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HIV and Your Oral Health

Conditions of the Mouth Caused by HIV

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Updated September 07, 2009

HIV and Your Oral Health

Oral Candidiasis (thrush)

Courtesy of Dr. Steve Debbink
A study appearing in the Journal of Dental Research examined just how many bacteria were present in the human mouth. While the numbers vary from person to person and from situation to situation, the study reported over 150 million bacteria are present in the mouth at any given time. If that’s the case, is it any wonder that there are so many dental and oral problems in the HIV positive person? Bacterial infections, fungal infections, and viral infections are just some of the problems that HIV patients encounter. And sadly, history shows that a vast majority of dental problems in HIV patients go untreated. Let's take a look at some of the problems in your mouth HIV can cause.

Fungal Lesions

Candidiasis
  • Commonly called thrush, this fungal infection is found on the tongue and oral mucosa.
  • Presents as white patches that can be scraped off with a toothbrush or tongue depressor.
  • Typically diagnosed by its appearance or by examining a smear under a microscope.
  • Treated with anti-fungal medications such has fluconazole or clotrimazole troches.

Histoplasmosis

  • While this fungal infection typically occurs in other parts of the body, oral lesions can occur.
  • Appears as an ulcer of the oral mucosa.
  • Histoplasmosis is diagnosed by biopsy.

Viral Lesions

Herpes Simplex
  • One of several types of herpes virus, this type found in the genital area.
  • Appears as fluid filled vesicles that rupture and crust.
  • Symptoms include painful and itching vesicles.
  • Diagnosis is typically made by culturing the lesions and the fluid contained in the vesicles.
  • There is no cure for herpes simplex but outbreaks can be shortened or prevented by using anti-viral medications such as Acyclovir or Valtrex.

Herpes Zoster

  • Another of the herpes virus family, herpes zoster oral lesions are reactivated varicella zoster (the virus that causes chickenpox).
  • Typically herpes zoster causes fluid-filled vesicles on the skin but oral lesions do occur.
  • Initially symptoms can mimic tooth pain.
  • While skin vesicles rupture and crust, oral lesions form ulcers.
  • The lesions of herpes zoster are usually in a linear pattern along nerve tracts.
  • Diagnosis is made by appearance and the distribution of the lesions.
  • Like other types of herpes virus, there is no cure but anti-viral medications like Acyclovir or Valtrex can shorten the course, reduce the risk of spreading to other people, and reduce the spread to other parts of the body.

Human Papillomavirus (HPV)

  • Typically causes genital warts but does cause oral lesions at times.
  • Oral lesions are found most often in people with HIV.
  • The type of HPV that causes oral warts is a bit different than those that cause anogenital warts.
  • The oral warts appear as single or multiple nodules that resemble cauliflower.
  • Diagnosis is made by biopsy.
  • The lesions can be surgically removed but relapses frequently occur.

Cytomegalovirus (CMV)

  • While it is fairly rare, oral lesions from cytomegalovirus (CMV) have been reported.
  • They can look much like apthous ulcers except CMV ulcers look necrotic around the borders not red.
  • CMV ulcers are diagnosed by biopsy.
  • CMV ulcers appear in cases of systemic CMV infection; therefore if they do arise, the patient should be assessed for systemic CMV infection.
  • The ulcers will resolve with the medication ganciclovir or Valganciclovir used to treat the systemic CMV infection.
Hairy Leukoplakia (HL)
  • Caused by the Epstein Barr Virus.
  • Presents as an asymptomatic, corrugated or “hairy” looking white lesion on the lateral aspects of the tongue.
  • In contrast to thrush, the lesion can't be scraped off.
  • Is more common in people with lower CD4 counts.
  • The presence of HL is indicative of a weakened immune system.
  • Past studies indicate that people with HL have a higher probability of progressing to an AIDS diagnosis when compared to people without HL.
  • HL can be diagnosed by an experienced clinician simply by appearance but a definitive diagnosis should be done with biopsy.
  • HL has been proven to improve in those patients taking acyclovir for a herpes outbreak but typically does not require treatment.

Bacterial Lesions

Periodontal Disease
Periodontal disease is a chronic inflammatory process, bacterial in nature, affecting the tissue and bone structures supporting the teeth. While periodontal disease can occur in anyone, regardless of HIV status, two particularly damaging types are unique to people with weakened immune systems.
  • Necrotizing Ulcerative Periodontitis (NUP) – This periodontal disease is considered a marker for severe immune system compromise. Formally known as HIV periodontal disease, NUP is characterized by severe pain and bleeding with rapid and significant bone and tissue loss. Also characteristic of this serious periodontal disease is premature tooth loss and a foul odor from the mouth. Left untreated, this periodontal condition can cause systemic symptoms as well. Treatment includes debridement of the dead and infected tissue by a dental professional using a solution known as chlorhexidine gluconate. Oral antibiotics are also indicated. Finally, pain control is an important key. Without adequate pain control, the person will not be able to eat, meaning their nutritional status will not be conducive to proper healing.

  • Linear Gingival Erythema (LFE) – LFE is commonly called “red band gingivitis” because of its characteristic red band appearance. The red band appears along the gingival (gum) line and may be accompanied by bleeding and pain. While it can extend to all parts of the gum, it primarily affects the front or anterior portions. Some experts believe there is a connection between LFE and chronic candida infections. In fact, The American Academy of Periodontology considers LFE a gingival disease of fungal origin. However, antifungal medications are not the treatment. Instead, plaque debridement by a dentist and twice daily mouth rinses with chlorhexidine is the treatment of choice, along with oral antibiotics and better oral hygiene at home.
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