Heather Lawson -Myers - TOOTH TALK HIV/AIDS is a condition that prevents the body from fighting off infection. As a result, someone with the AIDS virus is susceptible to other viruses, bacterial infections, fungi, cancers and other diseases.
Lesions found in the mouth of a patient diagnosed with HIV/AIDS are differentiated as fungal, viral, bacterial infections, neoplasms such as Karposi's sarcoma and non-specific presentations such as apthus ulcerations and salivary gland disease.
The most common fungal infection seen in association with the HIV infection is candidiasis (thrush). There are three types:
1. The first appears on the tongue and roof of the mouth. It is a flat, red lesion and persons with this condition often complain of oral burning, most frequently when eating salty or spicy foods or acidic fruits and drinks.
2. The second type appears as a white creamy curd-like plaque found mostly on the cheek and tongue. The white surface can be wiped away leaving a red or bleeding underlying surface.
3. The third type appears as inflamed cracks in the corners of the lips where the top and bottom lips meet.
Some forms of Periodontal (gum) disease can be oral manifestations of the AIDS virus. One of the more common presentations is a red band along the gum line which may or may not bleed and may cause discomfort. This can be improved by improving oral hygiene, dental treatment and a prescription rinse. There is also a more ulcerative form of periodontal disease. Periodontal disease that is not responsive to treatment is suspicious and should be further investigated.
Herpes lesions in the mouth are widespread in HIV patients. The lesions start as a small cluster of vesicles that rupture and produce painful ulcerations which may join together. The herpes lesions usually run for a course and resolve on their own but there are medications such as acyclovir which stop the virus from replicating and allow for healing. The herpes virus can occur along the nerve in the face (trigeminal nerve) and the pain may feel like a toothache.
Hairy-like projections on the sides of the tongue known as Oral Hairy Leukoplakia is another viral infection which is not normally painful but it is one of the sure signs of HIV/AIDS. Warts in the mouth may also be seen in persons with HIV/AIDS. They appear in various forms spiked or raised with a flat surface or cauliflower-like appearance.
By far, the most frequently seen malignancy in association with HIV is Kaposi's Sarcoma. The malignancy presents as blotches or nodules of purple (sometimes red) usually seen on the posterior roof of the mouth. Non-Hodgkins Lymphoma is another form of cancer that may be present as large, painful, ulcerated masses on the roof of the mouth or on the gum tissue.
Salivary gland disease presents as the salivary glands are enlarged, especially the parotids. (These are the same glands that are affected when you have mumps). Along with salivary gland disease is a condition that causes the mouth to feel dry (Xerostomia). This is a fairly common complaint with patients living with the AIDS virus and it can be temporarily alleviated by sucking on sugar-free hard candies, chewing sugar-free gum or drinking liquids often.
Finally, recurrent apthus ulcerations are small lesions that usually are found on movable tissue in the mouth. They may occur on the inside of the lip, cheeks, floor of the mouth under the tongue, back of the mouth and the upper part of the throat. They usually last a week or two and it is best to avoid salty, spicy and acidic foods or drinks.
Any of these symptoms may appear in persons who do not have HIV/AIDS. However, because the immune system is compromised and the body is unable to fight off infection, persons with this disease are more predisposed to the aforementioned conditions.
Routine visits to the dentist will aid in early detection and maintaining good oral hygiene and in obtaining an accurate diagnosis. It is very important for the entire primary health care team, including the primary care physician, dentist and oncologist to work closely together in order to provide optimum treatment to persons living with HIV/AIDS. Dr. Heather-Dawn Lawson-Myers, President, Jamaica
Dental Association (2003/4).
