Human immunodeficiency virus (HIV) and dental care

Dry mouth

Many people with HIV experience ‘dry mouth’. Saliva lubricates the mouth and assists speech, taste and  chewing. It also washes teeth, providing minerals for repair. Saliva also helps prevent bacteria, viruses and fungi from causing infections, tooth decay and gum disease. 

Medications, such as antidepressants and some antiretroviral medications, can make your mouth dry. Try: 

  • frequently sipping water
  • chewing sugar-free gum
  • using a saliva substitute.

Keep your teeth and gums healthy

Follow these simple steps to help keep your teeth and gums healthy. Early stages of tooth decay may also be reversed. 

  • Gently brush your teeth twice a day using a small, soft toothbrush and a pea-sized amount of fluoride toothpaste. 
  • Spit the toothpaste out, but don’t rinse. 
  • Gently clean between your teeth with floss or interdental brushes. Your dentist can show you how. 
  • Limit how often you have sugary food and drinks. 
  • Chew sugar-free gum – it stimulates saliva flow and neutralises acids in your mouth. 
  • Use fluoride gels – your dentist may suggest applying a small amount of fluoride gel to your teeth once a day on a toothbrush or in a specially made tray for extra protection. 
  • Use ‘tooth mousse’ – it helps protect your teeth from rapid enamel loss and keeps your mouth feeling moist. Your dentist will advise you on availability.

Caution: products containing fluoride (such as gels and fluoride rinses) should not be swallowed and must be kept out of reach of children

Gum infections

Healthy gums are pink, firm and don’t bleed when brushed.

Bacteria irritates gums and cause gum infections if plaque is not cleaned from teeth and gums daily. Irritated gums may look red, swollen and bleed. Other signs include receding gums, loose teeth and persistent bad taste or bad breath. 

Gently brush teeth and gums in the morning and before bed at night to keep gums healthy. To help prevent gum infection: 

  • brush with a soft toothbrush angled at the gum and move gently in tiny circles 
  • floss gently between teeth
  •  use interdental brushes where there are spaces between teeth 
  • rinse with antibacterial mouthwash
  • have regular dental visits for cleaning 
  • if you’re a smoker, think about quitting – smoking can make gum disease worse, your doctor or dentist can advise and support your decision to quit, call the QUITLINE 137 848.

If your gums are sore, bleed excessively or have a bad odour, see a dentist urgently. 

If you have mouth ulcers, sores, infections or pain in your teeth or gums, seek dental advice.

Thrush

Thrush (candidiasis) may appear as white spots or a film inside the mouth. Thrush is uncommon in people taking antiretroviral medication for HIV, but if you take asthma or antibiotic medication, or you are not taking medication for HIV, you may experience thrush. To help treat thrush, try: 

  • eating natural yoghurt daily 
  • fluconazole tablets – they can be given by your doctor and usually resolve the infection
  • Daktarin oral gel – it may be helpful in making your mouth more comfortable. Caution: patients taking warfarin should not use Daktarin gel or cream. 

If your thrush persists, or your mouth splits and bleeds, see your dentist. 

Dentures can aggravate thrush. Try soaking your dentures for 30 minutes in diluted Milton’s solution. If the thrush doesn’t improve, or is severe, see your dentist.

Sensitive teeth

Your teeth may be sensitive to hot and cold or sweet food and drinks. Teeth can become sensitive if enamel is lost from the surface of the tooth or if the root surface is exposed.

Sensitivity can be caused by:

  • dry mouth
  • poor tooth brushing
  • frequent intake of acidic foods and drinks such as lemons, wine, and soft drinks 
  • frequent vomiting or gastric reflux
  • grinding teeth – this can occur during sleep, your dentist may recommend and provide a night splint to protect teeth from wearing.

Desensitising toothpaste or fluoride gel applied to the necks of the teeth may improve sensitivity. If sensitivity does not improve, or is severe, see your dentist.

Mouth ulcers

Ulcers can occur anywhere in the mouth and may be painful. Viruses, hot foods and some medications may  cause ulcers.

People with HIV may need medication to help heal mouth ulcers. If ulcers do not heal within two weeks see your dentist for advice.

Note: Any unusual lumps, swellings, discolourations or persistent mouth ulcers should be reported to your dentist or doctor.

Oral Hairy Leukoplakia (OHL)

OHL is a white thickening generally found on the side of the tongue. It may be confused with thrush, but unlike thrush it cannot be wiped off. It does not require treatment, but it may indicate a significant viral load and should be discussed with your doctor. 

Pigmentation and unusual lumps 

Brown and purple discoloration may occur on the cheeks or gums. This can be caused by HIV medication or it may be Kaposi Sarcoma (KS). If discoloration is caused by medication then nothing needs to be done. If it’s KS, your dentist or doctor may prescribe treatment to make your mouth more comfortable.

Warts may occur on the inside of the cheek or on the lips. The warts may be removed by your dentist if you find them irritating.

Denture care

Rinse your dentures after meals. Brush dentures daily with a soft brush and mild soap. Don’t use toothpaste – it’s abrasive and may cause wear to your dentures. 

Place your dentures in cold water at night and when they are not in your mouth. If your dentures are stained, a small amount of vinegar or bleach may be added to the water. Rinse in water afterwards. 

Dentures should fit well to maintain a healthy mouth. It may help to add a small amount of denture adhesive (available from your chemist) to the fitting surface of the denture.