By Sarah Biel-Cunningham, M.S.W.
From AIDS Survival Project

Oral health is very important. It is a crucial aspect of maintaining general health. Unfortunately, this is a topic that does not get as much attention as it should in HIV health care. According to a study conducted by the U.S. Department of Health and Human Services, 80% of people with HIV disease will present with at least one oral manifestation at some time during the course of their infection.

Reasons why oral health is important to individuals living with HIV:

• Problems in the mouth not only may be the first symptom of HIV infection but also can signify clinical progression.
• Proper dental care can reduce the presence of bacteria, which reduces strain on the immune system.
• Open sores and exposed tissue is a potential entrance for infections into the body.
• Regular dental visits allow for early identification of conditions and infections. This allows for early treatment of these issues before they develop into serious problems.

Common Oral Manifestations

There are several oral manifestations associated with HIV. An important part of proper dental health care for individuals living with HIV is to be able to differentiate one manifestation from another, as well as practicing proper dental hygiene as a preventative measure to promote a healthy mouth.

Oral Candidiasis

This condition occurs frequently and is most often called “thrush.” The affected area can be all over the mouth and possibly in the throat. The problem appears as white patches that can be wiped away, leaving a red surface. Some of the symptoms related with oral candidiasis are pain, loss of taste, distortion of taste, burning and discomfort.

Kaposi’s Sarcoma

Kaposi’s Sarcoma is the most common tumor associated with HIV and may initially appear as an intraoral tumor. The affected area is commonly on the roof of the mouth, but may also appear throughout the entire oral cavity. The symptoms of Kaposi’s Sarcoma are red or purple patches or swellings, which may appear as raised or flat and may become painful.

Hairy Leukoplakia

This is a common condition which appears usually without any symptoms. This is a white lesion that most often presents on the sides of the tongue; however, it may appear in other parts of the mouth. If symptoms present, the oral manifestation is described as white, streaky, “hairy” patches that cannot be scraped off.

Gingivitis and Periodontitis

This is a commonly occurring problem, often described as the most painful of oral manifestations. Gingivitis and periodontitis affect the gums and teeth. Symptoms include inflammation of the gums, swelling, bleeding, bad breath and breaks in the seal between the gums and teeth.

Xerostomia

This problem is also called dry mouth. This is one of the most common complaints among individuals living with HIV. This problem should be addressed immediately to ensure the prevention of dental decay and periodontal problems. The affected areas can be the entire mouth and throat. The symptoms of dry mouth include the observation of reduced saliva production, leading to ongoing dryness of the mouth and throat area.

The above oral manifestations and descriptions are not a comprehensive listing of all potential problems. There are several other oral manifestations which may occur; however, the above have been listed as the most common. If you would like more information on specific oral manifestations, www.HIVdent.org and www.projectinform.org are two resources that can help in your research.

Promoting Good Oral Health

After understanding potential oral manifestations it is essential to learn the general guidelines promoted by the American Dental Association as a preventative measure associated with good oral health.

1. Brushing your teeth

Good brushing should take a minimum of two minutes and should involve brushing in a circular motion, working your way from one side of the mouth to the another, keeping in mind to pay attention to certain neglected areas such as the very back teeth and your tongue. Dentists recommend using soft bristle brushes and toothpaste that contain fluoride.
1. Floss regularly

It is recommended that individuals floss on a regular basis after meals and before brushing their teeth. The proper way to floss is to push the floss gently between your teeth to the gum to loosen debris your toothbrush cannot reach. When you begin flossing, you may experience light bleeding which will fade once your gums get used to the flossing process.
1. Mouthwash

Using a mouthwash that contains fluoride at least twice a day is a good preventative measure that kills bacteria responsible for the plaque that causes cavities and gum disease.
1. Dental visits

Regular dental visits about every six months are crucial to early identification of potential problems that could develop into more serious problems.

Finding a Dentist That is Right for You

Dental care is an important aspect of general health care. However, one must not overlook the issues of finding a dentist that is right for you. Finding a dentist can often be a difficult process, and it is important to find someone you feel comfortable with, one to whom you are willing to disclose your HIV status. This is important because there are conditions and problems such as those discussed in this article that the dentist will need to pay attention to during your regular checkups. Hopefully after reading this article, you will have a better understanding of the importance of dental care to your overall health.

