Thomas has made an appointment with his dentist, Dr. Henry, because he feels that his max-illary complete denture does not fit as it has in the past. He has had to use a denture adhesive because his no longer has the suction and the retention that is characteristic of this denture. Thomas also feels that the shape of his hard and soft palate has changed and feels that there is excess tissue displacing his denture away from the palate.
Thomas has not returned to see Dr. Henry since his dentures were made ten years ago since he was satisfied with the form and function of the dentures. When Dr. Henry reviews Thomas’s medical history he learns that Thomas was diagnosed with HIV about eight years ago. Thomas indicates that he has lost his job in the economic downturn and has not been able to afford his HIV medications for a long time. When he had insurance through his employer he could afford these medications, but was often noncom¬pliant due to the adverse side effects.
When Dr. Henry performs an oral examina¬tion, he notices a moderate-sized bluish-purple lesion that extends from the left ridge crest onto much of the left soft palate. The lesion is elevated and does not bleed. The size of the lesion is such that stability of the denture is compromised as the alteration of the soft pal¬ate anatomy in the area of the posterior palatal seal (post-dam) is lacking and precluding the ability to obtain the characteristic suction seal of the maxillary denture. Thomas just wants Dr. Henry to “fix” his denture so it fits better and so he can stop using his denture adhesive.
Questions
- Given the update in Thomas’s medical his¬tory, what is the most likely diagnosis of the lesion seen in the maxillary arch?
- What can Dr. Henry do to help alleviate Thomas’s symptoms?
Discussion
- Until a biopsy is completed, a definitive diagnosis cannot be made. However, given the HIV diagnosis, the lack of compliance with his HIV medications, and the loca¬tion and clinical appearance of this lesion, it is most likely Kaposi’s sarcoma. Dr. Henry must address the medical needs of Thomas first and refer him to a physician immediately. Kaposi’s sarcoma is an AIDS-defining condition that reflects a CD4+ lymphocyte count that is (less than) 200 cells/micro¬liter or (less than) 14% of the total lymphocyte count. Thomas is susceptible to many opportunistic infections that can be potentially fatal. The county health department may be a referral option that provides medical services on a sliding income scale or at a minimal cost.
- Dr. Henry may be able to place a chairside soft reline material in the maxillary denture that captures the altered anatomy of the pal¬ate to provide a better adaptation. However, these lesions can change in shape and size and new lesions can emerge that could negate any benefit obtained from the soft chairside reline material. The primary obli¬gation that Dr. Henry has toward Thomas is referring him for the appropriate medical care immediately.