OVERVIEW

What is HIV gingivitis?

HIV gingivitis (HIV-gingivitis) refers to gum inflammation occurring after infection with the human immunodeficiency virus (HIV). The latency period from infection to onset can last for years or even a decade. Approximately 30% of AIDS cases first manifest symptoms in the oral cavity, with many involving periodontal tissues, including HIV gingivitis.

Is HIV gingivitis common?

Among AIDS patients, about 30% initially develop gingival inflammation.

SYMPTOMS

What are the manifestations of HIV gingivitis?

Linear Gingival Erythema (LGE):

• A distinct bright red border approximately 2–3 mm wide along the gingival margin, which may appear as ecchymosis on the attached gingiva.
• Extremely prone to bleeding, presenting as a fiery red band or punctate erythema on the attached gingiva, often with spontaneous bleeding and localized swelling. At this stage, there is generally no alveolar bone resorption.

Necrotizing Ulcerative Gingivitis:

• The clinical manifestations of Necrotizing Ulcerative Gingivitis (NUG) in AIDS patients are very similar to those in non-HIV-infected individuals, but the condition is more severe and aggressive.
• It is primarily characterized by necrosis of the gingival margin and interdental papillae, especially in the lower anterior teeth. Initially, the interdental papillae become congested and swollen, with necrotic ulcers forming at the tips, covered by grayish-white necrotic debris. After removing the necrotic material, the buccal and lingual sides of the papillae may remain, while the center appears sunken like a crater.
• The affected gingiva bleeds easily and is noticeably painful, with a typical foul odor.
• Mild cases usually show no significant systemic symptoms, while severe cases may present with low-grade fever, fatigue, and other systemic symptoms. Some patients may also experience submandibular lymphadenopathy with tenderness.

What are the severe consequences of HIV gingivitis?

Primarily Necrotizing Ulcerative Periodontitis (NUP), and in severe cases, it may progress to Necrotizing Ulcerative Stomatitis.

• When the patient's immunity is extremely compromised, NUP can rapidly develop from Necrotizing Ulcerative Gingivitis. Alternatively, it may occur when Necrotizing Ulcerative Gingivitis exacerbates and accelerates pre-existing chronic periodontitis. Among HIV-infected individuals, the incidence of NUP ranges between 4%–10%.
• NUP patients exhibit particularly severe bone resorption and attachment loss, sometimes even with sequestrum formation. However, if local factors and inflammation are not overly pronounced but periodontal destruction progresses rapidly with necrotic gingival lesions, vigilance is warranted to assess systemic conditions.

What conditions should HIV gingivitis be differentiated from?

It should be distinguished from common plaque-induced gingivitis.

CAUSES

What are the causes of HIV gingivitis?

Due to the overall decline in immune function, individuals with HIV are prone to opportunistic infections in the oral cavity, including fungal, viral, and bacterial infections.

Many studies indicate that the microorganisms found in the gingivitis or periodontitis of HIV-positive individuals are not significantly different from those in HIV-negative individuals, primarily including Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Fusobacterium nucleatum.

The detection rate of Candida albicans in subgingival plaque is significantly higher in HIV-infected periodontitis patients compared to non-HIV-infected patients. The effectiveness of antibiotics and subgingival scaling in treating periodontitis in these patients further supports the role of microorganisms as the primary pathogens.

DIAGNOSIS

How is HIV gingivitis diagnosed?

LGE, NUG, NUP, and Candida albicans infections can occur in non-HIV-infected individuals or other immunocompromised patients. Therefore, an AIDS diagnosis cannot be made based solely on clinical symptoms of gingival and periodontal conditions. However, dentists must remain vigilant.

For patients already diagnosed with HIV infection, characteristic gingival manifestations can confirm a diagnosis of HIV gingivitis. Alternatively, if suspicious gingival features are observed first and the patient has not undergone HIV serological testing, appropriate and necessary laboratory tests should be conducted before diagnosis and referral.

What tests are required for patients with HIV gingivitis? Why?

Patients diagnosed with HIV gingivitis require comprehensive oral examinations to assess the extent of gingival and periodontal damage. They should also coordinate with disease control centers, immunology departments, and other specialties for further treatment and testing.

What precautions should be taken during oral examinations for HIV gingivitis?

During oral examinations for HIV gingivitis, in addition to routine oral cleaning procedures, patients must truthfully disclose their medical history to the dentist to avoid misdiagnosis, incorrect treatment, and delays in disease management.

TREATMENT

Which department should I visit for HIV gingivitis?

Dentistry. Infectious Diseases Department.

Does HIV gingivitis require hospitalization?

Usually not.

How is HIV gingivitis treated?

Treatment for HIV gingivitis includes the following aspects:

Periodontal Treatment: Patients with necrotizing ulcerative gingivitis and necrotizing ulcerative periodontitis can undergo conventional periodontal treatment. Treatment for periodontitis involves addressing both the cause and symptoms:

• Basic periodontal treatments such as scaling, root planing, and debridement are required.
• Periodontal surgery combined with medication may be necessary.

After the above treatments, most patients experience relief from periodontal inflammation, stabilization of loose teeth, and minimal impact on chewing function.

Periodontal Restorative Treatment: After basic periodontal treatment, some teeth—or even multiple teeth or the entire dental arch—may remain loose, impairing normal chewing function. In such cases, periodontal restorative treatment is needed.

• Systemic antibiotics are administered, with metronidazole (200 mg, 3–4 times daily for 5–7 days) as the first choice, as it is less likely to cause secondary fungal infections.
• Local oral treatment involves using 0.12%–0.2% chlorhexidine mouthwash, which is effective against bacteria, fungi, and viruses.

After treatment, pain typically subsides within 24–36 hours. Linear gingival erythema responds poorly to conventional periodontal therapy and often requires systemic antibiotics for resolution.

DIET & LIFESTYLE

What should HIV gingivitis patients pay attention to in their diet?

Eat more foods rich in vitamins, such as fruits and vegetables, and minimize spicy and irritating foods. Quit smoking and alcohol.

What should HIV gingivitis patients pay attention to in daily life?

Adjust your mindset, give yourself positive psychological cues, maintain oral hygiene, rinse your mouth after meals, clean dentures regularly, and keep them clean. Engage in frequent and regular physical exercise to improve the body's resistance.

Does HIV gingivitis require follow-up examinations?

Yes, regular outpatient follow-ups are needed to check the effectiveness of periodontal treatment and plan further oral treatment based on the results.

PREVENTION

Can HIV gingivitis be prevented?

Preventing AIDS can avoid HIV gingivitis:

• AIDS is a highly fatal infectious disease primarily transmitted through sexual contact, blood, and mother-to-child transmission. There is currently no cure, but it can be prevented.

• Practicing self-discipline and adhering to sexual ethics are fundamental measures to prevent sexual transmission of AIDS.

• Correct use of condoms not only prevents pregnancy but also reduces the risk of contracting AIDS and other sexually transmitted diseases.

• Early treatment and cure of sexually transmitted diseases can lower the risk of HIV infection.

• Sharing needles for drug use is a major route of HIV transmission, so avoiding drugs and valuing life are crucial.

• Avoid unnecessary blood transfusions and injections, and use blood and blood products that have been tested for HIV antibodies.

• Lastly, it is important to note that daily life and work contact with AIDS patients or HIV carriers will not lead to infection.

How can HIV gingivitis patients prevent further severe consequences?

Actively cooperate with systemic and local treatments to improve the body's resistance and immunity.