Hi Dr. Reznik , I tested positive for HIV in August of 1995 and my lab values are good at 702 cd4 33% and undetectable . Last week I went to the dentist for my six month cleaning and the dentist told me my gums are receding badly . The root is almost exposed on the sides . My dentist reccomended bonding and surgery removing an area of gum and putting it over the areas which the recession is in . It sounded very painful so I put off scheduling the appointment at the visit and said I'd call later in the week . I've realised this needs to be done soon so Ive decided to call tommorow .My insurance doesn't cover dental so this will be expensive but that is another story ( I hope there is a payment plan ). Why is this happening to my gums ? Do you have any suggestions to prevent this in the future ? Also if you have time could you explain the bonding and surgery to me . I'm a little bit phobic of dental work so I hightailed it out of the dentists office too fast after he started talking about the surgery and the bonding to really understand what he is going to do during the procedures .Thanks in advance . Cherri

Before I start my answer, I have a question for you: did this gum recession happen recently or is this problem something that has developed over time? The reason for the question is that although we have evidence of rapidly advancing dental decay in people living with HIV at any CD4 count, the gingival problems we see (Linear Gingival Erythema , Necrotizing Ulcerative Periodontitis and rapidly advancing periodontal disease) do not occur in people with high CD4 counts undetectable viral loads. The gingival/periodontal problems we see in the general population do however present in people living with HIV.

Periodontal surgery is a process where the underlying bone which holds the teeth in place is reshaped to prevent further problems. Periodontal surgery many times involves removal of inflammatory tissue (granulation tissue) which is a result of periodontal disease. What your dentist has talked to you about is to graft a healthy piece of tissue, usually taken from the roof of your mouth, to cover up the exposed root surfaces. The reason your dentist mentioned bonding, which is not a painful procedure, is that he/she wants to ensure a pleasing post-surgical appearance.

How do you prevent this from happening in the future? The key here is your home care and frequent recall appointments with either the dentist or dental hygienist, usually every three months until the condition is stabilized.

I hope this information proves helpful!

DR