If you don’t already have a dentist, take this opportunity to do some research. There are several outlets for research to find a dentist that fits your needs. First, if you feel comfortable doing so, you may want to ask your doctor for a referral to a dentist or for a listing of area dentists with experience working with individuals living with HIV. Also, there are several listings in the resource database at AIDS Survival Project. Just give a peer counselor a call at (404) 874-7926 ext. 11 and ask for help locating a dentist in your area. Lastly, if you still need help locating a dentist, visit www.HIVdent.org, which provides information on HIV dental care as well as referrals to HIV dental programs in your community.

Fluoride is a natural substance

Fluoride is not a medication. It is a mineral found naturally in rock, air, soil, plants and water. All fresh and sea water contains some fluoride.

Many foods and drinks naturally contain fluoride. It is also added to:

• Drinking water, where fluoride is added to the local water supply
• Fluoride toothpastes, gels and mouth rinses
• Fluoride products painted on the teeth by a dental professional.

Water fluoridation helps protect teeth against decay

Tooth decay occurs when acid attacks the surface of the tooth. Fluoride helps repair any damage before it becomes serious. A constant low-level supply of fluoride is best for this. Fluoride in your drinking water is like a constant ‘repair kit’ for your teeth.

Dental decay affects the community in many ways, including pain, suffering and cost.

Benefits of water fluoridation

Fluoride is helpful because it:

• Helps protect against tooth decay in children and adults
• Repairs weak spots that could become cavities (holes in teeth) on the surface of the tooth
• Reduces the amount of money people need to spend on dental treatment
• Saves the community money and time (away from work and school)
• Reduces discomfort and pain caused by tooth decay
• Provides a benefit to all people, especially individuals from low socioeconomic communities, who have less access to other forms of fluoride treatments.

Adult and baby teeth need protection from decay

Fluoride can help to protect young and old teeth because it:

• Helps protect against surface decay in older adults
• Helps protect against tooth decay in children
• Helps prevent early loss of baby teeth due to decay. Baby teeth are important because they help to guide the adult teeth developing underneath into the right place. Losing baby teeth early may result in the need for orthodontic treatment
• Helps prevent painful and costly dental complications like tooth abscess or other permanent tooth damage.

Other ways to help protect your teeth

Even if your water is fluoridated, it is important that you look after your teeth by:

• Eating a healthy diet
• Brushing and flossing your teeth regularly
• Having regular dental check-ups
• Using a toothpaste with fluoride in it.

Protecting your children’s teeth

Children’s teeth need particular protection as they develop. Suggestions include:

• Brushing teeth without toothpaste until the age of 18 months
• Introducing a low-fluoride toothpaste when a child is approximately 18 months old. Choose a low-fluoride toothpaste designed especially for children
• Using a child-size toothbrush with soft bristles
• Using only a pea-size amount of toothpaste, smeared over the toothbrush
• Encouraging children to spit out toothpaste, not swallow it. Don’t rinse
• Supervising children when they brush their teeth until you are sure they can do it well
• Continuing to use low fluoride toothpaste for children until they are six years old
• Don’t use fluoride supplements in the form of drops or tablets to be chewed or swallowed. They can affect the development of your child’s adult teeth.

If your drinking water is not fluoridated, seek professional dental advice about the use of fluoride toothpaste for children. A dental professional may advise more frequent use of fluoride toothpaste, commencement of toothpaste at a younger age or earlier commencement of use of standard toothpaste.

Dental fluorosis

Too much fluoride at an early age can cause a child’s adult teeth (which form underneath their baby teeth) to stain. This is called dental fluorosis. Dental fluorosis looks like fine, pearly-white mottling, flecking or lines on the surface of the teeth; it is usually very hard to see. It cannot develop after teeth are fully formed and does not affect the function of the teeth. Dental fluorosis can occur in areas with or without water fluoridation.

By following the toothpaste guidelines above, the chance of dental fluorosis occurring can be minimised.

