HIV and the mouth

January 2007     View PDF     En español

Bacterial infections

Some of the most common oral signs of HIV disease result from overgrown bacteria. Fortunately, these infections are among the easiest to treat; but if left untreated or detected too late, serious health problems may occur.

Gingivitis and periodontal disease
Gingivitis is inflammation of the gums, sometimes accompanied by bleeding and bad breath, caused by a bacterial infection. Periodontal disease includes all diseases of the gums, teeth and underlying bone. People living with HIV are more at risk to these fairly common conditions and may also face more rapid and severe forms of gingivitis and periodontal disease. These more severe forms include linear gingivitis erythema (LGE) and necrotizing ulcerative periodontitis (NUP), conditions that occur almost exclusively in people living with HIV.

LGE, or red band gingivitis, is marked by a profound red banding along the teeth where the gums and teeth meet. Because it often occurs with occasional bleeding, LGE may be difficult to tell from ordinary gingivitis. LGE is related to, and may be a precursor of, other HIV-related NUP.

NUP is a condition that causes pain, spontaneous bleeding of the gums and rapid destruction of gum tissue and bone, which may lead to tooth loss. People often describe their discomfort as “deep jaw pain”. What causes NUP is still unknown, but effective treatments are nonetheless available.

NUP and LGE are best treated with a thorough dental cleaning and by using a chlorhexidine rinse. People suffering from more severe NUP are also placed on antibiotics (typically 250mg metronidazole 3–4 times a day for 7–10 days or amoxicillin 500mg three times a day for 7–10 days) and a 0.12% chlorhexidine rinse for two weeks. Antibiotics may also be used for those with LGE. Early detection and treatment is very important. People unable to get emergency dental care might find relief by using chlorhexidine rinses, antibiotics, pain management and nutritional supplements until a dental appointment can be made.

In some cases, NUP may progress to include larger ulcers on the roof of the mouth and gums (called necrotizing stomatitis, or NS). NS is most often seen in people with lower CD4+ cell counts (below 200) and can be managed with antibiotics. This often involves taking the medicine through a vein (intravenously). Once NS, NUP or LGE is under control, keeping excellent oral health is crucial to prevent it from coming back.

Mycobacterium avium complex (MAC)
Mycobacterium avium complex (MAC) is caused by bacteria and leads to symptoms like night sweats, fevers and weight loss. Oral lesions are uncommon in MAC disease, but when they occur they’re likely to be ulcers on the roof of the mouth. For more information, read Project Inform’s publication, MAC.