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.