If fluoride is not the cause of staining of the teeth, it is not called dental fluorosis. Mottling of the teeth may be caused by other things including

• Injury to the teeth
• Certain medications
• Childhood infections.

Water quality

Water fluoridation does not noticeably change your water. Some facts about fluoride and the quality of your water are:

• Adding fluoride to the water does not change the taste or smell of your drinking water, as fluoride has no taste or smell.
• Your local water authority will be able to tell you if your supply has fluoride added to it.
• All Australian capital cities have fluoride added to the water.
• Boiling the water does not significantly change the levels of fluoride added.
• Most home water filters do not remove fluoride, with the exception of reverse osmosis systems.

Safety and water fluoridation

Water fluoridation is supported by leading Australian and international health, medical and dental organisations due to the following:

• The latest evidence confirms that water fluoridation is a safe and effective way to help protect teeth against decay.
• There is no evidence that fluoride in water fluoridation programs affects bone development or causes hip fractures or cancer.
• Fluoride is added to water in carefully controlled amounts. The total amount of fluoride in the water is monitored on a regular basis.
• Only very small amounts are used.

Water fluoridation is recommended

Many leading local, national and international health organisations endorse water fluoridation, including:

• World Health Organization
• Australia’s National Health and Medical Research Council
• Public Health Association of Australia
• Australian Medical Association
• Australian Dental Association
• FDI World Dental Federation
• Australian Institute of Environmental Health
• Australian Institute of Health and Welfare.
• Cancer Council Victoria
• Diabetes Australia Victoria Tel. 13 RISK (13 7475)
• Arthritis Australia
• Osteoporosis Australia
• The Pharmacy Guild of Australia.

Where to get help

• Water Fluoridation Information Line, Department of Health Tel. 1800 651 723
• Your dental professional
• Your local water authority

Things to remember

• Fluoride helps protect everyone’s teeth from decay.
• Use the correct fluoride toothpaste for children.

Green Tea

As we mentioned in an earlier post, green tea has been used medicinally for ages and is consumed by millions of people around the world every day. It has a higher number of antioxidants than black tea, which helps explain its many benefits for patients. Among the oral health benefits to look forward to, green tea actually kills cancer-causing free radicals and can reduce periodontal inflammation.

But that’s not all. Green tea is also known to aid in the reduction of dental plaque and can interfere with the production of hydrogen sulfide, which causes bad breath.

Dairy Products

Whether you’re talking about a slice of cheese, a cup of yogurt, or a glass of milk, dairy products can influence your smile for the better. For one thing, their low acidity protects teeth from decay and promotes a healthier pH. Dairy products are also high in calcium and phosphate, which help fortify teeth and bones alike. (You can view our earlier post on dairy here.)

Fruits and Vegetable

You’re probably all too familiar with the phrase “An apple a day keeps the doctor away.” Well, there’s some truth to it. The chewing action involved in eating raw fruit massages your gums and helps keep plaque from forming on teeth. What’s more, many fruits contain vitamin C, which is not only good for your overall health, its’ also good for supporting gum health. Likewise,  the act of eating raw vegetables, which contain a host of important nutrients (including vitamin A), helps keep teeth clean and strong, in addition to supporting overall health.

Water

If someone asked you to think about foods or drinks that are good for your smile, you might not have considered that water might be one of the best. But in addition to hydrating the body, water can help you wash away food trapped between your teeth and give the body extra protection from the development of bacteria and plaque, as it aids the natural neutralizing effects of saliva.

Want to know more about how certain foods can help your smile? Call your local dentist to schedule a visit, or you can also check out these two articles (from WebMD and Dental.net) on diet and oral health.

Testimonials

Find out beforehand if the doctor you’re considering has any testimonials or before-and-after pictures you can see. Some states—Texas, for example—don’t allow testimonials, but others do and this can be a great way to get to know a dentist and his or her work.

Experience

Knowing where a dentist studied, how long they’ve studied, what associations they’re a member of, and what awards they’ve one can all help you decide on a dentist. Typically, you can find information like this on a doctor’s webpage, under the “About the Office” or the “About Our Team” page. If the practice you’re considering is a new practice, what does this mean to you? Are you comfortable with the dentist’s expertise and training?

