Taking care of your mouth and teeth is a very important, yet often overlooked, part of maintaining general health. Good oral health can help you prevent or catch infections early. It can also give you clues as to the state of your overall health and your immune system.
Starting and Keeping Good Oral Health:
General guidelines for good oral health suggest that you:
General Guidelines are generally straightforward but they’re often not followed.
Brushing
A good brushing should take a minimum of two minutes, not the 30 seconds or less that most people devote to it. The way you brush is also important. It’s recommended that you brush with a gentle, circular motion and slowly work your way from one side of your mouth to the other. Keep bristles at a 45° angle to the gum line when brushing your front teeth and gums. Pay special attention to areas you tend to neglect, like the back of your front bottom teeth, the sides of wisdom teeth and the back side of your lower teeth below your tongue. It’s also important to avoid scrubbing your teeth.
Toothbrush and Toothpaste
Dental Floss
Experts recommend flossing after a meal and before brushing to loosen debris from where a toothbrush can’t reach. To floss, use a long length of floss and wrap the ends around your index fingers. Gently push it between teeth and all the way to the gums. If you rarely or never floss, you may experience slight bleeding. This will stop occurring once your gums get used to it and flossing becomes a habit. If it continues to be painful, consider using a waxed floss or check with your dentist to see if you’re flossing properly.
Mouthwash
Using a mouthwash at least twice a day can add fluoride to your teeth, kill bacteria often responsible for bad breath, reduce plaque which can cause cavities and prevent gum disease.
Many prescription and over-the-counter mouthwashes are effective, but most of them contain up to 25% alcohol. Since this amount of alcohol can cause a painful burning sensation, some may find it necessary to use an alcohol-free rinse. Most alcohol-free mouthwashes are as effective as those with alcohol.
Dental Visits
Regardless of a person’s HIV status, regular visits involve going to the dentist about every six months. The visits allow your dentist to identify infections and conditions early and treat them before they become a problem
Disclosing Your HIV Status
For proper care, it’s helpful for a dentist to know that you’re living with HIV because there are conditions that they will want to pay extra attention to. Finding a dentist who you trust, who’s supportive and can help you make informed treatment decisions is desirable.
If you don’t already have a dentist that you trust and feel comfortable with, consider a referral from your doctor, a friend or an AIDS service organization. However, before you ultimately choose one and decide to disclose your status, you may want to talk to him or her yourself. Find out how experienced they are, get a feel for the overall atmosphere of the office and discuss what information will be included in your file and what impact, if any, it may have on your insurance.
Oral Conditions of HIV Disease
It’s estimated that 90% of people with HIV will develop at least one oral condition associated with HIV disease. These conditions, like candidiasis and hairy leukoplakia, may be the first indication of immune suppression associated with HIV infection and in many people are the first signals that lead doctors to encourage HIV testing. Most show up as lesions or sores and can be categorized into four types: abnormal cell growth, bacterial, viral and fungal.
A p h t h o u s U l c e r s
Symptoms |
The formation of sores; pain, discomfort |
Affected Areas |
Mostly soft parts of the mouth like the cheeks and sides of the tongue |
Diagnosis |
With strong history of aphthous ulcers, or when other possible causes are ruled out |
Treatment |
Systemic and topical corticosteroid, occasionally thalidomide |
Prevention |
None |
C y t o m e g a l o v i r u s
Symptoms |
The formation of mouth sores; pain, difficulty swallowing |
Affected Areas |
Anywhere in the mouth. May appear in the throat as well |
Diagnosis |
Biopsy |
Treatment |
Ganciclovir, foscarnet |
Prevention |
None |
D r y M o u t h
Symptoms |
Ongoing dryness of the mouth |
Affected Areas |
In the mouth and throat |
Diagnosis |
Observations of reduced saliva flow, examination of one’s medication regimen |
Treatment |
Artificial saliva, chewing sugarless gum, and drinking plenty of liquids |
Prevention |
It’s hard to anticipate bouts of dry mouth, but most treatments will work for prevention too |
G i n g i v i t i s, P e r i o d o n t i t i s
Symptoms |
Inflammation of the gums, swelling, bleeding, bad breath, breaks in the seal between the gums and teeth |
Affected Areas |
The gums and teeth |
Diagnosis |
The presence of typical signs/symptoms |
Treatment |
A thorough professional cleaning, chlorhexidine rinse |
Prevention |
Follow the guidelines for good oral health; particularly thorough brushing, flossing and regular dental visits |
