HIV is a lifelong infection that causes the body to attack its own immune system. When not controlled by antiretroviral therapy (ART), HIV/AIDS can cause a number of infections across the body, including oral issues. Historically, more than one-third of people living with HIV have experienced at least one oral health problem, ranging from dry mouth to tooth decay, after their HIV diagnosis. “Has anyone experienced dental problems in dealing with HIV?” one myHIVteam member asked. “I have lost almost all my original teeth over the last 3 years.” However, people with well-controlled HIV, whose illness has never progressed to AIDS and who are taking modern ART, can expect to have no more oral health problems than those without HIV.

This article explains common dental and oral health problems that could be experienced by those living with HIV infection, plus some tips to deal with these issues. If you believe you are experiencing any of these conditions, see your dentist or primary care provider to prevent your symptoms from worsening.

1. Dry Mouth

Antiretroviral medications are crucial to allow your viral load (the amount of HIV in your blood) to get to and remain at undetectable levels. Older ART medicines could come with a variety of side effects, one of which was dry mouth. Untreated or inadequately controlled HIV can also cause dry mouth and, these days, is more likely than ART to cause this problem. Left untreated, dry mouth can lead to dental decay and fungal infections, as well as painful mouth sores and uncomfortable cracked lips.

How do you manage dry mouth? First, with your doctor’s help, rule out other causes associated with this problem, such as:

• Medications that produce dry mouth as a side effect, which can be worsened by alcohol, tobacco, and other drug use
• Conditions like diabetes, yeast infection, stroke, and uncontrolled HIV
• Snoring, mouth breathing, and dehydration
• Aging

If you and your doctor are able to address any of the above issues, your dry mouth may improve.

If your condition continues, your dentist can recommend specific mouthwashes that prevent dry mouth and protect your teeth from decay. Mouth moisturizers and artificial saliva can ease your symptoms. One member suggested, “What I do at night, when I wake up, is keep a cup of water and just take a sip to make sure I don’t get dry mouth.”

Never stop taking your ART — it’s essential for controlling your HIV symptoms and keeping your viral load undetectable. If you believe your ART could be causing dry mouth, speak to your doctor to see if a medication change would be right for you.

2. Mouth Sores

HIV can cause ulcers in and around your digestive tract. Lesions in your mouth, gums, tongue, and throat — called aphthous ulcers or canker sores — can be extra painful, especially when eating and drinking.

Your reduced immune functioning may cause ulcers, but so can a variety of other factors. If you’re experiencing mouth sores, make sure to rule out these other causes:

• Consumption of spicy or hot foods
• Canker sores resulting from an injury to the mouth, such as biting your lip or cheek
• Infections such as HPV, herpes, chlamydia, gonorrhea, and syphilis

Ulcers can be treated topically to relieve symptoms or with oral medications, with the help of your doctor.

3. Oral Cancer

Although less common now with the widespread use of ART to control HIV infection, Kaposi’s sarcoma is an oral cancer that became a defining sign of HIV/AIDS in the early years of the virus’s spread in the United States. Kaposi’s sarcoma originates from a virus called human herpesvirus 8 (HHV-8), which primarily infects people with weakened immune systems, like those with uncontrolled HIV.

Initial symptoms of Kaposi’s sarcoma include painless lumps or nodules in the mouth. Symptoms progress quickly to affect multiple organ systems, so the earlier you identify the problem, the better. The best way to prevent this type of oral cancer is to start and continue effective ART.

4. Gingivitis

Gingivitis (gum disease) is a bacterial infection in the mouth that can lead to redness and swelling of the gums, a receding gum line, bad breath, and bleeding while flossing or brushing your teeth. When your viral load is not under control, your immune system is weakened against other viruses and bacteria, such as the bacteria that cause gingivitis. In one cross-sectional study of a population infected with HIV in San Francisco, one-third of participants were diagnosed with gingivitis.

Many over-the-counter (OTC) products are designed to fight gingivitis, such as mouthwashes and toothpaste. Good oral hygiene, including brushing your teeth and gums at least twice a day and flossing regularly, can help prevent this serious oral health concern.

5. Herpes

HIV, especially when not suppressed by medication, worsens your body’s response to foreign invaders such as bacteria, fungi, and other viruses. This leads to infections such as recurrent herpes simplex virus disease. Herpes is a viral infection that can be spread from person to person through physical contact. When you are in contact with the sores or warts of a herpes-infected person, the current status of your immune system predicts how likely you are to develop herpes yourself and, once you have it, how often you’ll experience outbreaks. Oral herpes appears as sores on the gums, lips, or roof of the mouth that may go away and come back throughout your life.

Certain prescription and OTC balms and ointments can help treat oral lesions caused by herpes infection. If you have symptoms of herpes, see your doctor to receive treatment.

6. Tooth Decay

People living with uncontrolled HIV are at a greater risk of cavities and decay of permanent teeth. Poor attention to brushing and flossing contributes to the problem, but the following factors also generally increase the risk of tooth decay in people living with HIV:

• High rates of smoking
• High rates of diabetes, as well as diabetes that isn’t controlled well
• High-sugar diet
• Drug and alcohol use

Pain caused by untreated tooth decay can be excruciating, and the condition can lead to tooth loss and root canals.

Another reason for increased tooth decay in people living with HIV is the general lack of access to dental care. Without dental insurance, dental care is extremely expensive, and many people don’t call their dentist until they experience a problem. Further, many people with HIV may feel stigmatized when seeking dental care. The American Dental Association recommends and encourages those living with HIV to seek out regular dental care.

Preventing tooth decay through routine six-month dental visits will save you from pain and loss in the future. Between visits, make sure to limit sweet and sticky foods and brush and floss regularly.

Prioritizing Self-Care

Living with a chronic condition is especially tough when unexpected symptoms arise. Self-care is critically important when it comes to oral health, especially for people with HIV who have additional risk factors. This includes taking your HIV treatment as prescribed by your health care provider. Your clinicians are available and willing to help you identify oral health problems before they become severe, so reach out to them at the first sign of any dental issues.

Talk With Others Who Understand

On myHIVteam, the social network for people with HIV and their loved ones, more than 35,000 members come together to ask questions, give advice, and share their stories with others who understand life with HIV.

Have you experienced dental problems while living with HIV? What tips do you have for others at risk of oral symptoms? Share your tips and experiences in a comment below or on your Activities page.