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HIV and Oral Health: Treating Patients with HIV (PWH) In the Era of COVID-19

Table of Contents

  • What is Coronavirus disease 2019 (COVID-19)?
    • COVID-19 Transmission
    • Aerosol-Generating Procedures
    • Rapid Contamination
  • Dental Practice Protocols
  • HIV and COVID-19
  • HIV, COVID and Oral Health
  • Oral Health Recommendations
  • Resources

Editors

Mark Schweizer, DDS MPH
Dental Director, Southeast AIDS Education Training Center

Coronavirus disease 2019 (COVID-19) is caused by a new coronavirus first identified in Wuhan, China, in December 2019. A patient in the United States was given a diagnosis of infection with this virus by the state of Washington and the US Centers for Disease Control and Prevention on January 20, 2020. The new name of this disease is coronavirus disease 2019, abbreviated as COVID-19. In COVID-19, “CO” stands for “Corona,” “VI” for “Virus” and “D” for “Disease.”

COVID-19 Transmission

COVID-19 is transmitted mainly three ways in oral health care settings:

  1. Direct transmission through inhalation of droplets generated through coughing or sneezing;
  2. Direct transmission via exposure of mucous membrane such as eye, nasal or oral mucosa to infectious droplets;
  3. Indirect transmission via contaminated surfaces.

Aerosol-Generating Procedures

Aerosol-generating procedures (AGPs) are widely performed worldwide in oral health care settings. AGPs are defined as any medical, dental or patient-care procedure resulting in the production of airborne particles which can remain suspended in the air, travel over a distance and may cause infection if they are inhaled.

Rapid Contamination

Clinical procedures that use spray-generating equipment cause aerosolization in the treatment area, leading to rapid contamination of surfaces and potential for the infection to spread. The risk of airborne COVID-19 transmission when AGPs are performed can therefore not be excluded.

  • Screen and triage all patients and personnel before they enter the dental office.
  • Implement universal source control measures for staff and patients including the use of CDCrecommended personal protective equipment (PPE).
  • Utilize EPA-approved disinfectants.
  • Encourage social distancing.
  • Require frequent handwashing.

We are still learning about COVID-19 and how it affects people with HIV (PWH). Based on limited data, PWH who are on effective treatment to manage their HIV have the same risk for COVID-19 as people who do not have HIV. Older adults and people with serious underlying medical conditions might be at increased risk for severe illness from COVID-19.

The risk for people with HIV getting sick is greatest in:

  • People with a low CD4 cell count
  • People not on effective HIV antiretroviral therapy (ART).

For this reason, it is important to emphasize that PWH can care for themselves by taking HIV medicine regularly and following the advice of their healthcare provider.

Reminders should be given that preventative actions such as mask wearing, social distancing and frequent handwashing keep PWH and others safe from infection. Also, effective new vaccines were approved for Emergency Use Authorization (EUA) and are being distributed nationwide.

Recent studies are examining the relationship between oral health and COVID-19. Researchers have found a link between poor oral hygiene and severity of complications from the virus that causes COVID-19. The oral microbial flora of the mouth was explored in connection with outcomes from COVID-19. Periodontitis or infection of the gums is one of the most prevalent causes of harmful bacteria in the mouth. These bacteria lead to the formation of cytokines and Tumor necrosis factor (TNF), which can be de tected in the saliva and can reach the lungs, leading to infection within the lungs. Inadequate oral hygiene can increase the risk of inter-bacterial exchanges between the lungs and the mouth, increasing the risk of respiratory infections and potentially post-viral bacterial complications.

Sampson V, Kamona N, Sampson A. Could there be a link between oral hygiene and the severity of SARS-CoV-2 infections? Brit Dent J2020;228(12):971-975. doi:10.1038/s41415-020-1747-8.

Good Oral Hygiene

Good oral hygiene can serve as a means to prevent airway infections in patients, especially those over the age of 70. Individuals with periodontal disease are at a 25% higher risk for heart disease, three times the risk for diabetes and 20% higher risk for high blood pressure. These are all conditions that increase the risk for severe COVID-19.

Comorbidities

Each of these comorbidities is associated with altered oral biofilms and periodontal disease.

Regular Visits

The importance of regular oral health visits should be stressed for all patients, but especially those with HIV, to decrease the risk of severe complications from a COVID-19 infection.