Q: I occasionally get sores in my mouth and have a gel my dentist gave me that helps them heal faster. Lately, I have been getting sores on my tongue that turn white and seem to spread, with dead skin that I can scrape away. The gel helps, but should I be worried about this?
A: Yes, you should be concerned about any unusual looking lesion in the mouth, whether it is painful or not. Many HIV-related problems appear in the oral cavity, most of which can be treated very easily without surgery. If your dentist is familiar with HIV oral problems, he or she can determine if the dead skin is a problem or not.
Q: My viral load is undetectable, but my T cells are at 250. Do I need to worry about thrush or other mouth problems?
A: Yes, you need to be concerned with thrush and other mouth problems -- even if your viral load is undetectable. Even immune-healthy people can have thrush following certain drug therapies.
Q: I have heard about bone loss in people with HIV (especially in the last couple of years on combination therapy). Can teeth also lose minerals and become weaker? What should I do?
A: HIV-related gum diseases can be very aggressive and rapid. Bone (that holds your teeth in place, just under the gums) can be destroyed, causing the loss of the teeth in the affected area. Look for gums that bleed easily, even if painless. Blood on your toothbrush is another problem that is frequently ignored. Healthy gums do not bleed and are not painful or sore. If they are, see your dentist.
Teeth can lose minerals due to decay from sweets and acidic food and drinks (see next answer). However, mineral loss in the teeth has not been associated with the use of anti-HIV drugs.
Q: My mouth is dry since I have started taking my medications, should I be concerned?
A: Yes, dry mouth is very destructive to your teeth and gums. If this occurs, do not ignore it! Your dentist can help. First, stop drinking colas that are not sugar-free; even sugar-free ones are not suggested but are less harmful. Decreasing caffeine intake, using toothpaste with fluoride, brushing and flossing regularly, and using fluoride supplements, as directed by your dentist, can diminish the harm caused by dry mouth. Between-meal snacks that contain sugar should be eliminated completely.
Many times in my practice I have seen destruction of the teeth and gums caused by behaviors like tobacco use. Tobacco acts as a poison to the gums. For many people, stopping the use of tobacco is a choice of either their habit/addiction or their teeth. Tobacco can cause dramatic damage to your teeth and gums -- imagine what it does to the rest of your vital internal organs.
Q: I get painful ulcers in my mouth, is there anything that can help?
A: Unfortunately, ulcers are a frequent and common complaint. Again, your dentist can help. New drug therapies sometimes can cause ulcers or sores. However, any ulcer that lasts over several weeks and does not respond to medications may have to be removed surgically. See your dentist regularly as recommended. Prevention is far less invasive and certainly less expensive than treatment after the damage is done.
Edwin Cordray, D.D.S., is in general practice in Houston and has treated patients for 38 years, caring for HIV-infected patients since the beginning of the epidemic. To help meet the needs of patients with HIV/AIDS in difficult financial situations, he helped start the Bering Dental Clinic (see below). Send your questions for physicians to firstname.lastname@example.org or by mail: Questions, P.O. Box 66306, Houston TX 77266-6306.
This article was provided by The Center for AIDS. It is a part of the publication HIV Treatment ALERTS!. Visit CFA's website to find out more about their activities and publications.