ADULT HIV CARE

Oral health care is a critical component of comprehensive HIV medical management. Development of oral pathology is frequently associated with an underlying progression of HIV-disease status. A thorough soft-tissue examination may reveal pathology associated with dysphagia or odynophagia. Dental problems can result in or exacerbate nutritional problems. In addition, psychosocial and quality-of-life issues frequently are associated with the condition of the oral cavity and the dentition.

RECOMMENDATIONS
  • Primary health care providers should make an initial dental referral for every patient under their care. Oral health care providers should examine all patients on a semiannual basis for dental prophylaxis and other appropriate preventive care.
  • The primary health care provider should examine visually and through palpation the patient’s lips, labial and buccal mucosa, all surfaces of the tongue and palate, and the floor of the mouth. The gingiva should be examined for signs of erythema, ulceration, or recession.
  • Patients presenting with oral mucosal, gingival, or dental lesions should be referred promptly to an oral health care provider for appropriate diagnostic evaluation and treatment.
  • Health care providers should instruct patients in preventive oral health care, including dental visits, brushing, flossing, and the use of fluorides and antimicrobial rinses.
  • In the later stages of HIV disease, greater numbers of oral lesions and aggressive perio-dontal breakdown are more likely; therefore, oral health care visits should be scheduled more frequently.

Medications and oral health: Many of the medications received by HIV-infected patients have side effects that may manifest in the oral cavity. Potential side effects include the following:

  • Candidal growth: Antibiotics may cause or exacerbate
  • Xerostomia: Antihistamines, antidepressants, antipsychotics, antihypertensives, and anticholinergic agents
  • Increased risk of dental caries: Clotrimazole troches and nystatin suspension pastilles (contain sugar)
  • Gingival hyperplasia: Phenytoin
  • Oral ulcers: Zalcitabine (DDC)