Oral & Dental Care

Oral and dental care is an area often neglected by most people and more so when it comes to people with HIV. A healthy mouth is necessary for chewing and swallowing of food and for proper speech. Not to mention its importance to your appearance and self-esteem.
However this is an area most prone to infection when you have HIV because your immune system is weaker. This means that you may need more regular care and treatment. In addition, early signs of the progress of HIV can be detected in the mouth first. And as we all know, prevention is better than cure.
People often consider proper oral and dental care as a luxury but it should be a part of primary care. This is so because time and attention paid to oral and dental care is worthwhile and will result will result in an improved quality of life.
You'll find some frequently asked questions about dental care in this section that may help you understand the importance of dental care for people with HIV.

How often should I see a dentist?
At least every 3-6 months. More often if oral lesions appear.

I can't afford private dental care. What should I do?
There are government dental clinics in most towns. The charges are affordable. You can enquire at the clinics about the charges.

Do I need to see a dental specialist?
You may need to see a dental specialist for complex oral and dental problems. You will need a referral letter from any doctor to see a government dental specialist.

Do I need to pay to see government dental specialist?
Yes, but the charges are affordable.

Should I tell the dentist about my HIV status?
It's your personal decision whether you want to reveal status. However letting your dentist know about your HIV status will help him/her better manage and monitor your dental health. All qualified dentists are required to take standard infection control precautions which would prevent the spread of HIV and other blood borne disease to dental personnel and other patients.

Are there thing I should consider when deciding ion a dentist?
Here are a few guidelines.

• Choose a dentist who you can talk to, puts you at ease and makes you feel comfortable.
• Choose a dentist who understand your condition and who is aware of the oral manifestations of AIDS.
• Choose a dentist who has experience in treating people with HIV.
• Choose a dentist who takes standard infection control precautions to prevent the spread of HIV to others by:
  Using protection like latex gloves, masks, face shield etc.
• Sterilizing all instruments after use.
• Choose a clinic where the staff make you feel comfortable.

What is dental plaque?
Dental plaque is sticky deposit that starts to form on our tooth surfaces. It is usually caused by sugary food, resulting in tooth decay (Caries)
Different plaque bacteria cause gum disease (Gingivitis and Periodontitis). Plaque must be removed by flossing and brushing.

What are the types of infections that I should look out for?
 

• Caries(tooth decay)
• HIV gingivitis.
• Candidiasis
• Oral hairy leokoplakia
• HPV – oral Warts
• Ulcers
• Karposi's sarcom
   

You will find a brief description of the symptoms of these infections in the following pages.

Caries(Tooth decay)

Salvia has cleansing action which washes away bacteria when the mouth is functioning such as during eating and speaking. Talking anti-HIV medications can reduce salivary flow and may cause in increased number of bacteria, resulting in caries.
Keep yourself hydrated by taking small sips of water all day long. Sugar-free chewing gums can also help increase salivary flow. You will need to take extra care in keeping your teeth and mouth clean (brushing, flossing and rinsing).

Gingivitis

HIV gingivitis is a sever disease of the gums. It is painful, bloody and will keep getting worse if not treated. It could result in the loss of your teeth.
A weakened immune system could make you more prone to this problem. If your diagnosed with HIV gingivitis. You will need to visit your dentist frequently.

Candidiasis (Thrush)

Fungus in the mouth are normally kept in check by your body's immune system and friendly bacteria. When the immune system is weakened, it could cause a condition called oral thrush.
Symptoms are painful white or red patches on the tongue, gums and inner cheeks. Thrush can be controlled with topical anti-fungal agents. As an alterative, you could use garlic and cloves as they have anti-fungal properties.

HPV (Human Papillomavirus) –Oral Warts

Some starains of HPV cause warts in the mouth or lips especially in those with CD4 cell counts or 200 or less. They are only painful when they lie on the gumline. In rare case HPV can cause cancer.

Symptoms
Appear as multiple warts or localized and can be flat or cauliflower-like in appearance.

Treatment
Laser surgery but this may sometimes cause the virus to spread to other parts of the mouth. A better alternative may be to remove them surgically. However it must be noted that the recurrence rate is high.

Ulcers
Ulcers can occur in the soft tissue of both the mouth and throat and cause considerable pain, often making eating quite difficult. Stress can be a trigger. Your dentist may prescribe a medication to ease the pain.

Oral Hairy Leokoplakia
A viral infection that appears on the insides of the cheek, underneath and on the sides of the tongue.

Symptoms
White streaky patches that look folded or wrinkled and have a 'hairy' appearance and may look thrush. It can become extensive and cover the entire top and sides of the tongue. In most cases it is painless.

Treatment
Does not have to be treated unless a secondary infection occurs over oral hairy leokoplakia. When there is discomfort or if lesions appear, it can be treated.

Kaposi's Sarcoma
The mouth is common area of infection for Kaposi's Sarcoma.

Symptoms
Painful lesions that are purplish in color. They can either be flat or raised. Over time, these may become darker, ulcerated and in some cases can be infected with thrush.

Treatment
Chemotherapy or radiation.

Healthy Teeth & Gums

Don’t let all these infections worry you too much as prevention is always better than cure. There are a number of things that you can do to prevent infection.
 

Tips

• Brush your teeth at least twice a day
• Floss daily
• Use a soft-bristled brush and a fluoride toothpaste.
• Use mouthwash regularly.
• Replace your toothbrush after 3 months or when it starts to show signs of wear.
• Visit the dentist every 3-6 months.
• Rinse well after every meal.
• Don’t share your toothbrush.
• Avoid tobacco.
• Cut down on sugary food or if you do have them, rinse your mouth with water.
   

Home Care Tips
Everytime you brush your teeth, just check your mouth for any unusual signs like:

• Red patches
• White fluffy patches
• Ulcers in mouth an lips
• Difficulty or pain swallowing

Flossing
You can choose between:
Waxed or unwaxed floss-waxed floss slides between the teeth easier. However it does not clean the tooth surfaces as efficiently as unwaxed floss.
Your dentist or dental nurse can advice you on proper flossing techniques. If you do not use the proper techniques to floss your teeth, you can damage gum tissue and wear away tooth root surface.

Brushing
Use a toothbrush with soft, nylon round-ended bristles that will not damage your teeth and gums.
There is more than one technique to brush your teeth. Ask your dentist to advice and demonstrate to you any one of the techniques.

Tongue
Brush the tongue from back to front to remove bacteria, which contributes to bad breath.
Remember to replace your toothbrush every 2-3 months or earlier if the bristles are distorted. Bacteria grows on toothbrush bristles and handles. Most are harmless but some may cause cold, flu, cold sores and periodontal infections.
 

Remember, the first thing to do if you haven't visited a dentist for more than 6 months is to make that appointment NOW.

Ask your doctor to recommend a government dentist.