Transcript Slide 1
HIV Oral Health Review
Evaluation Center for HIV and Oral Health
Boston University School of Public Health
Health & Disability Working Group
Why is Dental Care Important?
• It’s important for EVERYONE!!!
• If you are infected with HIV, good oral health
and regular dental care become more
important.
– Many first signs of HIV appear in the mouth.
– Simple dental problems may become more
serious quickly with a weak immune system.
– Problems may be treated more easily if found
early.
Why do oral complications occur?
• Changes in your immune system
• From the drugs used to treat HIV
• Same as everyone else – poor oral
hygiene , smoking, aging
HIV-positive individuals should:
• Have frequent dental exams, cleanings and
prompt care
• Brush and floss daily or as recommended by
your dentist
• Examine face, neck and mouth weekly
• Inform your dentist or physician of any
changed in the face, neck or mouth.
• Inform your dentist of your medical history
and HIV status.
CD4 cell count, HIV viral load
and oral lesions
• HIV viral load and oropharyngeal Candida
colonization (Oral Dis 2000;6:158)
• CD4 cell count and periodontitis (Oral Dis 2000;6:158)
• CD4 cell count and oral candidiasis, and HIV viral
load and oral leukoplakia (J Acq Imm Def Synd 2000;25:44)
• CD4 count,HIV viral load and oral candidiasis (J Med
Microbiol 2000;49:985)
•Note: CD4<200 and VL>20,000 becomes predictive
for oral lesions
Infections in the Mouth
• Plaque is a film on the dental tissues that
attracts bacteria.
• Oral infections:
– Gingivitis – early stage of gum disease
– Periodontitis and Periodontal Disease – advanced
stage of gum disease which includes bone loss
(linked to increased risk of stroke and heart attack)
– Dental caries (cavities)
Too much of a “normal” thing?
• Is there such a thing as good bacteria?
• Normal flora
– micro-organisms that ordinarily grow on and in
the human body (streptococci, staphylococci,
candida, neisseria, etc)
• However, when conditions change the normal
environment in which these micro-organisms
live in our mouth, this can cause them to
increase in number resulting in infection.
What can we do on a daily
basis to improve oral health?
Tooth Brushing
Outer and Inner surfaces
• Hold brush at a 45 degree angle
with half-tooth wide strokes
Chewing surfaces
• Hold the brush flat and brush
back and forth.
Tooth Brushing
Inside surfaces of front teeth
• Tilt brush vertically and use
gentle up-and-down strokes with
toe of brush.
Don’t forget the tongue!
• Brush in a back-to-front
sweeping motion to remove food
particles and freshens breath
Or Just Use the “Shake, Rattle
N’ Roll” Method…
You should brush for 2 minutes, so try
humming a song you like or reciting the
words in your mind.
Dental Floss Technique
• Wrap an 18-inch strand
around your middle fingers
and hold a one-inch
section tightly.
• Ease floss between the teeth.
Clean up and down several times
while curving around teeth at the
gingival margin. Don't scrub!
Dentures
• Brush your gums, tongue and palate every
morning with a soft-bristled brush before you
insert your dentures to stimulate circulation
in your tissues and help remove plaque.
• Make sure and brush your dentures with a
denture brush and denture cleanser
So what do the structures in
our mouth look like up close?
The Tooth…..
• Tooth enamel is hard
and porous. It
consists of many
closely-packed rods
made of minerals.
When you eat, acid
forms on the outside
of the tooth and seeps
into the enamel's
pores
Important Tooth Structures
Enamel - hard, white outer layer of a tooth; the hardest substance in
the body.
Dentin - This is the main tissue that forms the shape of the tooth.
Dentin is the material which exists between the pulp and the enamel
Pulp - the soft tissue around the tooth that contains nerves, blood
vessels, and connective tissue.
Enamel
Dentin
Pulp
Dental Caries
• When you eat, acid forms
on the outside of the tooth
and seeps into the
enamel's pores. This
demineralization process
can produce a weak spot
in the tooth's surface. If
unchecked, the enamel
can decay and cause a
cavity –dental caries
Dental Caries
• Tooth decay often
begins on biting
surfaces, between the
teeth, and on exposed
roots.
