The human immunodeficiency virus (HIV) significantly impacts oral health due to the progressive deterioration of the immune system it causes. The virus targets and depletes CD4+ T-lymphocytes, which are white blood cells essential for fighting infections. This immune suppression allows various opportunistic pathogens—including fungi, viruses, and atypical bacteria—to thrive in the mouth. Oral health problems are frequently among the earliest clinical indicators of a person’s immune status and can signal the progression of the underlying condition. Dentists often play a role in identifying these manifestations, prompting timely medical evaluation and treatment.
Common Oral Manifestations
Oral conditions in individuals with unmanaged HIV infection are categorized by the type of pathogen exploiting weakened immune defenses. Fungal infections, particularly Oral Candidiasis (thrush), are the most common presentations. This infection, caused by the Candida fungus, appears as creamy white, cottage cheese-like patches that can be wiped away, revealing a red, inflamed surface underneath. The presence of thrush is strongly associated with a CD4+ T-lymphocyte count below 200 cells/mm³, marking significant immune deficiency.
Viral infections also manifest distinctly in the oral cavity. Oral Hairy Leukoplakia (OHL), caused by the Epstein-Barr virus (EBV), displays as painless, white, corrugated or “hairy” patches most often found on the sides of the tongue. Unlike candidiasis, these patches cannot be scraped off and are linked to a declining CD4 count. Kaposi’s Sarcoma (KS), caused by Human Herpesvirus 8 (HHV8), is a malignancy presenting as flat or raised red, blue, or purple lesions, commonly appearing on the palate. KS is considered an AIDS-defining illness and indicates severe immunosuppression.
Atypical forms of periodontal disease represent a distinct category of bacterial-related issues. Linear Gingival Erythema (LGE) is a localized condition characterized by a fiery red band along the gum margin that does not respond to conventional dental cleaning. LGE is sometimes associated with a fungal component, specifically Candida species, and often marks early immune decline.
Necrotizing Ulcerative Periodontitis (NUP) is a more aggressive and painful condition. It involves rapid tissue necrosis, deep ulceration of the gums, and swift destruction of the underlying bone and ligament supporting the teeth. This destructive process can lead to tooth mobility and loss quickly. NUP is seen in patients with profound immunosuppression and indicates a poor prognosis without immediate and aggressive intervention.
Role of Antiretroviral Therapy in Oral Health
The adoption of modern Antiretroviral Therapy (ART) has fundamentally changed the landscape of oral health for individuals living with HIV. By suppressing the viral load to undetectable levels, ART allows the CD4+ T-lymphocyte count to increase and the immune system to recover its function. This restoration of immune competence drastically reduces the incidence and severity of opportunistic infections that were once hallmarks of advanced HIV disease.
Conditions like oral candidiasis, oral hairy leukoplakia, and Kaposi’s sarcoma are now seen far less frequently in patients adhering to their ART regimen. When these conditions appear, they can signal a failure of the ART to control the virus or a lack of medication adherence. Effective systemic viral control translates directly into a healthier, more resilient oral environment.
However, ART is not without potential effects on the mouth. A recognized side effect of some antiretroviral medications, and even the HIV infection itself, is chronic dry mouth (xerostomia). Saliva plays a significant role in neutralizing acids and protecting teeth, so reduced salivary flow increases the risk of tooth decay and gum disease. Managing dry mouth is an important part of the overall oral health strategy for people on ART.
Proactive Dental Care and Prevention
Maintaining optimal oral health requires a proactive and collaborative approach between the individual and their dental team. Regular dental check-ups, often recommended at least every six months and sometimes more frequently, are necessary for early detection and management of developing oral issues. Open communication with the dental provider regarding HIV status, current ART regimen, and recent CD4 count and viral load results is essential for personalized care.
Diligent home care is the foundation of prevention, including brushing twice a day with a fluoride toothpaste and flossing daily to disrupt bacterial plaque. For individuals experiencing dry mouth, strategies to mitigate its effects are particularly important. These include sipping water frequently or using over-the-counter products like artificial saliva and specialized rinses. Using sugarless gum or lozenges can also help stimulate natural saliva flow, which protects against the increased risk of cavities.
The goal of this comprehensive care is to treat specific oral manifestations and prevent them from occurring. By controlling the systemic infection with ART and practicing consistent oral hygiene, individuals living with HIV can significantly reduce their risk of severe dental and oral complications. The dental provider is part of the broader healthcare team working to ensure long-term health and quality of life.