HIV/AIDS: Oral Effects
The oral effects of HIV and AIDS occur because of your weakened immune system and the medicines you must take. These effects are also found in other people with weakened immune systems.
- Dry mouth (xerostomia)
- Enlarged lymph nodes (lymphadenopathy)
- Thrush (oral candidiasis)
- Hairy leukoplakia associated with a viral infection (Epstein-Barr virus)
- Oral bacterial infections such as periodontal (gum) disease
- Swollen salivary glands
- Herpes simplex virus sores
- Human papilloma virus warts
- Canker sores (aphthous ulcers)
- Kaposi's sarcoma (no longer frequently seen)
If you have HIV, changes in your mouth may reflect changes in your immune status. Some oral conditions are seen when your immune system first starts to get worse. Others are seen at later stages.
Your dentist can show you how to do an oral exam and teach you to look for certain oral changes. If you see these changes, you should alert your dentist or physician.
Daily brushing with toothpaste, flossing, use of fluoride mouthwashes, and regular dental visits are important for people infected with HIV. When your immune system is still strong, visit your dentist every six months. However, if your disease gets worse, you should see your dentist more often.
Dry mouth (xerostomia) is a common side effect of medicines that you may take for HIV/AIDS. Dry mouth can make you more prone to tooth decay, gingivitis, thrush (oral yeast infection) and periodontal (gum) disease. That's because you have less saliva, and the quality of the saliva is changed. Besides water, saliva includes electrolytes, mucus, antibacterial compounds, enzymes and other proteins. The amounts of these substances change in people with dry mouth. A decrease in saliva reduces its ability to wash away sugars, food, bacteria and the acids that bacteria produce. These acids cause teeth to decay. Your dentist can prescribe a fluoride rinse or gel or a saliva substitute to counteract the increased risk of tooth decay and thrush.
Children With HIV/AIDS
Thrush, a fungus infection, is a common oral problem in children with HIV infection. It can be treated with medicated rinses.
Many medicines given to children with HIV or AIDS are thick liquids that contain high amounts of sugar to make them taste good. If your child takes such medicines, be sure to rinse his or her mouth out with water afterward to avoid tooth decay.
Tooth decay is a serious problem for a child with HIV. It can lead to pain, infection, difficulty with chewing, problems with gaining weight and malnourishment.
At the Dentist
Always tell your dentist about your medical condition. Your dentist should be a part of your treatment team and know as much about your condition as possible. This includes your immune status. Tell your dentist about all the medicines you take. This should include over-the-counter vitamins and herbal supplements.
HIV-infected and clinically stable AIDS patients should receive oral health care just like all other patients. Your dentist and physician should coordinate this care.
In general, people with HIV or AIDS do not need antibiotics before major dental treatment. Your dentist may use antibiotics if your blood count (neutrophil count) is low. This condition is called neutropenia. The dentist may also prescribe an antiseptic a mouthwash containing chlorhexidine, before and after treatment, and may treat your gums with this mouthwash before surgery.
AIDS also can reduce your blood counts of platelets (which help the blood to clot) and red blood cells. A low platelet count does not usually affect routine dental treatment if the count is above 50,000. If your platelet count drops below this, you should be treated by a dentist who is well informed about treating medically compromised patients.
Anemia (low red blood cell count) is common in people with HIV. The cause may be a side effect from antiretroviral drug therapy. If you are severely anemic, make sure your dentist knows. Because HIV/AIDS and commonly prescribed medicines can affect your blood counts, give a copy of your most recent blood tests to your dentist.
Because people with HIV have an increased risk of cavities, your dentist will provide a program to reduce your risk. This may include fluoride varnishes applied in the dental office, toothpastes that add minerals to teeth and rinses that contain fluoride or reduce acid in the mouth. Patient education is an essential part of this program.
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