Care of the Teeth and Mouth

Children with HIV have more cavities, tooth decay, and gum disease than other children—about 30% more. People with low CD4 counts cannot keep all the germs that commonly live in the mouth under control. This allows those germs to do more damage to teeth. Children who eat and drink a lot of sweets, who drink from a bottle in the crib, and those past one year of age are at even greater risk for teeth problems. Many liquid medications, even those for HIV, may be flavored with sugar at the pharmacy.

Sometimes, children with HIV are delayed in getting teeth. This can happen with both baby and adult teeth. They may also get thrush or white patches of fungus in their mouth, usually on the insides of their cheeks. This can do damage to teeth as well and requires medication. It is also important to prevent re-infection by boiling pacifiers and nipples each day until the white patches disappear. Cold sores may also be painful, damage teeth and require medication.

The American Dental Association currently recommends that a dentist see children within six months of the appearance of the first tooth. Parents can help maintain care to the teeth, mouth, and gums by doing the following:

1. Keep regular visits to the dentist.
2. Brush your child’s teeth with them after every meal or dose of medication until they are able to do this on their own. Use very small amounts of toothpaste until your child is able to spit it into the sink. Swallowing large amounts of fluoride from toothpaste is not healthy.
3. If the child is an infant, brushing may be very difficult. Cleaning a tooth or gums with a damp cloth may be helpful.
4. Children should never take a bottle of milk with them to bed. This will allow the milk to coat the teeth and pool in the mouth leading to cavities.
5. Tooth sealants are used by dentists to cover teeth in order to help prevent cavities. Please discuss this with your dentist. If you do not have a dentist, please ask the health care team for a referral.