Healthy Teeth for Life fact sheet

HIV and your oral health

This fact sheet explains changes that can Saliva also washes away food debris from occur in the mouths of people with HIV and around the teeth, neutralises harmful acids steps they can take to maintain oral health. produced by plaque, foods and drinks, protects the soft tissues of the mouth and Why a healthy mouth is important? prevents fungal infections.

Oral changes are very common in people Your doctor or dental professional will be able with HIV. They often arise because of the to determine the cause of your dry mouth and weakened immune system and side effects of offer advice regarding treatment. It may HIV drugs and other medications. Oral simply be a matter of making changes such problems can cause discomfort, leading to as reducing your intake of caffeinated trouble with eating and sleeping. Taste can beverages and increasing your intake of be affected and often results in decreased water. A dental professional may also appetite and changes food choices and recommend the use of products such as eating patterns which in turn can affect fluoride mouth rinses, gels or overall health and the ability of the body to with a higher level of fluoride to provide extra cope with the virus. Problems such as protection against decay and erosion. decay and gum disease may change personal appearance which has the potential To relieve the discomfort of a dry mouth you to affect self-esteem. can chew sugar-free gum to increase saliva flow or use ‘saliva substitutes’ which are Common changes to the mouth available from most pharmacies. You may also try using a small spray bottle (atomiser) Dry mouth: to frequently spray water into the mouth, or take frequent small sips of water. A dry mouth (xerostomia) is due to salivary gland dysfunction. There may be a decrease Clenching and grinding: in the amount of saliva produced and its quality. Dry mouth can be mild or severe and Habitual clenching and grinding of the teeth often develops gradually. can occur either during sleep or as an unconscious action during waking hours. Causes of a dry mouth include HIV infection Clenching and grinding can cause severe which can cause swollen salivary glands, the tooth wear and jaw and joint pain. side effects of HIV drugs and other medications (eg. antidepressants, Some HIV drugs can affect sleep, mood or antihypertensives, antihistamines, and anxiety levels and therefore increase the diuretics), the use of recreational drugs or likelihood of clenching and grinding. presence of other infections. Dry tooth surfaces are prone to increased You may experience a sore throat, difficulty wear from clenching and grinding. HIV drugs swallowing, excessive thirst, bad breath and and other medications which cause a dry burning or tingling sensations of the tongue mouth, leave teeth vulnerable to tooth to or mouth. tooth contact. Dry tooth surfaces also have an increased risk of acid damage (from foods, Saliva is the body’s natural defence against drinks and drugs). . Saliva acts as a vehicle for minerals such as fluoride, calcium and phosphate, which help strengthen .

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Taste changes: To prevent the infection, keep moist with balm, practice good oral hygiene and keep Taste changes can occur as a side effect of hydrated by drinking lots of water. Consult HIV drugs and/or oral thrush (candidiasis). your doctor or dental professional for advice

and treatment. Rinsing the mouth with water or a neutralising mouth rinse before eating may help with Oral hairy : taste. Consult your doctor or dental professional for advice on a neutral mouth This condition is believed to be caused by a rinse or other products which may be virus and often occurs early in HIV infection. suitable. It is not dangerous, but can be an indication of an increasing HIV viral load. It appears as Common Infections white folded patches typically on the tongue or in other areas of the mouth. Oral thrush: Ask your doctor or dental professional for Oral thrush (candidiasis) is a fungal infection advice if this condition is causing pain or of the mouth and/or throat. A compromised or interfering with eating and speaking. weakened immune system, such as in a person with HIV, provides an opportunity for Gum disease ( and periodontitis): an overgrowth of fungi leading to infection. Gingivitis is inflammation of the , which Oral thrush commonly occurs on, but is not become red and swollen, and bleed easily. limited to, areas of the tongue, roof of the Gingivitis may be more noticeable when mouth and inside of cheeks as small or large brushing or flossing. Gingivitis is rarely painful white patches. These patches can be wiped and is reversible with effective oral hygiene off with a cloth, exposing red ‘raw’ tissue practices. However, if gingivitis is not underneath. The mouth will often feel furry, managed, it may lead to the more serious sore and itchy. condition of periodontitis.