H a i r y L e u k o p l a k i a
Symptoms |
White streaky, hairy patches that can’t be scrapped off. Otherwise, none |
Affected Areas |
Usually sides of the tongue; May appear in other parts of the mouth |
Diagnosis |
Biopsy |
Treatment |
None; Severe cases: high dose acyclovir |
Prevention |
None |
H e r p e s S i m p l e x
Symptoms |
The formation of sores or small blister-like bubbles; pain, discomfort |
Affected Areas |
Primary HSV : lip and gums. Recurrent HSV: lip, hard parts of the mouth like the roof and the back of the tongue |
Diagnosis |
A history of herpes, the presence of typical physical signs/symptoms |
Treatment |
Acyclovir |
Prevention |
Acyclovir may be used in the presence of frequent recurrence |
H e r p e s Z o s t e r
Symptoms |
The formation of sores and small blister-like bubbles |
Affected Areas |
Anywhere in the mouth |
Diagnosis |
Biopsy |
Treatment |
Famciclovir or acyclovir |
Prevention |
None |
H i s t o p l a s m o s i s
Symptoms |
Cough, fever, fatigue |
Affected Areas |
All over the mouth |
Diagnosis |
Biopsy, culture |
Treatment |
Amphotericin B, itraconazole |
Prevention |
None |
H u m a n P a p i l l o m a v i r u s ( H P V )
Symptoms |
The formation of warts that are cauliflower-like, spiky, or slightly raised with a flat surface |
Affected Areas |
The inner lining of the mouth |
Diagnosis |
Biopsy |
Treatment |
The only treatment available is the surgical or laser removal of the warts |
Prevention |
None |
K a p o s i ’s S a r c o m a
Symptoms |
Red or purple patches or swellings either raised or flat; may become painful |
Affected Areas |
Commonly on the roof of the mouth. May also appear on the gums, tongue and back of the throat. |
Diagnosis |
Biopsy |
Treatment |
Small lesions: vinblastine, surgical removal, radiation, carbon dioxide laser. Large lesions: radiation. Treating KS with systemic chemotherapy should be help reduce or eliminate oral lesions as well. |
Prevention |
None |
L G E, o r L i n e a r G i n g i v i t i s E r y t h e m a
Symptoms |
Profound red banding along the teeth |
Affected Areas |
Where the teeth and gums meet |
Diagnosis |
The presence of typical signs/symptoms |
Treatment |
Thorough professional cleaning, chlorhexidine rinse |
Prevention |
Follow the guidelines for good oral health; particularly thorough brushing, flossing and regular dental visits. |
L y m p h o m a
Symptoms |
Lesions include firm masses and persistent sores. May simply show up as a small lump. |
Affected Areas |
In the mouth, near the tonsils |
Diagnosis |
Biopsy |
Treatment |
Chemotherapy |
Prevention |
None |
M y c o b a c t e r i u m a v i u m c o m p l e x ( M A C )
Symptoms |
Oral lesions occur as sores |
Affected Areas |
Sores appear on the roof of the mouth. |
Diagnosis |
Culture, secondary tests that may indicate MAC. |
Treatment |
Numerous options include: clarithromycin, azithromycin plus ethambutol, rifabutin, rifampin, ciprofloxacin, amikacin, etc. Some drugs, particularly clarithromycin, may interact with common anti-HIV meds. Talk to your doctor or pharmacist about possible drug interactions. |
Prevention |
Avoid exposure to MAC organisms, like boil drinking water, don’t eat raw foods, etc. |
N S, o r N e c r o t i z i n g S t o m a t i t i s
Symptoms |
Some symptoms of NUP may exist, but characterized mostly by large sores. |
Affected Areas |
Sores will form on the roof of the mouth and gums. Other symptoms appear in the gums and teeth. |
Diagnosis |
The presence of typical signs/symptoms |
Treatment |
Thorough professional cleaning, chlorhexidine rinse, antibiotic therapy with metronidazole. |
Prevention |
Follow the guidelines for good oral health; particularly thorough brushing, flossing and regular dental visits. |
N U P, o r N e c r o t i z i n g U l c e r a t i v e P e r i o d o n t i t i s
Symptoms |
Pain, spontaneous bleeding of the gums, rapid destruction of gum tissue and supporting bone; tooth loss in advanced cases. |
Affected Areas |
The gums and teeth |
Diagnosis |
The presence of typical signs/symptoms |
Treatment |
Thorough professional cleaning, chlorhexidine rinse |
Prevention |
Follow the guidelines for good oral health; particularly thorough brushing, flossing and regular dental visits. |
O r a l C a n d i d i a s i s
Symptoms |
Pain, loss of taste, distortion of taste, burning, discomfort |
Affected Areas |
All over the mouth, possibly the throat, sometimes the corners of the lips |
Diagnosis |
Biopsy, culture |
Treatment |
Systemic: fluconazole, ketoconazole, itraconazole Topical: nystatin, miconazole |
Prevention |
Mouth rinses (chlorhexidine), nystatin, miconazole |
T u b e r c u l o s i s
Symptoms |
The formation of sores |
Affected Areas |
On the tongue |
Diagnosis |
Prior diagnosis of a TB lung infection plus biopsy of the oral sore. |
Treatment |
Systemic antibiotics intended to treat TB throughout the body. |
Prevention |
For individuals who may have been exposed to or are at risk to get TB, isoniazid is usually used. |
MSMNPA Research - Source - Project Inform
