Original Research
HIV/AIDS & Oral Health
Key Takeaways
- Women living with HIV/AIDS (WLWHA) in Kelantan reported a high prevalence of oral health problems, including dry mouth, oral ulcers, bleeding gums, and difficulty eating — problems that significantly reduced their quality of life.
- Oral manifestations are among the earliest and most common clinical signs of HIV infection, with up to 80% of people living with HIV experiencing at least one oral condition during the course of their illness.
- Barriers to dental care for women living with HIV include fear of disclosure (concern that dental staff will learn their HIV status), perceived and actual stigma from healthcare providers, financial constraints, and prioritising HIV treatment over dental care.
- Integrating oral health screening into routine HIV care and ensuring that dental services are accessible, affordable, and stigma-free for people living with HIV could significantly improve their overall quality of life.
Why Oral Health Matters in HIV
Oral health is often treated as separate from general health — a different healthcare system, different providers, different insurance coverage. For people living with HIV, this separation is particularly harmful, because the mouth is one of the first and most affected sites of HIV-related disease.
The oral cavity is rich in immune tissue and is constantly exposed to a diverse community of microorganisms. When HIV compromises the immune system, the delicate balance between the body’s defences and these microorganisms is disrupted, leading to a range of oral conditions that can cause significant pain, difficulty eating, social embarrassment, and reduced quality of life.
Oral manifestations of HIV are so common and so characteristic that they serve as important clinical markers. In many cases, oral problems are the first observable sign that a person’s immune system is compromised, sometimes appearing before other symptoms of HIV infection. For this reason, dental professionals have an important role in the early recognition of HIV-related disease, and oral health assessment should be an integral component of HIV care.
Common Oral Problems in People Living with HIV
| Oral Condition | What It Looks Like | Impact on Quality of Life |
|---|---|---|
| Oral candidiasis (thrush) | White patches on the tongue, palate, or inner cheeks that can be wiped off; underlying tissue may be red and sore | Altered taste, burning sensation, difficulty eating |
| Oral hairy leukoplakia | White, corrugated patches on the sides of the tongue that cannot be wiped off | Usually painless but can indicate advancing immunosuppression |
| Herpes simplex ulcers | Painful clusters of small blisters that rupture to form shallow ulcers, often on the lips or gums | Severe pain; difficulty eating and speaking |
| Periodontal disease | Bleeding, swollen gums; loose teeth; rapid bone loss around teeth | Pain, tooth loss, difficulty chewing, social embarrassment |
| Kaposi sarcoma | Red or purple raised lesions on the gums, palate, or tongue | Can interfere with eating; psychologically distressing; indicates advanced disease |
| Xerostomia (dry mouth) | Persistent dryness caused by reduced saliva production (often medication-related) | Difficulty eating, speaking, and swallowing; increased risk of tooth decay; persistent discomfort |
| Aphthous ulcers | Painful round ulcers on the inner cheeks, lips, or tongue | Can be large and persistent in HIV; severe pain affecting eating |
The Experience of Women Living with HIV in Kelantan
Research conducted among Malay women living with HIV/AIDS in Kelantan investigated their self-perceived oral health problems and the impact of these problems on their daily lives and wellbeing. Kelantan, a predominantly Malay and Muslim state in northeastern Peninsular Malaysia, presents a unique social context in which HIV is heavily stigmatised and women living with HIV face particular challenges related to gender, cultural expectations, and social isolation.
The study found that a substantial proportion of participants reported oral health problems that affected their quality of life. Dry mouth was among the most frequently reported complaints — a condition often caused or exacerbated by antiretroviral medications, which are essential for managing HIV but can have oral side effects. Pain and discomfort in the mouth, difficulty eating certain foods, and self-consciousness about the appearance of their teeth and gums were also commonly reported.
Perhaps most significantly, the oral health problems reported by these women did not exist in isolation but interacted with the broader challenges of living with HIV in a stigmatised context. Women described avoiding smiling or talking to conceal dental problems, feeling that their oral appearance reinforced the stigma they already experienced as people living with HIV, and struggling to access dental care due to financial limitations and fear of how dental providers would react to their HIV status.
Barriers to Dental Care
The barriers that prevent women living with HIV from accessing dental care operate at multiple levels. Fear of disclosure is a primary barrier — many women expressed concern that seeking dental care would require disclosing their HIV status to dental staff, and that this disclosure would lead to judgement, gossip, or refusal of treatment. While healthcare providers are ethically and legally required to maintain patient confidentiality, the reality of small community settings where “everyone knows everyone” means that fears of disclosure are not unfounded.
Stigma from healthcare providers, including dental professionals, remains a documented barrier to care for people living with HIV in Malaysia and globally. Studies have found that some dental practitioners express reluctance to treat HIV-positive patients, citing concerns about infection risk — concerns that reflect inadequate knowledge about standard infection control procedures, which are designed to protect both patients and providers regardless of HIV status.
Financial constraints compound these barriers. Many women living with HIV in Kelantan have limited income, and dental treatment — particularly restorative procedures such as fillings, crowns, and dentures — can be expensive even in the government system where fees are heavily subsidised. When forced to choose between spending limited resources on HIV medication, food for their families, or dental treatment, dental care is typically the last priority.
Implications for Malaysian HIV Care
Oral health screening should be incorporated as a standard component of HIV care at all clinics managing HIV patients, not treated as a separate concern that patients must independently pursue. Dental providers should receive training on HIV-related oral conditions, standard infection control (which protects against HIV and all other bloodborne pathogens without requiring knowledge of individual patient status), and providing non-discriminatory care to people living with HIV. Antiretroviral prescribers should be aware of the oral side effects of HIV medications, particularly dry mouth, and should discuss management strategies with patients. Reducing financial barriers to dental care for people living with HIV — through expanded subsidies, integration of dental services within HIV clinics, or targeted assistance programmes — would address one of the most practical obstacles to care. Addressing HIV-related stigma within the healthcare system, including dental services, remains an overarching priority without which other interventions will have limited impact.