ContentsHIV and oral health 3Common dental health problems 3other things to get checked out 7Healthy lifestyle 9eating and drinking 9Quit smoking 15Reduce alcohol consumption 17Limit the use of drugs (prescription and illicit drugs) 19Clean your teeth 20sex and your mouth 23tips in managing symptoms of some 24of the common oral health problemsoral health self assessment tool 28Dental health services support and assistance 29for people with HIV

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GeneRaL tIps to LooK afteR youR moutH√ Cleanyourteethatleasttwiceperday.√ Cleanbetweenyourteetheveryday.√ Haveadentalcheckupevery6months. Youstillneedadentalcheckifyouhavedentures.√ Drinkmostlytapwaterthroughouttheday.√ Avoidsugaryandacidicfoodsanddrinks.√ Limitthenumberofsnacksyoueat.√ Quitsmoking.

GeneRaL tIps to LooK afteR youR moutHGeneRaL tIps to LooK afteR youR moutHGeneRaL tIps to LooK afteR youR moutH

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THE ROOT OF MANY DENTAL HEALTH PROBLEMS

The two major oral health conditions, decay and gum disease, are both caused by bacteria in a sticky film which grows on everyone’s teeth every day. This is dental plaque. Dental plaque grows more quickly if you have a dry mouth.

HIV AND ORAL HEALTHIf you are HIV positive you are more likely to have health problems because you have a compromised immune system. Your mouth is one of the first places to show changes caused by the virus and the medications used to manage HIV. Most HIV positive people will experience some changes.

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tootH DeCay•Toothdecayiscausedbybacteriaabovethe gumwhichfeedonthefoodyoueat.Theywill growfasterwhenyoueatsweetandstickyfood andsugarydrinks.•Toothdecaycancausepainwithhotorcoldfood anddrinksandeventuallycausestrongpain andswellingofthegums.Changestoyourdiet andcleaningtheplaquefromyourteethcan helppreventtoothdecay.

Gum DIsease (GInGIVItIs & peRIoDontItIs)•Gumdiseaseiscausedbybacteriabelowthe gumline.Itcancausebleedingandswellingbut maynotcausepainuntilitisadvanced.Inpeople whosmokegumdiseaseishardertodetect.•Earlygumdiseaseiscalledgingivitisandcan beimprovedbycleaningproperly.Advancedgum disease(periodontitis)willcauselossofteeth andhasaneffectondiabetesandincreases yourriskofheartdisease.

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•Thebacteriathatcausegumdiseasecangive youbadbreath.•Ifleftuntreatedgumdiseasecanadvancevery quicklyinpeoplewithHIVwhoarenottaking ART(antiretroviraltherapy)orwhentheir medicationsarenoteffective.

DRy moutH•HIVcandamagethesalivaglands.Salivais thefluidwhichkeepsyourmouthmoist, makeseatingandspeakingmorecomfortable andreversesaciddamage.Drymouthmeans youdonothaveaprotectivelayerofsalivaover theteethandgums•Ifyoudonotdrinkenoughfluidsyourbody cannotmakeenoughsaliva.Alcoholstrips normalsalivafromyourmouth.Thecaffeine incoffee,softdrinksandteacanalsocause drymouth.•ManycommonmedicationsandARTcancause drymouth.Drymouthcaninterruptsleep,make eatingdifficult,increasemouthulcersandcause badbreathandtastechanges.

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OTHER ORAL PROBLEMS

uLCeRs anD funGaL InfeCtIons •Ulcersandfungalinfectionscanbeworsein peoplewithHIV,especiallyinpeoplewitha lowerimmunefunction.Ulcersorsorepatches ongumshavemanycausessuchtrauma, infectionsandcancer.Haveahealthcare providercheckanyulcersorredorwhite patchesinyourmouth.•Fungalinfectionslikecandidalooklikeredor whitepatchesongumsaroundteeth,onthe insideofcheeks,onthetongueorthefloorof themouth.Theycanbepainful.Ifyouwear adentureallthetimeyouaremoresusceptible tofungalinfectionsthatcanbedifficultto controlandmayrequiremedication.

