HIV and oral health
Oral changes are common in people with HIV. They can occur because of the weakened immune system and side effects of HIV drugs and other medications. Oral problems can cause discomfort, leading to trouble with eating and sleeping. Taste can be affected and often results in decreased appetite and changes food choices and eating patterns, which can affect overall health and the ability of the body to cope with the virus.
Your dental practitioner
Dental care can be challenging with HIV infection and the side effects that can occur with its treatment, which is why keeping on top of your oral health is important. Your dental practitioner should develop your oral health care in partnership with your doctor. Visit your dental practitioner regularly for check-ups, preventive care and advice about home care products.
Disclosing your HIV status
There is no legal requirement for people with HIV to disclose their health status to a health practitioner. However, HIV often presents with some unique oral health problems. Disclosing your health status and providing details of the HIV drugs and other medications may lead to improved health outcomes.
Remember, whether your health status is disclosed or not, every person has the right to fair and adequate treatment provided in a caring and non-discriminatory manner. You also have no legal requirement to disclose your health status to a health practitioner for their protection—dental practitioners are trained in infection control procedures that reduce the risk of exposure to blood-borne viruses.
Maintaining a healthy mouth
Practicing good oral hygiene every day can minimise your exposure to opportunistic infections. It’s also important to take time to look inside your mouth for signs of infections and obvious changes.
Here are 5 essential steps to maintaining a healthy mouth:
- Brush teeth at least twice a day, in the morning after breakfast and just before bed. Use a small, soft-bristled toothbrush and fluoride toothpaste.
- Floss your teeth once a day prior to brushing. Flossing may be difficult at first but becomes easier with practice. There are alternative devices for flossing such as interproximal brushes and sticks. If you are unsure which type of dental floss to use, consult your dental practitioner.
- Drink plenty of water, 2 to 3 litres per day. This is required for an adequate production of saliva, which is the body’s natural defence against acid attacks. Chewing sugar-free gum will also increase saliva production and flow.
- Eat well-balanced, healthy meals. Limit the consumption of snacks between meals, and drinks that are sugary and/or acidic. Increasing dairy products may be helpful as these contain calcium and a protein that strengthens tooth enamel.
- Visit your dental practitioner regularly for check-ups, preventive care and advice about home care products.
Common changes to the mouth
Dry mouth
A dry mouth (xerostomia) is caused by a salivary gland dysfunction. There may be a decrease in the amount of saliva produced and its quality.
Saliva is the body’s natural defence against tooth decay. Without saliva to lubricate the mouth, wash away food and neutralise harmful acids produced by plaque, foods and drinks, your teeth are at risk of extensive decay.
HIV infection can cause swollen salivary glands, which can cause dry mouth. Dry mouth can also be caused by the side effects of HIV drugs and other medications (e.g. antidepressants, antihypertensives, antihistamines and diuretics), the use of recreational drugs or presence of other infections.
You may experience a sore throat, difficulty swallowing, excessive thirst, bad breath and burning or tingling sensations of the tongue or mouth.
Your doctor or dental practitioner determine the cause of your dry mouth and offer advice regarding treatment. It may simply be a matter of making changes such as reducing your intake of caffeinated beverages and increasing your intake of water. A dental practitioner may also recommend the use of products such as fluoride mouth rinses, gels, or toothpastes with a higher level of fluoride to provide extra protection against decay and erosion.
To relieve the discomfort of a dry mouth you can chew sugar-free gum to increase saliva flow or use ‘saliva substitutes’ which are available from most pharmacies. You may also try using a small spray bottle (atomiser) to frequently spray water into the mouth or take frequent small sips of water.
Clenching and grinding
Habitual clenching and grinding of the teeth can occur either during sleep or as an unconscious action during waking hours. Clenching and grinding can cause severe tooth wear and jaw and joint pain.
Some HIV drugs can affect sleep, mood or anxiety levels and increase the likelihood of clenching and grinding. Dry tooth surfaces are prone to increased wear from clenching and grinding. HIV drugs and other medications may cause a dry mouth which can leave teeth vulnerable to tooth-to-tooth contact. Dry tooth surfaces also have an increased risk of acid damage from foods, drinks and drugs.
