Oral Health and HIV - HIV/AIDS and Oral Health

Oral Health and HIV
Winter 2003/2004
By David I. Rosenstein, D.M.D., M.P.H.
The Body

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Introduction
Oral Health and HIV

Most oral health problems can be found in people who are either HIV positive or negative. Yet there are some important differences. A few conditions are seen almost exclusively in people with HIV, while some that are found in both populations are more problematic for people with HIV, especially those with advanced disease. A diminished immune system can alter the course of oral disease and require more aggressive treatment to prevent minor troubles from escalating into major health problems.

Over 30 different oral manifestations of HIV disease have been reported since the beginning of the AIDS epidemic. This article will address several of the most common of these oral health issues. As with any health condition faced by HIV-positive people, early identification and treatment should be emphasized. In many cases, referral to a dentist should be made as soon as possible.

Oral Health and People With HIV
The teeth are fully formed by the teenage years, and are not affected directly by HIV or anti-HIV medications. Reduced bone mineral density seen in people with HIV does not affect tooth enamel (the hard surface of exposed teeth), and it is unknown what affect, if any, it may have on the underlying bone that supports the teeth.

No treatment of any oral health problem should be avoided simply because a person is HIV positive. Reports early in the AIDS epidemic suggested that procedures such as root canals should not be performed in people with HIV. There were also suggestions that dental treatment should be postponed for anyone with a CD4 cell count below 200 cells/mm3. Though these reports were inaccurate, their impact continues to be felt; some textbooks with recent publication dates still contain these misstatements. Dentists who follow these erroneous recommendations do so in violation of the Americans with Disabilities Act, and in violation of accepted community standards.

All procedures and devices -- including periodontal surgery, endodontics (root canals), orthodontics (braces and retainers), implants, bleaching, and bridges -- can be safely and effectively provided regardless of immune status. Decisions about such procedures should be made by the HIV-positive individual in consultation with his or her dentist. As always, one should weigh the cost and time of the service against the expected benefits.

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