Technology

Whether you’re looking for general care or restorative care, finding a practicing with cutting-edge technology can be important. Tools like digital radiography expose patients to 80% less radiation while laser dentistry can make periodontal therapy more comfortable than traditional therapy with a scalpel and stitches. What advanced tools are important to you and will encourage you to seek the care you deserve?

Services

One of the most important questions to ask yourself as you look for a dentist is, what services do you and your family need? Do you already know that you need to have a specific procedure performed? For advanced surgical care, many dentists refer patients to a specialist, but some dentists have sought extra training and can perform these same procedures in their own office.

Comfort

If you have trouble sitting for long periods of time or you struggle with dental anxiety, finding an office that keeps patient comfort in mind can be very important. Some dentists do this through sedation dentistry, while others do so by advertising spa amenities.

From Tammy Davenport, former About.com Guide

Created: June 21, 2012

About.com Health’s Disease and Condition content is reviewed by our Medical Review Board

A lot of people have anxiety about going to the dentist. These facts can help put you on the right path to good oral health and avoid having dental problems in the future.

1. Dental Check Ups Include Oral Cancer Screenings

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When you go for your regular dental check up, your dentist and hygienist are also screening you for any signs of oral cancer. Every hour of every day, someone dies of oral cancer in the United States. This serious dental disease which pertains to the mouth, lips or throat is often highly curable if diagnosed and treated in the early stages. Visiting your dentistfor regular check ups and avoiding tobacco are the key factors in preventing oral cancer.

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Some people think that having good dental health takes too much effort. Seeing your dentist for regular dental check upsand cleanings, brushing twice a day, flossing daily and eating a nutritional diet are the key factors in having healthy teeth and gums. Now, what’s so hard about that?

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ANIMAL Dental Trivia

• Dogs have 42 teeth while cats have 30 teeth.
• Pigs have 44 teeth.
• Armadillos have as many as 104 teeth.
• Sharks have an unlimited supply of teeth.
• Rabbits, squirrels and rodents teeth never stop growing. They keep them worn down by gnawing on hard foods like bark.
• Even though whales are very big, some of them don’t have any teeth. They have rows of stiff hair-like combs that take food from the ocean.
• Snails are very small but they have thousands of tiny teeth all lined up in rows.
• Minnows have teeth in their throat.
• A crocodile replaces its teeth over 40 times in a lifetime.
• Turtles and Tortoises are toothless.
• A mosquito has 47 teeth.
• An Elephant’s tooth can weigh over 6 pounds. That’s heavier than a big jug of milk!
• Fangs are not found in all snakes, but all snakes do have teeth, usually 6 rows worth. The teeth are curved backwards, just like the barbs on a fishing hook which keeps their prey from escaping.
• “Long in the Tooth”, meaning “old”, was originally used to describe horses. As a horse ages, their gums recede, giving the impression that their teeth are growing in length. The longer the teeth look, the older the horse.
• Aardvark teeth have no enamel coating and are worn away and regrown continuously.
• The mammal that has the most teeth is the long snouted spinner dolphin with 252 teeth.

Famous Dentist Trivia

• Paul Revere – known for his famous ride and his work as a silversmith, put ads in a Boston newspaper offering his services as a dentist. Revere , in fact, is the first person known to use dental forensics, to identify the body of a colonial colonel killed at the Battle of Bunker Hill by the bridge appliance he wore.
• Doc Holiday – helped Wyatt Earp win the OK Corral Shootout.
• Thomas Welch – his company was the first to bottle grape juice.
• George Grant – invented the wooden golf tee.
• Zane Gray – wrote best selling Western Novels.
• William Morrison – invented the machine that makes cotton candy in 1897 and unveiled at the World’s Fair in 1904 in St. Louis . He was called “Fairy Floss”.
• Horace Wells – first dentist to use nitrous oxide “laughing gas” as an anesthestic for dental work in 1844.
• Grant Wood – famous artist of painting “American Gothic”. The stone-faced farmer was his dentist.
• George Washington – first President of the United States was the most famous dental patient of Dr. Greenwood. He had several sets of dentures that were made out of ivory. His teeth were not made out of wood!