Any change in the health of your body reflects some of its effects on the oral cavity as well. Oral health problems are widespread among people who suffer from health disease or syndromes.
One of the increasing immunodeficiency syndromes today is HIV/AIDS. A patient affected by human immunodeficiency virus acquires this immunodeficiency syndrome known as AIDS at an advanced stage.
Certain oral conditions can be commonly found in both HIV positive and negative patients. The only difference is that these oral conditions appear to be severe in HIV positive patients.
The reason behind the severity of such oral infections during HIV/AIDS is the diminished immune system that alters the course of disease in such patients.
Such cases require aggressive treatment to prevent the oral health from deteriorating further. Since the beginning of AIDS epidemic around 30 different oral manifestations have been reported.
In this article we will read about HIV/AIDS, its impact on the oral health of the patient and specific treatment modalities to heal the associated oral health problems.
What is HIV/AIDS?
HIV stands for human immunodeficiency virus that attacks specific T cells in the body, commonly known as CD4 cells.
These T cells are the key factors that provide immunity and strength to the body against infections.
HIV often gets undiagnosed as the symptoms are not too severe when a person doesn’t get tested for HIV and leaves it untreated.
It destroys the CD4 cells to the extent that the patient’s immunity goes down to null. Such a condition is recognized as AIDS or Acquired Immunodeficiency Syndrome.
How does it affect your oral health?
HIV doesn’t directly affect the teeth but it reduces the mineral density of the underlying jaw bones.
During the AIDS epidemic, when the CD4 count becomes less than 200 cells/mm3. Certain dental procedures like root canal treatments are restricted and cannot be performed.
During AIDS, the body becomes susceptible to a variety of infections and illness. Opportunistic infections start to develop, taking advantage of the low immunity.
Such infections are commonly seen in the oral cavity which slowly compromises the oral health of the patient. (1)
What are the oral conditions associated with HIV/AIDS?
The effects of HIV/AIDS on the oral cavity are diverse and it depends on the patient’s immunity to cope up with such oral conditions.
Some of the common oral conditions affected by AIDS are categorized as follows –
Caries and dry mouth
Tooth decay is a common dental problem among the general population as well. The aim of early detection of caries in HIV/AIDS patients is to prevent it from spreading and turning into a dental abscess.
The early lesions can be avoided with fluoride toothpaste and regular brushing. Certain anti-HIV medications may cause dryness in the mouth.
Care should be taken to detect this symptom and treat it with simple measures. If the mouth remains dry, it increases the chances of rampant caries especially in patients with HIV/AIDS.
Periodontal disease results from chronic inflammatory reactions due to bacterial accumulation and degradation of the surrounding gums.
Two different periodontal diseases that are prevalent in patients with HIV are –
- Linear gingival erythema – also called as HIV-gingivitis, presents as a red band along the gum line. It is usually painful and bleeds easily.
If left untreated, it can progress to a severe form of periodontal disease called as necrotizing ulcerative gingivitis.
- Necrotizing ulcerative gingivitis – also called as HIV-periodontitis, involves rapid loss of gums and underlying bone.
In advanced stages, the bone gets exposed to the oral cavity.
The rapid deterioration of the bone leads to loss of tooth support and premature loss of teeth. It is a painful condition, and the lesion bleeds on probing.
Although the response to conventional treatment methods is poor in patients with HIV, it is still recommended to continue dental therapies to treat the periodontal condition.
The rapid decrease in immunity acts as a host to many opportunistic oral infections that affect the oral tissues in a severe form.
There are two forms of viral infections that are common among patients with HIV and may deteriorate the oral health of the patient.
- Human Papilloma Virus – HPV is the most common virus transmitted to HIV patients. Its pronounced effects are characterized by a bunch of raised, white, smooth nodules that have a cauliflower-like appearance.
They are commonly seen on the lateral borders of the tongue and the lips. They are often painless but interfere with the functions and aesthetics of the mouth.
