports from research laboratories.

The book opens with an excellent brief presentation of the public health perspective on the AIDS pandemic. The section on the epidemiology of oral lesions is also excellent. Collectively, the six chapters in this section relate the oral findings to the more general clinical manifestations of HIV infection. The majority of the chapters in the book, which are clinical in nature, are helpfully grouped according to the principal clinical manifestations of HIV infection or AIDS in the oral cavity: candidiasis, salivary-gland disease, Epstein–Barr virus and hairy leukoplakia, Kaposi's sarcoma, oral ulcers, and HIV-associated periodontal conditions. Other chapters deal with HIV infection in children, occupational safety in the dental environment, and systems for providing dental health care to patients with HIV infection or AIDS.

The six chapters on periodontal disease in the context of HIV infection or AIDS are of great interest. The last of these papers is a provocative review of the issues addressed by poster presentations at the conference. As a group, these chapters provide a succinct and unusually candid view of what is known (and not known) about the pathogenesis of periodontal disease in otherwise healthy persons and clearly depict the altered clinical picture in patients with HIV infection or AIDS. The subtle but important question whether gingivitis and periodontitis associated with HIV infection are extensions of these conditions in normal people or separate entities is addressed in an engaging and thoughtful manner.

The clinical articles are accompanied by photographs, many in color, that show typical lesions. These images will prove useful to clinicians in identifying oral findings that may be premonitory signs of HIV infection or AIDS.

The first section of the book, on HIV in women, is a disappointment, because it contains only one chapter. Moreover, the title of this chapter, “The Natural History of HIV Infection in Women,” is misleading, since the discussion deals not with HIV infection itself but with vaginal and oral candidiasis in seropositive women and in seronegative women at high risk for HIV infection. Despite the appropriateness of a section devoted to HIV infection in women, it might have been better in the absence of other discussions of this important topic to include this paper in the section on candidiasis.

Oral Manifestations of HIV Infection conveys a vivid sense of urgency very much in keeping with the ongoing devastation attributable to this virus.

Edward B. Seldin, D.M.D., M.D.
Massachusetts General Hospital, Boston, MA 02114