HIV: MOUTH PROBLEMS-BLEEDING GUMS
Bleeding gums are usually a symptom of gingivitis. Gingiva is the medical term for the gums, and it is means inflammation. Some people have severe bleeding of the gums, severe pain, and severe gingival disease with rapid tooth loss over a period as short as two or three months. This rapid loss of the structure that supports the teeth is called periodontitis. Periodontitis and gingivitis both are more frequent and severe in people with HIV infection.
The cause of gingivitis and periodontitis is not clearly established. Most dentists think the cause is the same bacteria normally present in the mouth which have, for some reason, gone out of control. Like other conditions, gingivitis is also common in people without HIV infection, but it is more frequent and more severe in those with the infection.
Care must be taken to distinguish gum bleeding caused by gingivitis from bleeding caused by the low numbers of blood platelets that are a part of ITP, which is an entirely different complication of HIV infection. The distinction between the two is easily made by a blood test that counts the number of platelets, or by a consultation with a dentist who will identify diseases of the teeth and gums.
For gingivitis and periodontitis, the treatment is usually mouthwashes containing germicides. One such mouthwash is chlorhexidine in a concentration of 0.12 percent, known as Peridex. Another is povidone-iodine, or Betadine. Both can be purchased in most pharmacies; Peridex requires a prescription, Betadine does not. Chlorhexidine has a high alcohol content that can cause pain in people with advanced gum disease. In this case, it is probably more appropriate to apply povidone-iodine, which is less painful, for several days and then switch to chlorhexidine mouthwashes when they can be better tolerated. For people who have extensive periodontitis, the dental procedure usually recommended is removal of plaque by planing and scaling, a procedure done by dentists. In many cases, antibiotic treatment with metronidazole (Flagyl) is also recommended.
These treatments should be accompanied by rigorously doing what your dentist has always told you to do: use dental floss, brush regularly with a soft toothbrush, and see a dentist regularly.
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