HPV vaccinations are now available to prevent the risks of contracting this viral infection. (2)
- Herpes Simplex Virus – Herpes Simplex Virus-I usually causes oral herpes simplex. These are commonly referred to as cold sores and present as serum-filled vesicles or blisters that erupt on the face, lips, and tongue.
This condition is often associated with fever, fatigue, and illness. The patient may experience an urge to itch around the lesion. These vesicles erupt and rupture to form a scab.
- Oral hairy leucoplakia – another viral infection caused by Epstein Barr virus is clinically seen as white patches on the lateral border of the tongue.
The irregular surface of the lesion along with the papilla of the tongue gives a hairy appearance. These lesions are benign and often resolve on their own.
- Kaposi sarcoma – a variant of Herpes Simplex Virus – VIII, Kaposi sarcoma presents as an opportunistic neoplastic lesion which is characterized as raised, purple or red lesions that do not blanch when applied pressure. It is a malignant lesion that occurs in the endothelial lining of the blood vessels.
Oral Candidiasis, also known as Oral Thrush, is the most common opportunistic infections that are seen in HIV positive patients.
The fungus Candida Albicans causes it. Candidal infections can occur in various forms in the oral cavity, each having different clinical representation.
- Pseudomembranous Candidiasis – this is the most common representation of a candida infection. It is characterized by small white patches in the mouth that can be easily wiped off.
In some cases, a red erythematous area may be present under the white patch causing a burning sensation in the mouth.
- Angular Cheilitis – this form of candida is less common but can be in the form of blisters around the corners of the mouth. These lesions resemble chapped lips and can be treated with topical anti-fungal medications.
- Erythematous Candidiasis – these lesions are red, inflamed patches that are found on the tongue and hard palate. Unlike, pseudomembranous candidiasis, these lesions cannot be wiped off.
Pain and burning sensation of the mouth are the commonly associated symptoms.
Other oral infections
- Aphthous stomatitis – commonly called as canker sores, are slow healing ulcers that have two variants, i.e., aphthous ulcer minor and major.
The only difference between the two is the size of the ulcer, the minor ulcers are 0.04 inch in diameter, and major ulcers can grow up to 1 cm in diameter.
These ulcers are usually shallow, crater-like lesions with a grey pseudomembranous center surrounded by raised red borders.
What is the treatment for these oral conditions?
Treatment modalities differ with the type of oral condition present in the patient. Dental treatments have proved to prevent and maintain the conditions from advancing further. (3)
- Caries – Simple tooth restorations can treat tooth decay
- Dry mouth – sugar-free gums or artificial salivary stimulants are often recommended to prevent dryness of the mouth. Drinking plenty of water is a natural way to keep the mouth hydrated.
- Periodontal disease – A palliative therapy which starts with antibiotic medications along with antimicrobial mouthwash are the key to treat the periodontal conditions. In advanced stages, clinical debridement and surgical flaps can be placed.
- Fungal infections – all the fungal infections can be treated with antifungal medications like fluconazole (Diflucan) and topical use of clotrimazole spray.
- Viral infections – the treatment begins with anti-viral medications like acyclovir, famcyclovir and may involve surgical removal of lesions for example in case of Human Papilloma Virus.
- Kaposi sarcoma – being a malignant lesion, Kaposi sarcoma requires extensive chemotherapy, radiation, and surgical intervention.
Take away message
HIV/AIDS is the deadliest immunodeficiency syndrome that not only deteriorated your health but also compromises your oral health and hygiene.
Many parts of the oral cavity are affected by the adverse effects of decreased immunity in HIV/AIDS patients. It is necessary to consult a dentist and prevent them from further damage.
Today plenty of treatment modalities are available to reduce the adverse effects of HIV on oral health.
The only thing required is proper awareness and knowledge about such effects and the options available to save yourself from the misery of painful oral conditions.
Always check with your doctor and dentist to plan your treatment. Ask them to explain all the benefits and risk factors associated with a procedure.