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Oral Conditions and HIV

Dry Mouth
Oral Ulcers
Teeth Clenching and Grinding
Thrush
Oral Hairy Leukoplakia
Cold Sores (Herpes Simplex)
Herpes Zoster (Shingles)
Angular Cheilitis
Gingivitis and Periodontitis
Osteoporosis

Severe oral health problems were common before HIV treatments but are rare these days. However, 90% of people with HIV will develop at least one oral condition related to HIV. Conditions like Candidiasis and Hairy Leukoplakia may be early signs of immune weakness. Knowing what to look out for will help identify problems before they become more serious or losing teeth.

Dry Mouth (Xerostomia – pronounced ‘Zero-stomia’)

Dry Mouth (Xerostomia – pronounced ‘Zero-stomia’) or lack of saliva can be caused by HIV, HIV medications, prescribed drugs and recreational drugs, which affect saliva glands. If you feel this may be affecting you, contact your doctor.

Food can build up between the teeth promoting tooth decay, gum disease and thrush. Without saliva to wash away food, teeth can decay quickly, fillings can break down, abscesses can form and teeth may need to be extracted. A dry mouth can also affect a good night’s sleep.

To relieve dryness and preserve soft tissue:

Keep water by your bed for sipping during the night and on waking. Take frequent sips or use a spray to wet your mouth
Chewing sugarless chewing gum, lollies or ice
Use anti-bacterial, alcohol free mouthwash (eg. Biotene) and ‘Dry Mouth Toothpaste’, which contains salivary enzymes
Sip water frequently while eating
Use bland, non-spicy sauces and gravies or creamy sauces, which can be easier to swallow
Limit caffeine (coffee, tea and cola)

Talk with your dentist and/or chemist about products that can help with dry mouth such as oral lubricants and saliva substitutes.

Oral Ulcers (Aphthous Ulcers)

Oral Ulcers (Aphthous Ulcers) occur on the mucous membranes (mouth surfaces) as open sores. They can make eating difficult and uncomfortable. They are commonly caused by a reinvigorated immune system after commencing anti-retroviral therapy, although a suppressed immune system, medication side effects and injury to the area may also lead to oral ulcers. They may also be a symptom of other viruses.

When an ulcer or lesion does not heal after 10 days, talk to your doctor or dentist to enable diagnosis, treatment and prevent further progression.

Clenching & Grinding Teeth

Clenching & Grinding Teeth. Stress, anxiety and physical factors like an abnormal bite can cause teeth and gums to become painful, sore and sensitive, and results in wear of the teeth. Some HIV drugs which affect sleep, mood and anxiety, antidepressant medications, amphetamines and ecstasy can all contribute to teeth grinding.

Talk with your doctor and/or dentist about tooth grinding. A simple mouth guard worn at night can reduce symptoms.

Thrush (Oral Candidiasis)

Thrush (Oral Candidiasis) is perhaps the most common oral condition in people with HIV. Symptoms include red or white patches and grooves on the inside of your mouth. They may or may not cause minor pain. Even a mildly compromised immune system may not keep the fungus in check. Most outbreaks occur when the CD4+ cell count falls below 400. Stress, depression, and antibiotics may also lead to thrush. Early detection and treatment is crucial. Leaving thrush untreated commonly results in disturbed taste, pain, loss of appetite and weight loss. Progression of thrush to your airway or throat is a serious problem.

If you notice any symptoms, talk with your doctor or dentist ASAP.

Oral Hairy Leukoplakia

Oral Hairy Leukoplakia is a viral infection and a very common HIV oral condition. Symptoms include corrugated or folded white patches on the sides of the tongue or walls of the mouth, with hair-like particles along the folds. The condition is not generally painful or serious and can occur very early in HIV disease, but may indicate increasing risk of more serious illness and should be mentioned to your doctor.

If you notice symptoms, talk with you doctor or dentist.

Cold Sores / Herpes Simplex

Cold Sores / Herpes Simplex As well as sores on the lips, herpes can appear inside the mouth as ‘bubbles’ on the gums and on the roof of the mouth. It can also appear on the back or sides of the tongue or cheeks, with fever, pain and loss of appetite. They can be small and almost painless, or extensive, persistent and more troublesome. Simple treatment can be effective if started early.

If you notice any symptoms, talk with you doctor or dentist ASAP

Herpes Zoster (Shingles)

Herpes Zoster (Shingles) is a reactivation of the same virus that causes Chickenpox. Outbreaks produce sores on the skin or in the mouth. The sores begin as ‘bubbles’ and then break and crust over. Treatment should be started ASAP.

If you notice symptoms, talk with your doctor or dentist ASAP

Angular Cheilitis

Angular Cheilitis is a mixed infection, causing sore cracks in the corners of your mouth. It can occur more if lip-seal is poor because of poorly fitting dentures, mouth breathing or snoring. It can be treated with over-the-counter anti-fungal and anti-bacterial creams such as Daktarin. It is important not to moisten lips by licking.

If you notice symptoms, talk with you doctor, dentist or chemist.

Gingivitis and Periodontitis

Gingivitis is a common bacterial inflammation of the gums, sometimes accompanied by bleeding and bad breath. Bleeding gums are the earliest sign of many diseases and should be investigated. Bleeding may be less obvious among people who smoke. Periodontal diseases affect the gums, teeth and underlying bone. People with HIV are susceptible to aggressive forms of these conditions. Without proper dental care, severe problems can occur.

Gingivitis can be prevented by regular brushing, using fluoride toothpaste with a soft toothbrush and flossing. Short term use (less then 2 weeks) of an anti-microbial mouthwash containing Chlorhexidrine gluconate is sometimes advised in addition to good brushing and cleaning between the teeth. Other mouthwashes, without chorhexidine, are not usually recommended as the high alcohol content dries the mouth and dilutes the protective film of saliva.

If you notice any symptoms, it is important that you see your doctor or dentist as soon as possible. Left untreated, Gingivitis and periodontal disease can have serious consequences.

Osteoporosis

There is increasing concern for the development of osteoporosis (bone thinning) in people with HIV. If bisphosphonate therapies (either oral or intravenous) are suggested to you, it is extremely important to ensure that your teeth and gums are in excellent condition. There have been reports of severe infections following dental extractions.

Tell your dentist if you are being treated for Osteoporosis.