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Siyayinqoba Beat It! 2005 Episode 5 –

Oral Hygiene and HIV

Oral hygiene is about taking good care of our mouth, teeth and gums. Why is oral hygiene especially important for people living with HIV? Do we need to have regular check-ups and what should we be looking out for? How can we take better care of ourselves? This episode of Siyayinqoba Beat It! answered these questions.

Jason Wessenaar: Dumelang re ya le amohela mona ho Siyayinqoba Beat It! Support Group. {Sesotho} [Hello and welcome to the Siyayinqoba Beat It! Support Group.] My name is Jason. In the Siyayinqoba Support Group we are all living positively with HIV. Each week we get together to talk about issues that affects our lives with HIV; from disclosure to sex, sexuality and HIV. If you are living with HIV or you have a friend, a family member or a partner who is HIV positive this program is for you. Today we are talking about a subject a few of us deal with properly: looking after our dental and oral health. Can looking after our teeth and gums keep us healthy? Moeng wa rona kajeno ke Professor Sue Naidoo {Sesotho} [Our guest today is Professor Sue Naidoo] of the Department of Community Oral Health at the University of the Western Cape. Professor Sue will be answering some of our questions about oral health. Welcome Professor, but first we accompany Veliswa on her visit to Dr Mkhonza; a dentist in Khayelitsha. Let’s see what happened.

Oral Hygiene and HIV

Khayelitsha, Western Cape

Dr Mkhonza: Molo sisi {isiXhosa} Hello sister.

Veliswa Cebisa: Molo {isiXhosa} Hello.

Dr Mkhonza: Kunjani? {isiXhosa} How are you?

Veliswa Cebisa: Ndiphilile akhonto unjani? {isiXhosa} Fine. And you?

Dr Mkhonza: Ndiphilile, ungahlala. Ndingakunceda? {isiXhosa} Fine thanks. Please sit. Can I help you?

Veliswa Cebisa: Ewe ndiqaqanjelwa ngamazinyo {isiXhosa} My teeth are aching.

Dr Mkhonza: Uqaqanjelwa ngamazinyo? Aqaqamba nini, njani? {isiXhosa} Your teeth are aching. How and when do they hurt?

Veliswa Cebisa: Aqaqamba xa ndiphunga into eshushu naxa ndiphunga into ebandayo. {isiXhosa} They ache when I drink hot and cold liquids.

Dr Mkhonza: Ok, ayakuvusa ebusuku kuqaqamba? {isiXhosa} Do they ache at night?

Veliswa Cebisa: Awafane andivuse kodwa xa ndisela amanzi ababuhlungu. {isiXhosa} Not all the time, they ache only when I drink water.

Dr Mkhonza: The source of sensitive teeth when one has seen that you actually got clean teeth and no holes. You probably don’t have bone disease because I didn’t see any sign of gum disease. But I would like to think that there’s something else that’s causing your teeth to be sensitive. Most of the time your enamel is very thin from brushing improperly. Because some people brush away the top layer and leaves the sensitive layer exposed, which is the dentin. When you hold your toothbrush because of these circular movements or pattern or anatomy of the gums, you should actually be brushing in alignment with them. Rather than scrubing, rather go in circle. So you need to really get like a smallish toothbrush not the kids one’s but there’s a medium size which can get to back for an adult. And then you can clean all around, on top, on the sides everywhere else. All we need to do I think, is to just have your teeth cleaned, polished and we’ll re-enforce with fluoride. There is no difference or anything special about managing an HIV person and about managing a non HIV person. Do you understand? So when you’ve got HIV we not gonna now come and get the whole team and we mask ourselves more than we would normally do. There’s nothing special about it. We just take the usual precautionary measures. We use sterilization; I showed you the instruments I sterilized. All of these that we gonna use, this thing you sitting on it’s gonna be thrown way. This is gonna be thrown away; everything. This gets sterilized with alcohol and everything we use is disposable .This is gonna go inside your mouth. Throw it away, pull it out. Don’t be scared. Pull it out and throw it away and we sterilize; the rest goes in there. Now we gonna clean. This is fluoride, high concentration of fluoride. It’s going to help make your teeth stronger and less sensitive to temperature differences. You keep it for a minute or less and then you should be fine. That’s it, wonderful. Ok. Come to the dentist twice a year. We’ll see you soon.

Veliswa Cebisa: Thank you.

Support Group

Jason Wessenaar: I visit the dentist at least once a year. In the form that I was filling in I mentioned that I’m HIV positive. Is it important to tell your dentist that you positive, because I wouldn’t want anybody to go through what I went through; that this person was supposed to treat me, my doctor, but because I’m HIV positive and I mentioned the fact that I’m HIV positive they didn’t do that? They let another doctor treat me. I mean an hour and thirty minutes later.

Prof. Sue Naidoo: No one should be refused any kind of treatment, if they are HIV positive on the grounds that they are HIV positive. And a doctor or a dentist has to have a very good reason why they refuse to treat you. So that’s the first thing. It is in your interest whether to actually tell a doctor or a dentist, but your carer, that you are positive. Only so that they can just become more sensitive to looking out for specific things and to give you better care. When you say you’re HIV positive another thing we try to do is to avoid doing anything invasive. Avoid pulling out teeth, doing major surgery. There might be a variety of options that they will be able to then say it’s more suitable for you. Something we can do that’s less invasive.

