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Time for Dentures??
Jun 11, 2000

I am an HIV+ male, positive for approx. 15 years, 48 years old. February 2000 CD4 was 450 (it was 375 back in 1990) and VL was 55,000 - up from 27,000 in 1995. I have not as yet ever received any sort of HIV therapy or antiretrovirals, etc.

I have for many years had receding gums and bone loss. Have total of eleven teeth on upper and nine teeth on lower remaining. Have had several pulled (in rear only) due to recurring gum infections. My mouth is pretty much consistently sore (roof, tongue, everything) which I had thought was probably thrush of some sort but my Doctor does look in my mouth and sees no sign of it. It is a sort of "burning" sensation - especially when I eat something hot or spicy. Also - I am tired of the gum infections - which have been attributed to the bone loss and receding gums. I don't believe these recurring infections can possibly be good for me - even though they subside with antibiotic treatment. I have no objections to getting dentures (at least the uppers) - but seem to be absolutely unable to find a dentist willing to do this. Would you consider dentures a suitable solution to this problem (alleviating and ending the recurring gum infections)? Thank you.

Response from Dr. Reznik

This is a hard question to answer for two reasons:

1. Without the ability to examine your teeth and supporting structures and without any dental x-rays, it would be impossible for me to determine the severity of the problem you report. Therefore I cannot advise whether or not you should have complete extractions and dentures, or whether you needs to have periodontal (gum) therapy and restorative work (fillings) to address this problem. You may actually be somewhere in the middle where you would need some extractions, periodontal work, restorative work and partial dentures. The key is that you do have these recurrent dental infections treated because you are correct that this is not good for your overall well-being.

2. Without the ability to examine the soft tissues in your mouth, namely the hard and soft palates (roof of your mouth) and tongue, again an accurate diagnosis would be impossible. On the other hand, the symptoms you describe sound very much like erythematous candidiasis. Erythematous candidiasis appears as a red, flat, subtle lesion on the roof of the mouth and/or dorsal surface of the tongue that does tend to be symptomatic, i.e. will burn when eating or drinking salty or spicy foods. It is not that unusual for your provider to not be able to diagnose this condition as it tends to be the most under-diagnosed oral manifestation seen in association with HIV disease.

Which leads to the third question: finding someone who in knowledgeable of the oral manifestations seen in association with HIV infection as well as willing to do the necessary dental work. Before I proceed, please be advised that dental work cannot be refused to someone due to their HIV status. The Americans with Disabilities Act, which is a piece of federal legislation, prevents refusal of said services based on HIV serostatus. A potential solution to this problem would be to contact me offline or access HIVdent's Resource Section for referrals to qualified dental professionals who are experienced in treating people living with HIV disease.

Take care,

DR


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