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HIV/AIDS and oral care: oral and dental health issues in HIV/AIDS patients (3)
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Why saliva is important? And why a dry mouth can be a serious health problem?
A dry mouth may enable food particles to remain in the mouth and build up between the teeth and the gum, thus causing tooth decay, periodontal disease, and candidiasis. A dry mouth can also cause high acid levels to persist in the mouth after eating, thus allowing the appearance of cavities, which, in turn, can further lead to infections that can spread throughout the entire body.
In HIV/AIDS patients, cavities develop at the cervical region of the tooth, that is where the crown meets the root of the tooth and where the surface consists of cementum (not enamel). Cementum is a bony substance with a faster decaying speed. The process can lead to infections of the tooth pulp (the soft tissue inside the tooth) and abscesses (infections, pus). Oral care is vital in discovering these kinds of issues in early stages. Treatment includes a technique called "scoop and fill." Using hand instruments and usually no anesthetic, dentists scoop out the damaged part of the tooth and fill it in with a temporary fluoride-based filling that prevents further decay. For abscesses, treatment options include antibiotics, in particular penicillin.
Dry mouth treatment options vary from prescription drugs and artificial saliva to therapies that stimulate the salivary glands (for instance, pilocarpine therapy) and certain herbs like demulcents, chickenweed and slippery elm. Also chewing sugarless gum or sucking on sugarless candy can stimulate more saliva.
Bacterial infections are a result of overgrowth bacteria. In HIV/AIDS patients, bacterial infections that occur in the mouth signal the virus' presence in the rest of the body. They are easier to treat but, if left untreated, undetected, or if they are detected late, they can lead to serious health problems.
Among the bacterial infections frequently met in people living with HIV/AIDS are gingivitis, also called HIV-gingivitis or linear gingival erythema (LGE), and periodontal disease, also called HIV-pertiodontitis or necrotizing ulcerative periodontitis (NUP).
Gingivitis is a chronic inflammation of the gums and it can happen to anybody. Symptoms include bad breath and bleeding. In HIV/AIDS patients, gingivitis is more severe and appears as red band-like lesions along the gumline (where teeth meet the gum). If left untreated, LGE can lead to HIV-periodontitis (NUP), which is an extremely serious condition. NUP attacks the gums, teeth and surrounding bone structure. It can cause tooth loss, bleeding and severe pain. Treatment includes antibiotics, surgical procedures and local debridement (getting rid of dead tissue).
Abnormal tissue growths, or neoplastic lesions, can be benign or cancerous. If cancerous, in the case of HIV patients, they can be manifestations of HIV-related cancers like Kaposi's sarcoma or lymphoma.
Kaposi's sarcoma (KS) is a cancer that affects a patient's skin and/or organs. It appears as purple lesions on the skin. In the mouth, KS can appear as patches or swellings on the gums, tongue, on the roof of the mouth or at the back of the mouth. KS is usually not painful but it can become painful when it interferes with other infections. When painful, oral KS lesions can affect chewing and talking, and also increase the risk of wasting associated with HIV/AIDS or affect treatment, because some medications have to be taken with food. KS usually goes away when the immune system recovers due, for example, to a HAART regimen that works for the patient. KS can be treated locally, using local administered chemotherapy or surgically removing the lesion, or in the entire body, using intravenous chemotherapy.
Lymphoma is more rare than KS and more serious. Lymphoma appears as a small lump in the mouth or near the tonsils. Only a biopsy can determine if a lesion is indeed lymphoma. Treatment includes chemotherapy.
When it comes to dental care, the first question that may occur to HIV/AIDS patients is the disclosure issue. Patients are advised to find a dentist they can trust, be that through referrals or through an AIDS Service Organization (ASO) they work with. It's always best to find a dentist that has experience working with HIV/AIDS patients and knows to look for oral signs of HIV-related illnesses, in order to monitor the progression of the disease and possibly prevent certain oral conditions from occurring. In order to do that, though, dentists have to first be aware of their patients' HIV status. Also, while living with HIV commands certain rules when it comes to dental care, the virus should not exclude patients from dental work or dental maintenance. Quite the contrary.