Oral health problems if left untreated can cause bad breath. This may have an impact

on your self-esteem and social life.

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taste CHanGes •Tastechangesarecommonindrymouthand canbeassociatedwithanumberofcauses includingupperrespiratorytractinfections(URTI), agerelatedlossoffunctionoftastebuds, infectionsinthemouthorasasideeffectfrom medication.Persistenttastechangeshouldbe investigatedbyyourdoctorordentist.

OTHER THINGS TO GET CHECKED OUT

DRy moutHpigmentationcanoccurmorefrequentlyonyourgumsandcheekswhenyouhaveHIV.Talktoyourdoctorordentisttogetitchecked.

Wartscanoccuronyourgumsandcheeks.

Hairy tongueisnotseriousbutcanmakeithardtoclearfoodfromyourmouth.Youmightneedtobrushyourtonguetomakeyourmouthfeelfresh.

Tips to manage some of the symptoms of the common oral health problems are describe on page 24

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Ahealthymouthcanhelpyou:√ Feelgood√Lookgood√ Enjoyyoursexlife√ Speakwell√ Eatwell

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HEALTHY LIFESTYLEHealthylifestyleshelppeoplewithHIVinmaintainingahealthymouth.Eatingwell,drinkingplentyoftapwaterandgoodoralhygienewillhelpachievingandmaintainingahealthymouth.

EATING AND DRINKING WELLWhatyoueatanddrinkplaysamajorroleindentalcaries(toothdecay)andenamel(outsidelayerofthetooth)erosion.

Toothdecayiscausedbybacteriawhichcangrowveryaggressivelyinyourmouthfromtheremainsofyourfood.Particularlywhenyoueatstickyandsugaryfoodsanddrinks,suchassweets,lollies,sportdrinks,energydrinks,carbonatedmineralwater,vitaminwaters,cordial,fruitjuicesandanyfoodthatcontainssugars(e.g.biscuits,crackers,potatochips,driedfruit,snackandmueslibars).Peoplewhograzethroughoutthedaywillalsohavemoreplaque.

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Itisnotalwayseasyorpracticaltocompletelycutoutallfoodsthatcontributetotoothdecaybutknowingsomebasicfactsabouttooth-friendlyeatinganddrinkinghabitscanhelpyoutomaintainahealthymouth.

fLuIDs •Drinkplentyoftapwater,especiallyafter eatingsweetorstickyfoods.Tapwaterisbest asitcontainsfluoride,mostbottledwaterdoes notcontainfluoride.Drinkingaglassofwater firstthinginthemorningandsippingwater duringthedayhelpsclear‘bitsandpieces’ fromyourmouththatcancausedentalcaries.•Limitintakeofsugarydrinkssuchasjuice, softdrinks,vitaminwaters,flavouredmilks, sweetenedteaandcoffee,sweetenedicedteas, energydrinksandsportsdrinks.•Toreduceexposureanddamagebyacids: •Useastrawwhenconsumingacidicdrinks (includingjuice,‘regular’anddietsoftdrinks, sportsdrinks,evenmineralwater)andavoid sippingforlongperiods.

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•Donotholdorswishacidicdrinksin yourmouth. •Avoidacidicdrinksbeforeyougotobed.•Drinkteawithnosugarinsteadofcoffee.•Usesugarsubstitutesforhotdrinksifyouneed tosweetenhotdrinks.•Choosecordialswithoutsugar,e.g.dietcordials oraddfreshherbslikeminttoflavourwater.•Rinseyourmouthwithwateraftertaking liquidnutritionalsupplements,especially betweenmeals. betweenmeals.

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Chewingsugarfreechewinggumfor15minuteswillincreasesaliva.

Note:chewinglargeamountsofsugarfreegummaygiveyoudiarrhoea.

