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HIV Oral Health Review. Evaluation Center for HIV and Oral Health Boston University School of Public Health Health & Disability Working Group. Why is Dental Care Important?. It’s important for EVERYONE !!!
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HIV Oral Health Review Evaluation Center for HIV and Oral Health Boston University School of Public Health Health & Disability Working Group
Why is Dental Care Important? • It’s important for EVERYONE!!! • If you are infected with HIV, good oral health and regular dental care become more important. • Many first signs of HIV appear in the mouth. • Simple dental problems may become more serious quickly with a weak immune system. • Problems may be treated more easily if found early.
Why do oral complications occur? • Changes in your immune system • From the drugs used to treat HIV • Same as everyone else – poor oral hygiene , smoking, aging
HIV-positive individuals should: • Have frequent dental exams, cleanings and prompt care • Brush and floss daily or as recommended by your dentist • Examine face, neck and mouth weekly • Inform your dentist or physician of any changed in the face, neck or mouth. • Inform your dentist of your medical history and HIV status.
CD4 cell count, HIV viral load and oral lesions • HIV viral load and oropharyngeal Candida colonization (Oral Dis 2000;6:158) • CD4 cell count and periodontitis (Oral Dis 2000;6:158) • CD4 cell count and oral candidiasis, and HIV viral load and oral leukoplakia(J Acq Imm Def Synd 2000;25:44) • CD4 count,HIV viral load and oral candidiasis (J Med Microbiol 2000;49:985) • Note: CD4<200 and VL>20,000 becomes predictive for oral lesions
Infections in the Mouth • Plaque is a film on the dental tissues that attracts bacteria. • Oral infections: • Gingivitis – early stage of gum disease • Periodontitis and Periodontal Disease – advanced stage of gum disease which includes bone loss (linked to increased risk of stroke and heart attack) • Dental caries (cavities)
Too much of a “normal” thing? • Is there such a thing as good bacteria? • Normal flora • micro-organisms that ordinarily grow on and in the human body (streptococci, staphylococci, candida, neisseria, etc) • However, when conditions change the normal environment in which these micro-organisms live in our mouth, this can cause them to increase in number resulting in infection.
Tooth Brushing Outer and Inner surfaces • Hold brush at a 45 degree angle with half-tooth wide strokes • Chewing surfaces • Hold the brush flat and brush back and forth.
Tooth Brushing Inside surfaces of front teeth • Tilt brush vertically and use gentle up-and-down strokes with toe of brush. • Don’t forget the tongue! • Brush in a back-to-front sweeping motion to remove food particles and freshens breath
Or Just Use the “Shake, Rattle N’ Roll” Method… You should brush for 2 minutes, so try humming a song you like or reciting the words in your mind.
Dental Floss Technique • Wrap an 18-inch strand around your middle fingers and hold a one-inch section tightly. • Ease floss between the teeth. Clean up and down several times while curving around teeth at the gingival margin. Don't scrub!
Dentures • Brush your gums, tongue and palate every morning with a soft-bristled brush before you insert your dentures to stimulate circulation in your tissues and help remove plaque. • Make sure and brush your dentures with a denture brush and denture cleanser
The Tooth….. • Tooth enamel is hard and porous. It consists of many closely-packed rods made of minerals. When you eat, acid forms on the outside of the tooth and seeps into the enamel's pores
Important Tooth Structures Enamel - hard, white outer layer of a tooth; the hardest substance in the body. Dentin - This is the main tissue that forms the shape of the tooth. Dentin is the material which exists between the pulp and the enamel Pulp - the soft tissue around the tooth that contains nerves, blood vessels, and connective tissue. Enamel Dentin Pulp
Dental Caries • When you eat, acid forms on the outside of the tooth and seeps into the enamel's pores. This demineralization process can produce a weak spot in the tooth's surface. If unchecked, the enamel can decay and cause a cavity –dental caries
Dental Caries • Tooth decay often begins on biting surfaces, between the teeth, and on exposed roots.
What is de-mineralization? • A process in which minerals are removed from the molecular structure of the tooth – caused by acids in the foods we eat and can lead to holes (cavities) in the tooth structure. Minerals removed from teeth Teeth Cavities are formed Gums
What is re-mineralization? • A process in which minerals are returned to the molecular structure of the tooth itself Minerals Teeth Gums
How can we re-mineralize our teeth? • Water with fluoride • Fluoridated toothpaste • Fluoride mouth rinses ( alcohol vs. no alcohol) • Topically applied fluorides • Gels • Professionally applied • Prescribed home therapy • Fluoride varnish
Why is Saliva Important? • It helps digest food • It protects teeth from decay • It prevents infection by controlling bacteria and fungi in the mouth • It makes it possible to chew food and swallow • Can be a great and cheap lubricant for sex!
Xerostomia (dry mouth) This may cause increase in cavities and periodontal disease • Sip water • Suck on crushed ice • Humidifiers at night • Avoid liquids containing caffeine or alcohol • Commercial artificial saliva • Discontinuation of xerostomia-inducing drugs • Stimulation of salivary flow
“Dry Mouth” • Side effects of some medicines. More than 400 medicines can cause the salivary glands to make less saliva. Medicines for high blood pressure and depression often cause dry mouth. • Disease. Some diseases affect the salivary glands. Sjögren's Syndrome, HIV/AIDS, diabetes, and Parkinson's disease can all cause dry mouth. • Radiation therapy. The salivary glands can be damaged if they are exposed to radiation during cancer treatment. • Chemotherapy. Drugs used to treat cancer can make saliva thicker, causing the mouth to feel dry. • Nerve damage. Injury to the head or neck can damage the nerves that tell salivary glands to make saliva.
Symptoms • a sticky, dry feeling in the mouth • trouble chewing, swallowing, tasting, or speaking • a burning feeling in the mouth • a dry feeling in the throat • cracked lips • a dry, tough tongue • mouth sores • an infection in the mouth
Lymphadenopathy – disease of the lymph nodes • Often times referred to as “swollen • glands/lymph nodes” • Can be caused by cancers, infections, diseases of the immune system
What are lymph nodes? • Small round structures present all over the body that are involved in protecting the body from infections • Tiny bean shaped gland – main locations include the neck, armpits, groin • Filter fluid through your body that capture infectious organisms and destroy with the white blood cells.
Thrush Fungal infection White curd-like Wipes off Red below Appears on buccal mucosa or tongue
What is it? This HIV-positive patient has signs of advanced oral hairy leukoplakia (OHL) on the lateral border of his tongue. OHL is caused by the Epstein-Barr Virus, a type of herpes virus also responsible for mononucleosis.
What is it? Oral warts secondary to HPV (Human Papillomavirus)
HPV – Human Papillomavirus • Is a papillomavirus that infects the skin and mucous membranes of humans • Commonly known for causing genital warts and increased risk of cervical, penile, and anal cancer • The types of HPV that cause warts don’t cause cancer and vice versa – some HPV infections have little to no symptoms • Oral HPV is thought to be caused in large by oral sex with a partner who has genital HPV • Studies are now showing an increased risk of oral cancers with HPV infection
THRUSH White curd-like Wipes off Red below Appears on buccal mucosa or tongue
KAPOSI’S SARCOMA or “KS” • Most common malignancy in HIV • Is associated with a type of herpes virus • KS often shows up as purple discoloration on the skin, but can affect internal organs and the lining of the mouth as well • While KS is usually not a fatal illness, it can cause significant disability and disfiguration.