Oral health: The First Reflector of AIDS

About Oral health And AIDS

AIDS has taken on massive proportions in modern times. It is estimated that over 15 million people are suffering from the disease and many more are harboring the dreaded Human Immunodeficiency Virus (HIV). Besides creating havoc on the body's immune system, the AIDS virus also causes serious damage to the mouth and the surrounding structures. The mouth as we know is a hotbed of all kinds of microorganisms, some of which are quite normal to the area. But under immunocompromised conditions, these 'normal' microorganisms start to cause irreparable damage to the area. Besides, the teeth themselves, lips, tongue, gums and cheeks are affected by AIDS.

What actually happens in AIDS?

The basic defect in AIDS is that the virus destroys the immune system of the affected individual. In fact, it is not as much the virus as the individual who is responsible for all the illnesses suffered as a result of AIDS. All that the virus does is rendering the immune system impotent, thereby affecting the individual's capacity to ward off common infections. This is why pneumonia happens to be the leading cause of mortality in AIDS. One thing to be noted is that being HIV-positive does not necessarily mean having AIDS. These two are different scenarios. Full-blown AIDS occurs only after certain immune functions are completely destroyed by the virus.

AIDS and the mouth

The mouth is the first area where the AIDS virus presents striking signs. Some of the conditions exclusively associated with AIDS are as follows:

1. Oral Hairy Leukoplakia
2. Oral Candidiasis
3. Kaposi's Sarcoma
4. Oral Pigmentation
5. Gum Disease

Oral Hairy Leukoplakia

This condition is exclusively AIDS-related, and is a 100 per cent sure sign that the individual has begun to develop the full-blown version of the disease. Typically, Oral Hairy Leukoplakia (OHL) occurs on the lateral borders or on the sides of the tongue. It is a white lesion without any borders that cannot be rubbed off even by vigorous efforts. OHL can also occur on the palate, the cheeks, or the lips, but such instances are very rare. It is estimated that an individual who has this condition will develop full-blown AIDS within 31 months after the condition first arises.

Oral Candidiasis

Candida is a fungus that forms a normal part of the oral flora. The diminished resistance and the reduced overall immunity in AIDS trigger its proliferation to high levels to cause Candidiasis, a fungal infection in the oral cavity. This condition is present in 90 percent of AIDS cases. The infection can occur either on the hard or the soft palate, or the tongue. Sometimes it also occurs at the corners of the lips leading to crusting of the area. On very rare occasions, it can occur on the cheeks.

Kaposi's Sarcoma

Kaposi's Sarcoma is a malignant tumor that occurs most often on the palate and on the gums. It is again a diagnostic feature of AIDS. It occurs almost exclusively in homosexual males, and the male: female ratio is 20:1. The condition is usually painless and takes on a brownish or a purple hue after sometime. Most often Kaposi's sarcoma is present only in the mouth.

Oral Pigmentation

In most cases of AIDS, there is increased pigmentation in the oral cavity. The areas affected in succession are the gums, the tongue and the palate. Most often drugs like ketoconazole and zidovudine are responsible for this condition. The pigmentation is usually brownish-black in color.

Gum Disease

It is natural to expect that any condition that lowers host immunity to affect the gums. So also is the case with AIDS. Both Gingivitis-- of the gums, and Periodontitis--inflammation of the tooth-supporting tissues, is a manifestation of AIDS. The inflammation of the gums appear inflamed in a straight line. The inflammation of the tooth-supporting tissues varies widely and could range from a simple inflammation to a complex one, involving loss of a number of teeth. Both conditions are very painful and traumatic.

Treatment

The line of treatment for the above conditions is usually symptomatic. The fact is that as of now there is no known treatment for AIDS and the Anti Retroviral Therapy (ART) remains the only recourse.

FAQs

Which doctor should I see if I have AIDS?

Your physician is the first doctor that you should consult. In case the oral symptoms are causing mush distress, you can consult your dentist for symptomatic relief of the same.

Does Oral Hairy Leukoplakia occur in any other condition?

No. Till date, OHL has been exclusively associated with AIDS and is an indicator that the individual is on the road to developing the full-blown version of the same.

What about Candidiasis?

Candidiasis is basically a fungal infection and in cases where no other reason for its occurrence can be discerned, it is almost always due to AIDS.

What precautions must be taken to avoid gum disease in AIDS?

It is said that a clean tooth never decays. Hence, the best way to prevent the impact of gum disease in AIDS is to keep the teeth as clean as possible. Brush twice daily and use an anti-bacterial mouthwash to gargle after every meal so that food particles do not get stuck between the teeth.

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