Oral Manifestations of HIV and Dental Treatment

Millions of Americans visit the dentist on a regular basis. This is no different for HIV patients, except that patients cope with much more severe manifestations of many oral diseases. Furthermore, because HIV is a disease that severely affects the immune system, symptoms in the mouth can reflect important changes in the course of their illnesses. This leads to much more severe dental disease manifestations and requires more aggressive care. In up to 80% of HIV patients, dental irregularities are found which makes dental care both a maintenance and preventative care for the patient’s teeth and overall health.

Some dental disturbances include:

• Dental Cavities – Patients with HIV generally develop dry mouth due to a lack of saliva in their mouths. Saliva is what carries away excess food particles which would turn into bacteria and also aids in the reminerlization of the tooth. Remineralization is a key process in replacing enamel and without it, teeth decay at a faster rate. This deficiency of saliva leaves a patient at a higher risk for periodontal diseases. Because HIV medications cause dry mouth syndrome or lack of saliva, dentists will see many cavities that need to be fixed. Aided with a glass ionomer filling and anti-biotics, the patient should be able avoid any further complication. Some ways to help prevent complications include anti-bacterial mouth wash as well as artificial saliva.
• Leukoplakia – White, thick and hairy patches can form on the side of the tongue in many HIV patients. This can also be a form of Epstein-Barr virus which occurs when a patient has a weakened immune system. Although not treated in most cases, severe cases may be prescribed medications.
• Thrush or Candidasis – Appearing as white patches, red dots and sometimes involving crustiness all around the tongue area, thrust is a treatable HIV ailment. Thrush is a disease caused by bacteria due to the weakened immune system of the patient. Sometimes the white spots can be wiped off leaving a bleeding sore underneath which is a sign in diagnosis. Different strains of thrush can appear at the corners as well at the roof of the mouth. Dry mouth can also contribute to bacteria formation. All strains are treated with anti-biotics.
• Canker Sores or Aphthous – Noted as red sores that are recessed into the inside of the cheeks or mouth covered by a thin film of skin, sores are not treated unless they are painful. Canker sores affect the general population at some point, but HIV patients may experience them more severely. The sores can appear up to one half of an inch in diameter. In extreme cases, a dentist will recommend a topical steroid gel or a steroid based oral medication.
• Herpes Simplex or Viral Infection – Widely known to the general population, Herpes can be a very painful red sore that appears on the roof of the mouth or around the lips. Because it is a systemic disease (virus), a doctor will treat the disease with an anti-viral medication like Valtrex.
• Opportunistic Tumors or Neoplasm – This disease is more likely to strike when the patient’s immune system is compromised. It is a type of oral cancer that shows itself as red and purple lesions that can multiply in size. If the neoplasm is small, nothing will likely be done until the virus tumor disappears on its own. If the tumor starts to interfere with the comfort of the patient, treatments such as oral medication, chemotherapy or surgery are all options.

Oral Treatment Planning and Care for HIV Patients

HIV Patients should plan on their dental examination every six months and with a doctor who understands the treatment of patients with HIV. Because many of the diseases present themselves with only a slight variation, it is important to choose a dentist that can properly diagnose a condition. Patients can focus on preventative treatment which includes brushing their teeth, flossing, consuming very little alcohol and not using any tobacco products. Most dental diseases start with oral bacteria and so, dentists recommend using any anti-bacterial method possible as prevention.

Some types of care for HIV patients include:

• Preventative care is extremely vital when it comes to HIV patients. Flossing, brushing and using fluoride are some of the steps in prevention. Also, patients should notice whether they have a decrease in saliva as it can cause other types of periodontal diseases etc. HIV patients should be examined twice per year by a qualified dentist.
• Anti-biotic use is very common as it kills the bacteria that fester and multiply in the mouth. Because of the sensitivity of an HIV patient, anti-biotics must be used carefully as patients can develop a resistance to them. Many patients also have allergic reactions to the drug and so their use is carefully monitored especially during surgeries.
• Bleeding abnormalities are observed in patients with anemia or low hemoglobin blood levels. Patients with anemia should be advised that they are at a higher risk for bleeding during surgery and a doctor should keep a close eye on this after knowing the patient’s blood hemoglobin.
• Deeply injected anesthetics put HIV patients at a higher risk for bleeding and, therefore, more local injections and anesthetics are used.
• Endodontic therapy is known to have post-surgical problems including bleeding.
• Aesthetic minded dental care involves more risk than the typical patient. It is always best to seek the advice of a dentist who knows the complications of HIV but is sympathetic to the will of the patient in terms of the appearance of the mouth.

Dental care guide for parents of children with HIV

If a mother has HIV, she will most likely transmit the virus to the child. If this is the case, the child must be monitored for dental disease. Prevention is the most important technique and a dentist will be able to advise the parent. Flossing, brushing and anti-bacterial mouthwash are the best way to avoid problems, but parents must monitor and work with a dentist to properly take care of the child’s oral plan.

Does your dentist do proper sterilization

Safety standards for sterilization are set by the Center for Disease Control (CDC) as well as the American Dental Association (ADA). These standards are imposed so that infectious diseases of all kinds including Aids are not transmitted to a patient. Dental staff is required to wear all the proper safety accessories such as latex gloves, protective clothing, masks and eye protection. These items are all replaced after each patient. Items such as needles, blood and saliva are required to be disposed of properly and hand instruments are sterilized for each patient. All pertinent surfaces of the dental room are cleaned with disinfectant. Shields or covers in the dental room are replaced. There is a specified sterilization room where instruments that are recycled are sterilized using either heat or chemicals.