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 defected 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 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.

What should I do if oral lesions appear and I can’t afford private dental care?

There are government dental clinics in most towns. The charges are affordable. You can enquire at the clinics about the charges.

When 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 a government dental specialist?

Yes, but the charges are affordable.

Should I tell the dentist about my HIV status?

It’s your personnel decision whether you want to reveal your status. However letting you 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 diseases to dental personnel and other patients.

Are there things I should consider when deciding on 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 understands your condition and who is aware of the oral manifestations of AIDS.
· Choose a dentist who has experience in treating people in 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 shields etc - sterilizing all instruments after use
· Choose a clinic where the staff make you feel comfortable

What is dental plaque?

Dental plaque is a 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 causes 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 Sarcoma

Caries (tooth decay) – saliva has a cleansing action which washes away bacteria when the mouth is functioning such as during eating and speaking. Taking anti-HIV medications can reduce salivary flow and may cause an 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 severe 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 you’re 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 call 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 alternative, you could use garlic and cloves as they have anti-fungal properties.

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 like 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.

HPV (Human Papillomavirus) – Oral Warts. Some strains of HPV cause warts in the mouth or lips especially in those with CD4 cell counts of 200 or less. They are only painful when they lie on the gumline. In rare cases 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 – 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.

Kaposi’s Sarcoma – the mouth is a common area of infection for Kaposi’s Sarcoma. Symptoms – painful lesions that are purplish in colour. 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 and 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.
You 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 surfaces.

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 you 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 you 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.

Exercise & HIV : Exercise is one of the 4 main keys to living with HIV. The other 3 are getting plenty of sleep, eating well and keeping your stress levels down. And really, this is the recipe for living well even for people without HIV. However most people cringe at the thought of exercise especially if they haven’t done it before. But once you get into it, you may actually feel good about it and find that it’s not hard to do. This is because exercise gives you energy and a sense of well being. So be a sport and give it a try. And as always, talk to your doctor about what you can and cannot do.

What types of exercises are there?

We’ve given a simple guide to what you can do.
Build those Muscle This is important for people with HIV as they tend to lose muscle mass.
What kind of exercises can I do? The most common is weight lifting with dumb-bells or machines, yoga, tai-chi to name a few.

How often should I do this?

Ideally 3-4 times a week, every other day. However before you start on any exercise programme, talk to your doctor about it. He/She will be able to advise you about how heavy or light your weights should be, how many times you should lift them etc. There are a lot of things to take into account depending on your state of health.

Must I join a gym? You don’t have to. You can do it at home by using simple alternatives for weights like soup cans, mineral water bottles etc. Exercise should be pleasure not pain. These exercises include walking, running, swimming laps, cycling, aerobic dance and others. Choose an activity that you enjoy so it won’t be a chore.

Stretch, Stretch, Stretch Exercises that fall into this category are yoga, tai-chi and basic stretches. Remember, stretch only after you’ve warmed up your body and muscles or you may risk injuring them.
Tips
· Commit yourself to the exercise programme. Many start and give up. You can do this by getting some friends to join you.
· Safety is important. Learn the techniques before you start. If not, you may risk injury which may prevent you from exercising in the future.
· Keep your goals simple. Do 5-10 minutes a day and work up to longer periods. Don’t overstrain.
· Listen to your body. If your body is feeling tired while you’re exercising, STOP.
Most importantly, talk to your doctor before you start anything. He knows what’s best for you.