Gingivitis literally means inflamed gums. This is a gum disease frequently caused by bacteria and dental hygiene problems. HIV-positive people are more susceptible to gingivitis.

HIV-related gingivitis causes redness and swelling of the gums, loss of gum tissue between the teeth, and sometimes ulcers, bleeding or pain. If untreated it may rapidly progress to HIV-related periodontitis (known as necrotizing ulcerative periodontitis or NUP), or inflammation around the teeth. Soft tissue may be destroyed and the underlying bone exposed, and the bone itself can be destroyed, loosening the teeth and causing severe pain.

Gingivitis needs to be seen by a dentist experienced in HIV care.

Treatment

Gingivitis is treated by removing plaque from the teeth and clearing away any dead tissue. Infections may be treated with medical mouthwashes such as chlorhexidine or povidone-iodine; chlorhexidine contains alcohol which can cause pain. Antibiotics such as penicillin, metronidazole or clindamycin may also be required. If the condition has progressed to periodontitis, affected teeth may need be removed. Pain killers and nutritional supplements may be necessary if the gingivitis is inhibiting intake of food. Regular dental follow-up is then recommended.

Combination antiretroviral therapy has reduced the incidence of severe gingivitis in people with HIV. Anti-HIV treatment should be considered to prevent oral infections such as gingivitis among individuals with weakened immune systems.

Key research

Tappuni conducted a cross-sectional study of oral manifestations among 284 HIV-positive patients at St Thomas Hospital, London. 89 were undergoing antiretroviral therapy (12 on monotherapy, 41 on dual therapy, and 36 on triple therapy) and 195 who were not taking anti-HIV treatment. Overall, the rate of oral infections was lower among those on dual or triple therapy compared with those on monotherapy (p<0.05) or no treatment (p=0.014). CD4 count below 200 and a viral load above 3000 were also associated with greater likelihood of oral infections. Rates of necrotizing ulcerative gingivitis were 8% among the untreated group and 2% among those on anti-HIV therapy.

References

Tappuni AR et al. The effect of antiretroviral therapy on the prevalence of oral manifestations in HIV-infected patients: a UK study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics 92(6): 623-628, 2001.

Winkler JR et al. AIDS update: Periodontal disease. Journal of the Californian Dental Association 15: 20-24, 1987.

Winkler JR et al. Periodontal disease: a potential intraoral expression of AIDS may be rapidly progressive periodontitis. Journal of the Californian Dental Association 12: 20, 1987.

Winkler JR et al. Periodontal disease associated with HIV infection. Oral Surgery, Oral Medicine, Oral Pathology 73: 145-150, 1992.