HIV / AIDS

Oral health effects

• Oral thrush (candidiasis)

  Common opportunistic infection, often an early sign of immune suppression.

  Clinical management: Antifungal therapy; assess immune status.

• White ridged patches on the sides of the tongue (oral hairy leukoplakia)

  EBV-associated white lesion on the lateral tongue, fairly specific to immunosuppression. Much less common in patients on effective antiretroviral therapy.

  Clinical management: Usually no treatment needed; reflects immune status.

• Dry mouth and salivary gland swelling (HIV-associated salivary gland disease)

  Chronic dry mouth is one of the most common oral problems in HIV, from salivary gland disease and from medications; parotid enlargement may also occur.

  Clinical management: Ask about dryness; recommend sugar-free saliva substitutes, frequent water sips, high-fluoride toothpaste and caries-risk recall intervals.

• Oral warts (HPV)

  Cauliflower-like white, grey or pink bumps on the lips, gingiva or mucosa caused by human papillomavirus; can persist or even increase despite antiretroviral therapy.

  Clinical management: Document and photograph; refer for removal (surgical, cryotherapy); note they can recur; avoid traumatizing lesions during instrumentation.

• Red band along the gum line (linear gingival erythema)

  A distinct fiery-red band along the marginal gingiva that bleeds easily and responds poorly to plaque control alone; often Candida-associated.

  Clinical management: Do thorough debridement plus chlorhexidine rinse; refer for antifungal therapy if it does not resolve; monitor as a possible marker of immune status.

• Cold sores and mouth ulcers (herpes / aphthous ulcers)

  Recurrent herpes and canker-sore-type ulcers are more frequent and can be larger and slower to heal with immunosuppression.

  Clinical management: Postpone elective care during active herpes lesions; refer large (>1 cm) or non-healing ulcers for evaluation; offer topical anesthetic/protective agents.

• Dark patches in the mouth from HIV medicines (oral hyperpigmentation)

  Brown-to-black mucosal pigmentation occurs in about a quarter of people on antiretroviral therapy (especially NRTIs); it is harmless but can be mistaken for other pigmented lesions.

  Clinical management: Record location and appearance at baseline; reassure; refer any solitary, raised, growing or irregular pigmented lesion for evaluation.

• Rapidly destructive, painful gum disease (necrotizing periodontal disease)

  Necrotizing gingivitis and periodontitis are more likely with advanced immunosuppression.

  Clinical management: Prompt debridement and periodontal care; coordinate with the patient's HIV care team.

• Purple or red mouth tumors (Kaposi sarcoma)

  An HIV-associated malignancy that can appear in the mouth.

  Clinical management: Refer suspicious lesions for biopsy.