HOW DOES HIV AFFECT THE MOUTH?
In the early years of the HIV epidemic, dentists were often the first healthcare professionals to notice signs of a weak immune system. These signs were infections that are normally controlled in a healthy person with a healthy immune system.
When people get tested for HIV infection and get started on antiretroviral therapy (ART), most of these infections never show up. However, many people do not get tested for HIV. They may be infected and not know it. Regular dental care is an important way they may learn they have a weak immune system.
According to the U.S. Health Resources and Services Administration (HRSA), over one third of people with HIV will have at least one major oral health problem and almost two thirds do not receive regular dental care.
DON’T IGNORE MOUTH PROBLEMS!
Pain or bleeding in your mouth can be a sign of infection. It can keep you from eating normally. Severe pain makes some people skip taking their medications. Serious infections in your mouth can cause other health problems. Be sure to see a dentist or let your healthcare provider know if you have trouble swallowing, changes in how food tastes, pain, or other problems with your mouth or teeth.
Some dentists or their office staffers do not want to treat patients with HIV. This goes against community standards and violates the Americans with Disabilities Act. Dental healthcare workers know how to protect themselves from diseases carried in the blood of their patients, including HIV.
WHAT ARE THE SIGNS OF HIV IN THE MOUTH?
Several problems with the teeth, mouth, and gums can show up in people with HIV.
Dry mouth and tooth decay: HIV infection can cause dry mouth. So can some medications, as well as coffee, carbonated beverages, alcohol, and smoking. Many people with HIV have dry mouth because they don’t make enough saliva to chew and swallow comfortably. Saliva protects teeth and gums from infection and decay. If you have dry mouth, take frequent drinks of water. You can talk to your healthcare provider about using sugar-free gum or candy or a saliva substitute.
Candidiasis (thrush): Candidiasis is caused by a fungus (yeast) called Candida. It shows up as red patches on the tongue or roof of the mouth or white lumps that look like cottage cheese that can form anywhere in the mouth. Candidiasis infection can move into the throat. It can also cause painful cracks at the corners of the mouth called angular chelitis. Many anti-fungal treatments can treat thrush. However, some cases of thrush are resistant to the usual medications.
Canker sores (apthous ulcers): Canker sores are small, round sores on the inside the cheek, under the tongue, or in the back of the throat. They usually have a red edge and a gray center. The sores can be quite painful. They can be caused by stress or by certain foods such as tomatoes. Hot, spicy, or acidic foods or juices make them hurt more. Some ointments, creams, and rinses can help.
Cold sores: Cold sores are a common infection caused by the herpes simplex virus (HSV). In people with HIV, cold sores can be more severe and can keep coming back. The most common treatment is the antiviral drug acyclovir.
Gum disease (periodontitis or gingivitis): Gum disease causes swelling of the gums. Sometimes painful and bloody, it can progress from gum loss to loosening and even loss of teeth. This can happen as quickly as 18 months. Dry mouth and smoking can make gum disease worse. Brush your teeth, floss, and see a dentist regularly. Gum disease has been linked to higher levels of inflammation throughout the body. This can increase the risk of heart disease and stroke.
Hairy leukoplakia: Hairy leukoplakia is an irritation that usually shows up as painless, fuzzy white patches on the sides of the tongue. It can be an early sign of HIV infection.
Kaposi Sarcoma (KS): Kaposi sarcoma usually shows up as dark purple or red spots on the gums, the roof of the mouth, and the back of the tongue. KS is rarely seen when people are tested early and start taking ART. It can be the first sign of HIV infection in people who have not been tested for HIV. The best treatment for oral KS in someone with HIV is effective ART.
Oral warts/human papillomavirus (HPV): Human papillomavirus is a sexually transmitted infection (STI). Some strains of HPV cause warts or cancer. HPV warts can show up in the mouth. The warts can be frozen or cut out.
THE BOTTOM LINE
Signs of HIV infection often show up in the mouth. People who haven’t been tested for HIV should pay close attention to any mouth problems.
Keep your mouth healthy by brushing your teeth and flossing. Get your teeth cleaned regularly by a dental health professional. See a healthcare or dental care provider about any serious issues.
MORE INFORMATION
American Dental Association: HIV/AIDS and Dental Health
NIH National Institute of Dental and Craniofacial Research: HIV/AIDS & Oral Health
healthline: What Do HIV Mouth Sores Look Like?
nam aidsmap: Mouth problems
Reviewed May 2021
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