What is de-mineralization?
• A process in which minerals are removed
from the molecular structure of the tooth –
caused by acids in the foods we eat and can
lead to holes (cavities) in the tooth structure.
Minerals removed
from teeth
Cavities are formed
Teeth
Gums
What is re-mineralization?
• A process in which minerals are returned to
the molecular structure of the tooth itself
Minerals
Teeth
Gums
How can we re-mineralize our teeth?
• Water with fluoride
• Fluoridated toothpaste
• Fluoride mouth rinses ( alcohol vs. no
alcohol)
• Topically applied fluorides
– Gels
• Professionally applied
• Prescribed home therapy
– Fluoride varnish
Why is Saliva Important?
• It helps digest food
• It protects teeth from decay
• It prevents infection by controlling bacteria and
fungi in the mouth
• It makes it possible to chew food and swallow
• Can be a great and cheap lubricant for sex!
Xerostomia (dry mouth)
This may cause increase in cavities and periodontal disease
Sip water
Suck on crushed ice
Humidifiers at night
Avoid liquids containing caffeine or alcohol
Commercial artificial saliva
Discontinuation of xerostomia-inducing
drugs
Stimulation of salivary flow
“Dry Mouth”
• Side effects of some medicines. More than 400
medicines can cause the salivary glands to make less
saliva. Medicines for high blood pressure and depression
often cause dry mouth.
• Disease. Some diseases affect the salivary glands.
Sjögren's Syndrome, HIV/AIDS, diabetes, and Parkinson's
disease can all cause dry mouth.
• Radiation therapy. The salivary glands can be damaged if
they are exposed to radiation during cancer treatment.
• Chemotherapy. Drugs used to treat cancer can make
saliva thicker, causing the mouth to feel dry.
• Nerve damage. Injury to the head or neck can damage the
nerves that tell salivary glands to make saliva.
Symptoms
• a sticky, dry feeling in the mouth
• trouble chewing, swallowing, tasting, or
speaking
• a burning feeling in the mouth
• a dry feeling in the throat
• cracked lips
• a dry, tough tongue
• mouth sores
• an infection in the mouth
Oral Manifestations Seen in
Persons Living with HIV
Effects of Dry Mouth
Lymphadenopathy –
disease of the lymph nodes
- Often times referred to as “swollen
glands/lymph nodes”
- Can be caused by cancers, infections,
diseases of the immune system
What are lymph nodes?
• Small round structures present all over the
body that are involved in protecting the body
from infections
• Tiny bean shaped gland – main locations
include the neck, armpits, groin
• Filter fluid through your body that capture
infectious organisms and destroy with the
white blood cells.
Thrush
• Fungal infection
• White curd-like
• Wipes off
• Red below
• Appears on buccal mucosa or tongue
What is it?
This HIV-positive patient has signs of advanced oral hairy leukoplakia
(OHL) on the lateral border of his tongue. OHL is caused by the EpsteinBarr Virus, a type of herpes virus also responsible for mononucleosis.
What is it?
Oral warts secondary to HPV (Human Papillomavirus)
HPV – Human Papillomavirus
• Is a papillomavirus that infects the skin and mucous
membranes of humans
• Commonly known for causing genital warts and increased
risk of cervical, penile, and anal cancer
• The types of HPV that cause warts don’t cause cancer and
vice versa – some HPV infections have little to no symptoms
• Oral HPV is thought to be caused in large by oral sex with a
partner who has genital HPV
• Studies are now showing an increased risk of oral cancers
with HPV infection
THRUSH
• White curd-like
• Wipes off
• Red below
• Appears on buccal mucosa or tongue
KAPOSI’S SARCOMA or “KS”
• Most common malignancy in HIV
• Is associated with a type of herpes virus
• KS often shows up as purple discoloration
on the skin, but can affect internal organs
and the lining of the mouth as well
• While KS is usually not a fatal illness, it can
cause significant disability and disfiguration.