When thrush is unmanaged, it can cause a Periodontitis is a deep inflammation of the significant change in taste, loss of appetite gums and affects the bone holding the teeth and subsequent weight loss and an overall in place. If left untreated, periodontitis may decline in health. destroy the attachment that holds the tooth in the bone leaving a space or ‘pocket’ where Antifungal medications are available for use more bacteria can collect and cause in the mouth. An antiseptic mouth rinse or gel permanent bone loss. The teeth become containing chlorhexidine may help. In addition loose and may eventually be lost. to advice from your doctor or dental professional you may wish to seek the advice The major cause of gum disease is bacterial of a nutritionist or dietician regarding plaque. This colourless, sticky film contains nutritional approaches to help manage oral millions of bacteria, and constantly forms on thrush. teeth.

Angular chelitis: Brush and floss every day to remove plaque. Visit your dental professional regularly to help Angular chelitis can be caused by fungal you develop an effective tooth cleaning and/or bacterial infections, poor nutrition or method. Your dental professional can remove immune deficiencies. It presents as cracked, calculus (scale or tartar) from around the red crusting at the corners of the mouth, teeth and from root surfaces. which often bleeds when the mouth is opened.

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Smoking seriously complicates periodontitis How do I maintain a healthy mouth? and affects oral health generally. Among There are five essential steps to maintaining other side effects, smoking reduces blood a healthy mouth. flow to the gums and hence may camouflage a serious underlying problem. 1. Brush teeth at least twice a day (in the

morning after breakfast and just before Other Conditions bed) to remove dental plaque. Use a soft

bristled toothbrush with a small head, and Mouth ulcers: fluoride . Mouth ulcers can be very painful and affect a person’s ability to eat. They present as red 2. Floss your teeth once a day, prior to characterised by a halo of brushing. inflammation, often with a yellow-grey covering. Ulcers can appear on the floor of Flossing may be difficult at first, however, the mouth, gum tissue adjacent to the teeth, with practice, becomes easy. If you are on the tongue and inside the cheeks. unsure which type of to use, consult your dental professional. There are Mouth ulcers can be associated with a alternatives devices such as interproximal compromised immune system, HIV drug side brushes and sticks to reach in between the effects and localised trauma to the area. teeth if flossing is not possible. Mouth ulcers can be symptoms of other viruses and therefore should be mentioned to 3. Drink plenty of water (2-3 litres per day). your doctor or dental professional as soon as This is required for an adequate they appear. production of saliva which is the body’s natural defence against acid attacks. Warm saltwater used as a mouth rinse may Chewing sugar-free gum will also increase aid healing and provide relief from mouth saliva production and flow. ulcers. Over the counter products from the pharmacy may also provide temporary relief. 4. Eat well balanced, healthy meals. Limit the In more persistent and severe cases, consumption of between meal snacks and prescription medication may be required. drinks that are sugary and/or acidic. It is useful to increase the consumption of Kaposi’s sarcoma (KS): dairy products, as these contain calcium and a protein that strengthens tooth This condition is an abnormal growth (tumor) enamel. which occurs in the later stages of HIV infection. KS most commonly appears as flat By limiting your consumption of sugars or raised purple spots on the skin and can and acids, particularly between meals, you also occur in the mouth. limit the number of times plaque produces

the acid that causes tooth decay and It is important to seek advice from your doctor erosion. or dental professional as soon as you notice any unusual swellings, growths or soft tissue 5. Visit your dental professional regularly for discolourations within the mouth. check-ups, preventive care and advice

about home care products. Treatments used to boost the immune system in persons with HIV, generally help to resolve

KS lesions.

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How do I get the most from my For more information relationship with my dental professional? ƒ Contact your dental professional It is optimal that your course of oral health ƒ Visit www.health.qld.gov.au/oralhealth care is developed by your dental professional ƒ Call 13 HEALTH (13 43 25 84) for in partnership with you and your doctor. confidential health advice 24 hours a day, seven days a week Do I need to disclose my HIV status? ƒ Email [email protected].

There is no legal requirement for people with HIV to disclose their health status to a health © The State of Queensland, Queensland Health, 2009. professional. However, HIV infection often presents with some unique oral health problems and therefore disclosing your health status and providing details of your HIV drugs and other medications, may result in 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, non-discriminatory manner. You also have no legal requirement to disclose your health status to a health professional for their protection. Dental professionals are trained in infection control procedures that reduce the risk of exposure to blood-borne viruses.

Remember

ƒ Find a dental professional that will work in partnership with you and your doctor for optimal care. Visit your dental professional regularly for check-ups, preventive care and advice about home care products.

ƒ Make sure you practice good oral hygiene every day to minimise your exposure to opportunistic infections.

ƒ Take time to look inside your mouth for signs of infections and obvious changes.

ƒ Although HIV infection and the side effects that can occur with its treatment can make dental care challenging, these issues make dental care even more important.

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