HIV/AIDS and Dentistry

By: Heather Atchley-Grey, Cevinah Chotard, Cambria Curran, Lauren McCall, and
Chelsie Vandehey

1.

A description of the condition(s).

AIDS (Acquired immune deficiency syndrome or acquired immunodeficiency syndrome) is a

syndrome that is caused by a virus called HIV (Human Immunodeficiency Virus). HIV is a virus
where as AIDS is a medical condition. Just because one is infected with HIV doesn't always
guarantee the person develops AIDS. HIV illness alters the immune system, therefor making
people more vulnerable to infections and diseases. This susceptibility worsens as the syndrome
progresses. HIV is the virus that attacks the T-cells in the bodys immune system. AIDS is the
syndrome that appears in advanced stages of HIV infection. HIV is a retrovirus that infects the
vital organs of the human immune system. The virus progresses in the absence of antiretroviral
therapy. The rate of virus progression varies widely between individuals. HIV can be transmitted
through sexual transmission, perinatal transmission and blood transmission.

2.

Does/do the condition(s) require a consultation with the patient's physician?

In general the HIV/AIDS population goes to a primary care physician on a regular basis and thus
is informed and can accurately inform the dental professional of their current CD4 levels, viral
load, and current medications. It is important to dental professionals to be aware of the patients
CD4 count because the number of CD4 white blood cells indicate the patients ability to fight
infection. If the CD4 count is lower than 500, a medical consultation is required before
proceeding with treatment due to delayed healing and an increased risk of infection. The viral
load is important to know because they correlate with the magnitude of viral replication and are
associated with the rate of CD4 lymphocyte destruction and thus the rate of disease progression.
If the viral load is higher than 100,000, a medical consultation is required. It is important to be
aware of the multitude of medications that the patient is taking for their HIV/AIDS and other
diseases/conditions so that the dental professional is aware of any contraindications and/or
complications to dental treatment.
If the HIV/AIDS patient is not under regular care of a physician or has not been to their
physician in over three months, then a medical consultation to obtain their accurate and recent
CD4 levels and viral load is required before proceeding with treatment.
3.
Investigate association or link of the condition(s) with gingival or periodontal
diseases.
HIV/aids can lead to gingival and/or periodontal diseases when oral conditions are left untreated.
People infected with HIV/aids have compromised immune systems and are more susceptible to

acquiring oral infections. Some of these patients also have severe forms of periodontal diseases,
such as NUG and NUP (necrotizing ulcerative periodontitis). This occurs because their immune
system is weak and cannot defend itself properly against the bacterial invasions.
Another issue that leads to increased oral issues is the use of HIV medication. Some of these
medications cause dry mouth, which increases the risk of tooth decay and can make chewing and
swallowing difficult.
Gingival and periodontal diseases cause the oral tissues to become inflamed and painful. If the
affected patient does not seek proper dental care, the disease can progress rapidly. Increased
dental visits may be needed and the use of an antimicrobial mouth rinses are recommended to
assist in the reduction of plaque bacteria.
4.
List any changes in the oral tissues that might be observed with the condition, and
whether these changes are related directly to the condition or medications prescribed for
the condition.
The most common is a fungal infection known as candidiasis and it is caused by the over growth
of the yeast commonly found in the normal oral microbiota. It appears as a white patch on the
palate or buccal mucosa and can be wiped off leaving a reddened, ulcerated, and tender mucosa.
This appears because of the suppressed immune system. Epstein- Barr virus is another indication
of HIV. It is a herpesvirus and is generally kept dormant as long as immune defensives are
intact. Due to the suppressed immune system many individuals with HIV or AIDS develop oral
lesions at a higher rate from certain viruses when compared to a person who is HIV or AIDS
negative. The viruses include human papilloma viruses, which cause oral warts, herpes simplex,
herpes zoster and other ulcers. Hairy Leukoplakia is often the first sign of an HIV infection and
is triggered by the Epstein-Barr virus. It presents as a white corrugated patches on the tongue or
other areas of the mouth and may look hairy. Unlike candidiasis it cannot be removed, and may
cause discomfort. It is caused from conditions that weaken the immune system such as HIV, and
is generally a sign the persons HIV has worsened. Patients with HIV also have severe forms of
periodontal disease such as rapidly progressing periodontitis and necrotizing ulcerative
periodontitis (NUP or NUG). NUP affects the osseous structures of the periodontium. Clinical
features include pain, interproximal gingival necrosis, and cratered soft tissues. Another
immunosuppressed sign of HIV is Kaposis Sarcoma and presents as flat purple plaques or raised
nodules found on the palate and maxillary gingiva. Some side effects seen for medications can be
found in the chart below (taken from http://www.hivguidelines.org/clinicalguidelines/adults/oral-health-complications-in-the-hiv-infected-patient/):

Agent(s)
Antibiotics
Antihistamine,
antidepressant,
antipsychotic,
antihypertensive, and

Potential Side Effect

May cause or exacerbate
candidal growth
Xerostomia

anticholinergic agents
Clotrimazole troches and Because these agents
nystatin suspension
contain sugar, they may
pastilles
increase the risk of dental
caries
Phenytoin
Gingival hyperplasia
Zalcitabine (ddC)
Oral ulcers

List the modifications (if any) for dental/dental hygiene care that would be needed to treat
the patients with the condition.
From an infection control stance, patients infected with HIV should not be treated any differently
than patients not infected. Universal precautions should be used the same as with all patients.
Avoid cross contamination and any exposures through direct contact, dental aerosols, body fluid
splatter, and contact from contaminated instruments. However, the clinician should be aware of
all medications and other treatments being given. The clinician should also be in communication
with the infected persons primary medical care provider.
The clinician should also examine the patient for any oral lesions. Oral lesions are common in
patients infected with HIV. If there is an oral lesion present, it should be diagnosed and treated.
Oral lesions may represent the initial manifestation of the disease and parallel the development
of opportunistic infections and neoplasms with worsening immunosuppression. Patients on
HAART therapy usually have fewer oral manifestations but their medications may cause
xerostomia. Oral lesions are often chronic and will require lifelong follow-up and treatment.

References:

http://www.dentalcare.com/media/en-us/education/ce70/ce70.pdf
Abel, S.N., DDS, MS., et al. (2000). Principles of Oral Health Management for the
HIV/AIDS Patient. Retrieved from
http://aidsetc.org/sites/default/files/resources_files/Princ_Oral_Health_HIV.pdf
Perry, Dorothy, Phyllis Beemsterboer, and Gwen Essex. "Systemic Factors Influencing
Periodontal Diseases." Periodontology for the Dental Hygienist. 4th ed. St. Louis:
Elsevier, 2014. 151-152. Print.
https://www.aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/potential-relatedhealth-problems/oral-health-issues/
http://scienceblog.cancerresearchuk.org/2014/04/09/epstein-barr-virus-and-the-immunesystem-are-cures-in-sight/
http://www.hopkinsmedicine.org/healthlibrary/conditions/infectious_diseases/oral_hairy_
leukoplakia_134,213/

http://www.hivguidelines.org/clinical-guidelines/adults/oral-health-complications-in-thehiv-infected-patient/
Nordqvist, Christian. "HIV / AIDS: Causes, Symptoms and Treatments." Medical News
Today. MediLexicon, Intl., 18 Nov. 2015. Web.6 Jan. 2016.
http://www.medicalnewstoday.com/articles/17131.php