As the face is an index of mind, Oral Cavity is the index of the body.
While good oral health habits are important for all people, they have particular significance for people living with HIV. Many of the first signs of HIV infection may occur as oral manifestations that can be identified during a routine oral examination by a dentist.
On the other hand, if a person is aware of their HIV status and oral manifestations are present, this could indicate a change in the immune system or a failure of the current drug regimen. Early recognition, diagnosis and treatment of these HIV related diseases may reduce morbidity.
It is very important to disclose your HIV status beforehand to your Dentist so that they can take the necessary precautionary measures important for you and others.
How Does HIV/AIDS Affect the Mouth?
Your mouth may be the first part of your body to be affected when infected with HIV. Because infection with HIV will weaken your immune system, this means you will be susceptible to infections and other problems. In your mouth, this can cause pain and tooth loss.
People with HIV may experience the following mouth issues:
1) TOOTH DECAY
• It causes pain with hot or cold food and drinks and can cause strong pain and swelling of the gums. Changes to your diet and cleaning your teeth can help prevent tooth decay.
2) GUM DISEASE
•Caused by bacteria on teeth below the gum line. It can cause bad breath, bleeding and swelling but may not cause pain until it is advanced.
• Early gum disease (gingivitis) can be reversed by cleaning properly.
• Advanced gum disease (periodontitis) will cause loss of teeth, has an effect on diabetes, increases your risk of heart disease, and needs professional treatment. Untreated gum disease can advance very quickly in people with HIV who are not taking medications and is worse in smokers.
3) DRY MOUTH
HIV can damage the salivary glands and many common medications including ART can cause dry mouth.
• Saliva protects your teeth by reversing acid damage and keeps your mouth moist to make eating and speaking comfortably.
• Dry mouth interrupts sleep, makes eating difficult, increases mouth ulcers and causes bad breath and taste changes.
• If you do not drink enough fluids your body cannot make enough saliva. Alcohol strips saliva from your mouth. The caffeine in coffee, soft drinks and tea can also cause dry mouth.
TIPS TO MANAGE DRY MOUTH:
• Drink water every time you drink tea, coffee or alcohol.
• Dry mouth rinses and sprays can help reduce the symptoms of dry mouth.
• Carry a water bottle and sip water throughout the day.
• Chew sugar-free gums or hard foods like raw vegetable sticks and fruits like apples. Keep well hydrated with plenty of water. Use a sun-safe lip balm or lipstick for dry or cracked lips. Do not lick your lips.
4) TASTE CHANGES
• Taste changes are common in dry mouth and can be associated with a number of causes including upper respiratory tract infections (URTI), age-related loss of function of taste buds, infections in the mouth or as a side effect of medication.
• Persistent taste change should be investigated by your doctor or dentist. TIPS TO MANAGE TASTE CHANGES:
• Keep your mouth clean and rinse your mouth before you eat to clean your palate & tongue.
• Use marinades, gravies and sauces to alter the taste of meats if meat tastes unusual to you.
• Add spices, herbs, lemon juice, onion, pepper or vinegar to foods you find too sweet or bland.
• Use plastic cutlery and try not to drink out of metallic containers if the food tastes metallic.
• Vary the texture (e.g. smooth, crunchy, rough), colour, and temperature of foods you eat to enjoy the way food feels and looks.
• Try a paper or reusable straw for liquids: an easy way to bypass your tastebuds.
TIPS TO MANAGE PAINFUL MOUTH:
• Choose foods that are soft and smooth such as eggs, baked boneless fish, canned fruit, soups, pasta dishes, custard, puddings, yoghurt, tender meat and vegetables.
• Blend, mince and chop food finely to reduce chewing time.
• Avoid acidic, spicy and salty foods. Allow very hot food to cool for up to 30 minutes.
• Make dry foods softer by dipping them in liquids such as milk and soups.
• Drink plenty of cool fluids, especially with meals to help moisten the food. OTHER THINGS TO GET CHECKED OUT
• Ulcers and fungal infections can be worse in people with HIV, especially in people with a lower immune function. Ulcers or sore patches on gums have many causes such as trauma, infections and cancer. Have a health care provider check any ulcers or red or white patches in your mouth. Fungal infections like candida look like red or white patches on gums, cheeks, on the tongue or the floor of the mouth. They can be painful. If you wear a denture all the time you are more susceptible to fungal infections that can be difficult to control and may require medication.
• Pigmentation can occur more frequently on your gums and cheeks when you have HIV. Talk to your doctor or dentist to get it checked.
• Warts can occur on gums and cheeks. Talk to your doctor or dentist to get it checked.
• Hairy tongue is not serious but can make it hard to clear food from your mouth. Brush/Scrape your tongue to make your mouth feel fresh.
How Can I Cope with Dental and Mouth Issues Related to HIV?
Regular trips to the dentist are an important part of maintaining optimal dental health. But even there are things you can do at home to maintain a healthy set of teeth, including Brush regularly and properly at least twice each day using a manual or electric toothbrush. Make sure the bristles of your toothbrush are soft to avoid trauma to the gum tissue. And remember to gently brush/Scrape your tongue, as well. Flossing regularly and correctly removes plaque that builds up between teeth and prevents the development of inflamed gums, cavities, and sores. Antimicrobial mouth rinses can provide additional protection from bacteria and bacterial infection. It’s important, however, to note that mouthwashes do not replace brushing and flossing but rather support overall good oral hygiene practices.
Ask your Oral Health Therapist to show you the best way to clean your teeth and any special places like crowns or implants and which mouthwash is best for you.