HIV and Your Mouth

From The Well Project

August 2011

Table of Contents

Oral Problems Are Common
Oral Conditions That Are More Common in HIV+ People
Oral Health and Street Drugs
Oral Health and Tobacco
Getting Dental Care
Taking Care of Yourself

Oral Problems Are Common

Oral (mouth) problems are very common in people living with HIV (HIV+). Anywhere from a quarter to a half of all HIV+ people will have oral conditions that arise because of their weakened immune systems. This puts HIV+ people at greater risk for gum problems (gingivitis or periodontal disease), mouth infections, and sores.

Oral problems can cause discomfort and embarrassment and affect how you feel about yourself. Oral problems can also lead to trouble with eating and speaking. If mouth pain or tenderness makes it difficult to chew and swallow, or if you can't taste as well as you used to, you may not eat the food you need to stay well. It is important to see your dentist or health care provider as soon as possible if you notice any changes in your mouth.

Oral Conditions That Are More Common in HIV+ People

Condition	What and Where	Treatment
Aphthous ulcers (canker sores)	Painful red sores that might have a yellow-gray film on top. Usually on the underside of the tongue or the inside of the cheeks and lips.	Mild cases -- Over-the-counter cream or prescription mouthwash that contains steroids. More severe cases -- steroids in a pill form, or, in rare cases, thalidomide.
Herpes Simplex (cold sores) are caused by viral infection	One or more small blisters or ulcers on the lips or on the roof of the mouth and/or gums	Antiviral medications (ie, acyclovir) in pill form are prescribed and can reduce healing time. Over-the-counter medicine (Abreva) can also reduce healing time.
Oral hairy leukoplakia (OHL) is caused by the Epstein-Barr virus	White patches that do not wipe away; sometimes very thick and "hair-like." Usually appear on the side of the tongue.	OHL is not harmful and usually goes away without treatment. More severe cases can be treated with antiviral medication (ie, acyclovir). Topical treatments are also available. Stopping smoking and ETOH can help.
Candidiasis (thrush) is a fungal (yeast) infection	White or yellowish patches inside the mouth, throat and on the tongue. If wiped away, there will be redness or bleeding underneath.	Mild cases -- prescription antifungal lozenge or mouthwash. More severe cases -- prescription antifungal pills.
Angular Cheilitis is another form of thrush	Cracks on the corners of the mouth.	Antifungal cream applied directly to the site.
Warts are caused by the human papilloma virus (HPV)	Small, white, gray, or pinkish rough bumps that look like cauliflower. They can appear inside the lips and on other parts of the mouth.	Inside the mouth -- a health care provider can remove them surgically or use "cryosurgery" -- a way of freezing them off. On the lips -- a prescription cream that will wear away the wart. Warts can return after treatment.
Kaposi's sarcoma (KS) is a cancer associated with HIV (KS is actually a virus caused by a virus)	Red or purple lesions that can be raised or flat. KS usually occurs on the roof of the mouth but can be found anywhere in the mouth.	Surgical removal, freezing, chemotherapy, and radiation therapy.
Periodontal disease is an infection of the gums and supporting bone	Red gums that bleed easily and bad breath.	Regular dental visits and good oral hygiene both prevent and treat periodontal disease.
Xerostomia (dry mouth) can be caused by HIV, HIV drugs, or antidepressants	Lack of saliva (spit); trouble chewing and swallowing; dry, sticky, or burning mouth; and cracked or chapped lips. If untreated, dry mouth can lead to tooth decay.	Artificial saliva Sipping water or sugarless drinks Chewing sugarless gum Sucking sugarless hard candy Avoiding tobacco Avoiding alcohol

Oral Health and Street Drugs

Additional mouth problems may occur if you use street drugs. Opium, heroin, and cocaine can increase tooth decay and gum disease. Crystal meth can cause severe oral problems, sometimes described as "meth mouth," including dry mouth and widespread decay.

Oral Health and Tobacco

Tobacco use is a primary cause of several oral diseases and conditions. People who use tobacco, whether they smoke it (e.g., cigarettes, cigars, pipes) or use smokeless tobacco products (e.g., chew, plug, loose leaf, twist, or snuff), are more likely to develop oral cancer, throat cancer, and gum problems (periodontal disease). Tobacco use commonly causes tooth decay, discoloration of your teeth (yellow teeth), and bad breath.

Using tobacco also weakens the immune system's response to infections in your mouth. As a result, you will be more likely to get infections in your mouth and these infections will heal more slowly. Since the immune system of HIV+ people is already weakened, it is important for those living with HIV not to further weaken their immune response to oral problems by using tobacco products. If you use tobacco, talk to your health care provider about how to stop smoking or chewing. There are many resources to help you (see links provided).

Getting Dental Care

You cannot legally be refused dental treatment because of your HIV status, but finding dental care can be difficult depending on your financial resources, insurance coverage, and where you live. Asking your health care provider or HIV specialist for suggestions on where to find dental care in your area is a great place to start. Options for people with fixed incomes and/or no insurance are limited, but they do exist:

Federal Ryan White CARE Act-funded dental clinics: These clinics may be able to provide low or no cost dental care; however there may be a waiting list. Go to:
- www.hrsa.gov
- http://findhivcare.hrsa.gov/Search_HAB.aspx
Dental schools: Some cities have dental schools or dental hygiene schools that provide good quality care at reduced rates. Check for a program near you at:
- www.ada.org/267.aspx
- www.adha.org/careerinfo/dir_education.htm
Public health or community-based primary care clinics: Clinics provide treatment at either a reduced rate or completely free. Call your local Department of Health office to find a clinic or check the US Department of Health and Human Services website service locator at http://aids.gov/locator/

Taking Care of Yourself

Because of the increased risk for oral problems, it is especially important for HIV+ people to take good care of their mouths. Proper dental care is needed to keep teeth and gums healthy. Basic guidelines for good oral health suggest that you:

Develop a good home care routine -- brush two to three times daily and floss once a day (preferably at night)
Use a toothpaste or mouthwash that contains fluoride
See the dentist every six months
Avoid smoking and street drugs
Eat a healthy diet

Most common oral conditions linked with HIV can be treated. If you notice any problems, talk with your health care provider or dentist about what treatment might work for you. Remember, with the right treatment, your mouth can feel better. And that's an important step toward living well with HIV.

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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.

HIV and the Mouth