Periodontal disease is a chronic inflammatory process involving specific bacteria and affecting the tissue and bone supporting the teeth. While periodontal disease can occur in anyone regardless of HIV status, one particularly severe form (necrotizing ulcerative periodontitis) and a related condition (linear gingival erythema) appear to be unique to those with compromised immune systems.
The gingival (gum) condition originally known as HIV-gingivitis, and now called linear gingival erythema (LGE), consists of a red band-like lesion along the gumline. LGE may be painful and bleed, and may progress to periodontal disease (see NUP, below). LGE is sometimes mistaken for ordinary gingivitis (inflammation of the gums), which usually is not painful and does not lead to periodontal disease. People diagnosed with LGE should be given an antimicrobial mouth rinse such as chlorhexidine (Peridex) until a visit to a dentist or periodontist (a specialist in gum disease and related conditions) can be arranged. In severe cases, a systemic antibiotic may be used, though only for one week at most.
Necrotizing ulcerative periodontitis (NUP), which previously was called HIV-periodontitis, is a condition associated with rapid soft tissue and bone loss, including exposure of the bone; rapid deterioration of tooth attachment; and the premature loss of teeth. Bleeding and severe pain may be present. Palliative treatment (i.e., to mitigate symptoms) includes antimicrobial mouth rinses, systemic antibiotic medication, and pain medication when necessary.
Periodontal disease may go unnoticed until the tissues supporting the teeth are so damaged as to cause the loss of a tooth.
Treatments include local debridement (excision of dead tissue) as well as surgical procedures and/or antibiotic medication.
Periodontal conditions should be treated without regard to HIV status. Treatment success may not be dependant upon whether or not a person is HIV positive, although some clinicians report that response to conventional therapy may be poorer in those with HIV. Preventing the premature loss of teeth due to periodontal disease is important for everyone. Like dental caries, periodontal disease is best treated at an early stage, again supporting the recommendation for routine dental examinations every six months. Notably, some research has shown smoking to be a risk factor in the development of periodontal disease.