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fooDs•Eatavarietyoffoodsfromeachofthefive majorfoodgroups,including;wholegrains, fruits,vegetables,leansourcesofproteinsuch asleanbeef,skinlesspoultryandfish,drybeans, peasandotherlegumes,andlow-fatand fat-freedairyfoods(includeatleast2-3serves eachdayastheseareprotectiveforyourteeth).•Limitthenumberofsnacksyoueat. Frequentsnackingcancausemoreharmto yourteethbecausethereislesssaliva productionthanduringamainmeal.Therole ofsalivaistowashfoodsfromthemouthand itreducestheharmfuleffectsofanyacids.•Choosehealthyfoods,ifyouchosetosnack likefreshfruit,lowfatandlowsugaryoghurt, vegetablesticksorsoups,unsaltednutsora pieceoflowfatcheese.•Eatamealthatincludescrunchyfreshfoodif youchoosetoeathighsugarorstickyfoods suchaslollies,chocolates,cakesorbiscuits. Makesureyoualsodrinkwaterwiththisfood.

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•Avoidhavingacidicfoodslastthingatnight e.g.fruit,picklesorevenchewable vitaminCtablets.•Avoidtoothbrushingimmediatelyafterany acidicfoodsordrinksasthiscancausetooth enameltowearaway.

www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating

Enjoy a wide variety of nutritious fofof ods

Drink pplenty ofy of water.r.r

Grain n (cereal) foofoof ds, mosttly wholegrain and/or or /or / high cereal

VeVeV getables aand lleegugummeess//bbeeaaaansns

Lean meats and

tofu, nuts and seeds and legumes/beans

Milk, yoghurt, cheese and/o/o/ r alternatives, mostly reduced fafaf t

Fruit

Polenta

Muesli

Quinoa

Mixed nuts

Red kidney beans

Red kidney beans

Red lentils

Lentils

Chickpeas

Chickpeas

Penne

Fettuccine

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QUIT SMOKINGSmokingcanmakegumdiseasehardertodetectatthesametimeasmakingitworse.SmokerscandevelopaverypainfulandsmellyguminfectioncalledNUP(necrotisingulcerativeperiodontitis).IfyouarenottakingARTitcanbeveryaggressiveandyoucanlosealotofbonearoundyourteeth.Thisboneandgumdoesnotgrowbackleavingbiggapsaroundtheteethormaycauseyoutoloseyourteeth.Talktoahealthprofessionalformoreinformation.

Quitting can be hard but…Itisoneofthemostrewardingthingsyoucandotoimproveyouroverallhealth,includingyourmouth.Therearemanybenefitstoquitting,someevenoccurwithinhoursofyourlastcigarette.Onceyoustopsmokingyouarelesslikelytohavebadbreath,stainedteethandstainedtongue.Youwillfindbreathingeasierespeciallyonexertionandinthelongtermyouwillreduceyourriskofgumdisease,toothlossandcancerofthethroat,mouth,lipsorgums.

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usefuL suppoRtSmoking-talktoahealthprofessionalorcallQuitline 13 7848 orcallpositive Life nsW 02 9206 2177forquitsmokingprogramsforPLHIV.

Alcoholand/ordrugs-talktoahealthprofessionalorcallAlcohol&DrugInformationServiceon02 9361 8000 orfromcountryNSW1800 422 599.

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REDUCE ALCOHOL CONSUMPTIONExcessivealcoholusecanincreasedehydrationandadrymouth.Allalcoholisacidicandsomedrinkscontainlotsofsugarsthatbacteriainthemouthcanusetoproducemoreacid.Increasedacidcombinedwithlesssalivaproductioncanseverelyerodeteeth.

Thiserosiondestroyswhiteenamelontheoutsideofteethandmakesteethlookdarkerandmoresensitivetohotandcold.

Ifyoudrinkalcohol,limityourintaketotwostandardsdrinksperday(forbothmenandwomen).Onestandarddrinkis80-100mlofwine,30mlspirit,1middyofbeer(285ml).

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Mouthwash–avoidalcoholbasedmouthwashesifyouhaveadrymouth.Talktoyourdentistaboutthebestmouthwashforyou.