If you know or suspect you are clenching or grinding your teeth, speak to your dental practitioner.
Taste changes
Taste changes can occur as a side effect of HIV drugs and/or oral thrush (candidiasis). Rinsing the mouth with water or a neutralising mouth rinse before eating may help with taste. Consult your doctor or dental practitioner for advice on a neutral mouth rinse or other products which may be suitable.
Common Infections
Oral thrush
Oral thrush (candidiasis) is a fungal infection of the mouth and/or throat. A compromised or weakened immune system, such as in a person with HIV, provides an opportunity for an overgrowth of fungi leading to infection.
Oral thrush commonly occurs on, but is not limited to, areas of the tongue, roof of the mouth and inside of cheeks as small or large white patches. These patches can be wiped off with a cloth, exposing red ‘raw’ tissue underneath. The mouth will often feel furry, sore and itchy.
When thrush is unmanaged, it can cause a significant change in taste, loss of appetite and subsequent weight loss and an overall decline in health. Antifungal medications are available for use in the mouth. An antiseptic mouth rinse or gel containing chlorhexidine may help. In addition to advice from your doctor or dental practitioner, you may wish to seek the advice of a nutritionist or dietician regarding nutritional approaches to help manage oral thrush.
Angular cheilitis
Angular cheilitis can be caused by fungal and/or bacterial infections, poor nutrition or immune deficiencies. It presents as cracked, red crusting at the corners of the mouth, which often bleeds when the mouth is opened.
To prevent the infection, keep lips moist with lip balm, practice good oral hygiene and keep hydrated by drinking lots of water. Consult your doctor or dental practitioner for advice and treatment.
Oral hairy leukoplakia
This condition is believed to be caused by a virus and often occurs early in HIV infection. It is not dangerous but can indicate a weakened immune system. It appears as white folded patches, typically on the tongue or in other areas of the mouth. Ask your doctor or dental practitioner for advice if this condition is causing pain or interfering with eating and speaking.
Gum disease (gingivitis and periodontitis)
Gingivitis is inflammation of the gums, which become red and swollen, and bleed easily. It may be more noticeable when brushing or flossing. Gingivitis is rarely painful and is reversible with effective oral hygiene practices. However, if gingivitis is not managed, it may lead to the more serious condition of periodontitis.
Periodontitis is a deep inflammation of the gums and affects the bone holding the teeth in place. If left untreated, periodontitis may destroy the attachment that holds the tooth in the bone leaving a space or ‘pocket’ where more bacteria can collect and cause permanent bone loss. The teeth become loose and may eventually be lost. The major cause of gum disease is bacterial plaque. This colourless, sticky film contains millions of bacteria, and constantly forms on teeth. Brush and floss every day to remove plaque.
Visit your dental practitioner regularly to help you develop an effective tooth cleaning method. Your dental practitioner can remove calculus (scale or tartar) from around the teeth and from root surfaces.
Other Conditions
Mouth ulcers
Mouth ulcers can be very painful and affect a person’s ability to eat. They present as red lesions characterised by a halo of inflammation, often with a yellow-grey covering. Ulcers can appear on the floor of the mouth, gum tissue adjacent to the teeth, on the tongue and inside the cheeks.
Mouth ulcers can be associated with a compromised immune system, HIV drug side effects and localised trauma to the area. Mouth ulcers can be symptoms of other viruses and should be mentioned to your doctor or dental practitioner as soon as they appear.
Warm saltwater used as a mouth rinse may aid healing and provide relief from mouth ulcers. Over-the-counter products from the pharmacy may also provide temporary relief. In more persistent and severe cases, prescription medication may be required.
Kaposi’s sarcoma (KS)
This condition is an abnormal growth (tumour) which occurs in the later stages of HIV infection. KS most commonly appears as flat or raised purple spots on the skin and can also occur in the mouth. It is important to seek advice from your doctor or dental practitioner soon as you notice any unusual swellings, growths or soft tissue discolouration within the mouth. Treatments used to boost the immune system in persons with HIV help to resolve KS lesions.