The Tribune

By Dr Andre Clarke

THE Caribbean region has the second highest prevalence for adult HIV in the world.

It was estimated in 2008 that 240,000 persons lived with HIV in the region. In 2010, approximately three out of every 100 persons living in the Bahamas were said to be infected with the human immunodeficiency virus.

The fight against the spread of HIV is a very difficult one, but the Bahamas is notably making headway in the reduction amongst the youth population.

Regardless of your HIV status, it is recommended that you visit a dentist at least every six months. These regular visits allow the dentist to find early signs of decay, infection and disease and to treat problems at a manageable stage.

Studies show that cavities in people living with HIV can act as fungal reservoirs. Therefore, treating cavities immediately may reduce infections like ‘thrush’ (ie mouth infection) in those individuals. For proper care, it is helpful for a dentist to know that you are living with HIV because there are certain conditions that he will want to pay extra attention to.

Finding a dentist who you trust, who is supportive and who can help you make informed treatment decisions is mandatory. If you do not already have a dentist who you trust and feel comfortable with, consider a referral from your doctor, a friend or an AIDS service organisation.

Oral conditions

of HIV disease

It is estimated that 90 per cent of people with HIV will develop at least one mouth condition related to HIV disease. A condition such as ‘candidiasis’ may be the first sign of immune suppression linked to HIV infection, and in many persons can be the first signal that leads doctors to encourage HIV testing.

Many persons show up with lesions or sores which can be categorised into four types: abnormal cell growth (cancer), bacterial, viral and fungal.

1. Abnormal cell growth

One of the most common cancers associated with HIV which can affect the mouth, is Kaposi’s sarcoma (KS).

KS is the most common AIDS-related cancer reported in about 15 per cent of people with AIDS. Commonly KS is on the skin, although over half the people with it report mouth lesions as well. Sometimes mouth lesions that appear as patches or swellings are the first obvious sign. The roof of the mouth is the most common site, but they also occur on the gums, tongue and at the back of the mouth, near the throat.

1. Bacterial infections

Some of the most common mouth signs of HIV disease result from overgrown bacteria. Fortunately, these infections are among the easiest to treat; but if left untreated or when detected too late, serious health problems may occur.

Gingivitis is inflammation of the gums (sometimes accompanied by bleeding and bad breath) caused by a bacterial infection. Periodontal disease includes all diseases of the gums, teeth and underlying bone. People living with HIV are more at risk of these fairly common conditions and may also face more rapid and severe forms of gingivitis and periodontal disease.

1. Viral infections

Many mouth conditions in persons with HIV are caused by viruses. One virus in particular, can cause painful blisters and is rarely fully cleared from a person’s body. However, with effective therapies, it can be treated and future outbreaks suppressed.

Herpes simplex virus type 1 (HSV-1), which causes blisters on the lips, is fairly common in the general population and even more so in people living with HIV. In addition to sores on the lips, HSV-1 can appear inside the mouth, as “bubbles” on the gums and in the mouth, often in firmer tissue, like the roof of the mouth. Herpes sores can occur with fever, pain and loss of appetite. They can either be small and almost painless or they can be troublesome, extensive and persistent.

1. Fungal infections
   

Oral candidiasis is perhaps the most common oral condition in people with HIV. A healthy immune system can suppress the overgrowth of this fungus, but even a mildly compromised system may not keep the fungus in check. Factors that may cause candidiasis are prolonged stress, depression and using antibiotics.

Planning a course of action for dental care and treatment is important for people living with or without HIV. Your dentist is a partner in helping you develop this plan. Optimally, any course of treatment should be determined by you, your doctor and your dentist working together.

• This article is for informational purposes only. It is not intended and may not be treated as, a substitute for professional medical/dental advice, diagnosis, or treatment. Always seek the advice of a physician or dental professional with any questions you may have regarding a medical/dental condition. Never disregard professional medical/dental advice or delay in seeking it because of a purely informational publication.

If you have questions, please send email to dr_andreclarke@hotmail.com.