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THE EFFECT OF PRESCRIPTION ANDILLICIT DRUGS ON YOUR MOUTHTheregularandexcessiveuseofrecreational/illicitdrugscancausedrymouth,teethgrinding,andjawclenchingpotentiallyleadingtogumproblems,andtoothdecay.

Someprescribedmedicationscanalsocausetoothdecayiftheyareacidicorreducesaliva(yournaturaldefenceagainstacidattack).Askyourdentistandprescribingdoctorforadviceonminimisingtheharmfromanydrug.

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CLEAN YOUR TEETHGoodoralhygieneisimportanttoreducethebuildupofbacteriaonyourteethandgums.Brushingtheflatsurfacesandcleaningbetweenyourteethhelpstopreventtoothdecayandgumdisease.

Bacteriawillgrowthicklyincrevicesnearthegumsandbetweentheteeth.Theyproduceacidwhichremovesmineralfromthetoothsurfaceandtoxinswhichcausegumdisease.Physicalremovalisneededtoremovethefilmofbacteria.Waterandmouthwashwillnotwashitaway.Fluoridecanreplacesomeofthemineralwhichisremovedfromthetoothsurfacebybacterialacid.

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Followingtheserecommendationsforcleaningyourteethwilldecreasetheriskofdevelopingtoothdecay,gumdiseaseandotherdentalproblems.•Lookatandfeelyourtoothbrush(handbrush orelectrictoothbrush).Choosesoftbristles andasmallheadtoothbrush.•Replaceyourtoothbrushevery2months orearlierifthebristlesarebent.•Brushyourteethforatleast2minuteseach timewith10circularmovementsofthe brushpertooth.•Cleanbetweenyourteethwithaninterdental brushorflosseverydaybeforebrushing yourteeth.•Useasmallamountoffluoridetoothpaste forallnaturalteeth.•Getyourdentistorhygienisttoshowyou thebestwaytocleanyourteethandany specialplaceslikecrownsorimplants.•Rinseyourmouthwithwateraftervomiting ordrinkingacidicdrinks.Brushwithfluoride toothpasteafter30minutes.

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•Youcanbrushyourtongueoruseaspecial scraperifitcollectslotsoffood.

Somepeopleneedtowearpartialorcompletedenturestoreplacemissingteeth.Likenaturalteeth,denturesattractplaque,becomestainedandcollectfoodparticlesthatcancausebadbreathorirritateyourgums.Keepingyourdenturescleanisvitalforgoodoralhealth.

Thefollowingaresometipstolookafteryourdentures.•Useasoftbrushandunscentedmildbarsoap andwatertocleanyourdenturetoavoid scratches.Don’tusetoothpastetoclean dentureteeth.•Cleanyourdentureoveraclothinthebasin toavoiddamageifyoudropit.•Cleanorrinseyourdentureaftereverymeal.•Removefullandpartialdenturesbeforebed andkeepinwaterovernightsoyourgumscanbe bathedinsalivawhichisprotectiveforyourmouth.•Youcanalsosoakyourdentureusingaspecial solutionortablets.Askyourdentistfordetails.

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SEX AND YOUR MOUTHAlthoughoralsexisconsideredalowriskactivityforHIVtransmission,oralsexisanefficientmodeoftransmissionforSTIs(sexuallytransmissibleinfections).ThereareasmallnumberofrecordedcasesofpeoplegettingHIVfromperformingoralsexandtakingejaculateintotheirmouth.

Theriskcanbereducedifyourmouthishealthy,thatis,therearenosores,tears,abrasions,inflamedorbleedinggumswhichmayallowHIVoranSTItoenter.Avoidejaculateandmenstrualbloodinyourmouth.

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tIps to manaGe symptoms of some of tHe Common oRaL HeaLtH pRoBLems

Dry mouth:•Keepwellhydratedwithplentyofwater.•Drinkwatereverytimeyoudrinktea,coffee oralcohol.•Carryawaterbottleandsipwaterthroughout theday.

•Salivasubstitutesfromthechemistsuch asmoisturisinggelscanbeused. Oliveoilcanberubbedonyourgums.•Salivawillincreasewhenyouchewe.g.sugar freegumsorlollies,hardfoodse.g.raw vegetablesticksandfruitslikeapples.•Usealipbalm,lipstickorsunprotection lipproductifyourlipsaredryorcracked.•Askyourhealthcareprofessionalformore informationonanyoftheabove.

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painful mouth:•Getahealthprofessionaltocheckitoutfirst.•Cleanslowlyandcarefullytoreducethenumber ofbacteriainyourmouth.•Choosefoodsthataresoftandsmoothsuchas eggs,bakedbonelessfish,cannedfruit,soups, pastadishes,custard,puddings,yoghurt,tender meatandvegetables.

•Blend,minceandchopfoodfinelytoreduce chewingtime.•Avoidacidic,spicyandsaltyfoods.Allowvery hotfoodtocoolforupto30minutes.

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•Makedryfoodssofterbydippingtheminliquids suchasmilkandsoups.•Drinkplentyofcoolfluids,especiallywithmeals tohelpmoistenthefood.

taste changes:•Keepyourmouthcleanandrinseyourmouth beforeyoueattocleanyourpalate.•Usemarinades,graviesandsaucestoalter tasteofmeatsifmeattastesunusualtoyou.•Addspices,herbs,lemonjuice,onion,pepper orvinegartofoodsyoufindtoosweetorbland.•Useplasticcutleryandtrynottodrinkout ofmetalliccontainersiffoodtastesmetallic.•Varythetexture(e.g.smooth,crunchy,rough), colour,andtemperatureoffoodsyoueattoenjoy thewayfoodfeelsandlooks.•Tryastrawforliquids:aneasywaytobypass yourtastebuds.

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GeneRaL tIps to LooK afteR youR moutH√ Cleanyourteethatleasttwiceperday.√ Cleanbetweenyourteetheveryday.√ Haveadentalcheckupevery6months. Youstillneedadentalcheckifyouhavedentures.√ Drinkmostlytapwaterthroughouttheday.√ Avoidsugaryandacidicfoodsanddrinks.√ Limitthenumberofsnacksyoueat.√ Quitsmoking.

GeneRaL tIps to LooK afteR youR moutHGeneRaL tIps to LooK afteR youR moutHGeneRaL tIps to LooK afteR youR moutH

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ORAL HEALTH SELF ASSESSMENT

Askyourself:

Youneedtoseeadentistifyouansweryestoanyofthesequestions.

Askyourhealthprofessionalforadviceonkeepingyourmouthhealthy.

Haveregulardentalcheckups–don’twaituntilthereisaproblem.

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Has it been more than 1 year since you have been to the dentist?

Do you have tooth pain, mouth sores, bleeding gums or loose teeth?

Do you often have a dry mouth or experience a change in your sense of taste?

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DentaL HeaLtH seRVICes suppoRt anD assIstanCe foR peopLe WItH HIV

Informationonprivatedentists,financialassistanceorsubsidiseddentalservicesforpeoplewithHIVwhoholdahealthcarecardorpensioncardcanbeaccessedby:Calling:1800 451 600 Goingto:www.dental.positivelife.org.auwww.ada.org.au (private dentists)

Adietitiancanprovideadviceoneatingifsymptomsarepresent.Contactyourlocalhospitalorclinicorfindadietitianathttp://daa.asn.au/for-the-public/find-an-apd

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DevelopedbytheOralHealthPromotionWorkingGroup:HARPHealthPromotionSES,SandSWSLHDs,TheAlbionCentre,HIVOutreachTeamSESLHD,HIVCommunityTeamSLHD,SydneyDentalHospital,S&SWSLHDOralHealthServices,PositiveLifeNSW,ACONandBGF.

WithfinancialsupportfromS&SWSLHDsOralHealthServicesandSydneyDentalHospital.