Busisiwe Maqungo: I have a, I’m not going to say it’s an ulcer but it’s some sort of a blister. It always comes out below the tongue. The first time I had it I reported it to my doctor, Francois. She told me uba ayonto endifanele uwara ngayo leyo {isiXhosa} [that I should not worry about it.] Because she’s a doctor, I was fine. It goes away and it leaves this little scar and it comes back. It keeps coming back. Now what happened a few weeks ago, a friend of mine who is also HIV positive showed me the same thing and I looked at it and I was like “Oh, it’s nothing to worry about.” Because this is what my doctor told me and I was like “Ok, it’s nothing to worry about.””

Prof. Sue Naidoo: Busi would you like me to look at your mouth, if you come and sit on my chair, on my red chair. So let’s have a look, let’s see. I think if you can hold that for me, and put your head back. I’m going to have a look and you can just tell me where the problem is.

Busisiwe Maqungo: It’s below the tongue.

Prof. Sue Naidoo: Just lift up. Oh, this little problem here just below the tongue, but I think, let’s have a look at the rest of the month. It looks very good. The rest of her mouth has teeth that are very good. Nice clean teeth, healthy gums. See when you get this nice scalping of the gums around the teeth. Nice rounded edges that show that the gums are actually very healthy. So its nothing to worry about, its like I said: it’s an irritation that’s from your tooth. That is why it also comes and goes.

Busisiwe Maqungo: So can I continue to tell my friends it’s nothing to worry about?

Prof. Sue Naidoo: But having said that I think whenever anyone does have a problem with their mouth, they must go to the dentist. Just to check it out, because you can get a variety of different ulcers for different reasons. And it might be that it can be serious and might need, they might look the same. So you still need to go and check it out to see what it’s about. For whatever problem you have in your mouth.

Jason Wessenaar: Re bua le Professor Naidoo ka oral health ha re kgutla papatsong. {Sesotho} [We talk more with Professor Naidoo about oral health after the break. Don’t go way.]

Jason Wessenaar: Re ya ho amohela hape mona mo Siyayinqoba Beat It support group – {Sesotho} [Welcome back to the Siyayinqoba Beat It! Support Group] – the program for everyone infected and affected by HIV. We are still with Professor Naidoo of the Department of Community Oral Health at the University of the Western Cape. The professor is going to give us some practical advice on oral and dental health.

Primrose Mathabatha: Doctor, is there a specific way of brushing our own teeth and why is that?

Prof. Sue Naidoo: What we usually recommend is to have a nice rounded motion. If you gonna go up and down, you going to be dragging the gums back up again. So sometimes you find if you heavy and you up and down, you suddenly start dragging the gums above the teeth and it becomes sensitive there. So we recommend a nice gentle rounded motion around the edges of the teeth. So to really get the bristles between the teeth edges of the teeth and to clear way the dirt in a nice rounded fashion. We recommend really you use a small, a soft toothbrush firstly certainly if you having problems with your gums and to brush at least for about three to five minutes. I know people get in there 30 seconds and …exactly.

Jason Wessenaar: We’ve been told a minute. I see you say four to five minutes.

Prof. Sue Naidoo: Yes, at least three to five minutes to make sure that you get the whole mouth. The inside as well. You will have to get in there with brush, and brush the pallet around the inside’s of the teeth. And similarly not to forget the inside’s of the bottom teeth. And this is often where we tend to get a lot of that hard dirt, the hard calculus. And that’s often when you need to then get the oral hygienist to professionally use the machines and the instruments to remove the hard dirt from in between there. Flossing, if Jason is willing, we can try and demonstrate some flossing. So he gets a nice piece of floss out. Just basically open, open wide now Jason. Let’s have a look. And again you start from one side of the mouth. And it’s a whole business of; you put the floss in between and gently wiggle it to dislodge any of the food in it. Gently wiggle it one side from left to right. Go to the next tooth again, gently wiggle it. When you do this you should go quite far down into the gum to really be able to take out bits and pieces that are in between there. So let’s do a top one it’s easier. Let’s see we get the floss right in between the gums wiggle it a little bit and take it out. You see and bits and pieces. Again put it right in there wiggle it about left and right and then pull that out. So is that enough? His getting a bit nervous.

Lihle Dlamini: And Doc, what I want to ask is, can I have a short piece of floss or does it have to be long and why?

Prof. Sue Naidoo: We usually say a nice, this sort of size of piece that you can twine around just to get some grip. So if it’s too short you not might have a nice grip to put it between your teeth. So we usually say a nice piece and you can grip it along the teeth and you’ve got control over it.

Lihle Dlamini: Oh, ok.

Jason Wessenaar: Do you need to rinse after that?

Prof. Sue Naidoo: Ja, if you want to. And you usually rinse your mouth and then obviously you discard this and use a new piece everytime you floss.

Ricardo Moses: What is the challenges from a parent’s point of view to treat a child because a child likes to eat sweet stuff? What is the challenges between the child and the adult?

Prof. Sue Naidoo: The parents really need to check their mouth everyday if they have to. Help the child to brush their teeth. And the message we give to parents whose children are not HIV positive. The main thing it’s all to do with diet, diet, diet and to avoid sweet and sugary foods. We know it’s difficult with children like you mentioned. The other big problem we have is with bottles and the dummies where people put sweetened tea and juice liquids in the bottle. And that is the worst for those baby teeth in the mouth. The baby teeth are not as strong as the adult teeth, so those kinds of things with that constant flow of sweet liquid is ideal for the bacteria to act on and then form the acids and destroy the teeth.

Jason Wessenaar: What else should we avoid to have healthy gums and teeth?

Prof. Sue Naidoo: It’s really because of the sugar and the sugary things and the sweet things and the fizzy drinks, sweets, chocolates, sweetened drinks all those.

Jason Wessenaar: What does sugar do?

Prof. Sue Naidoo: The bacteria in your mouth and the germs in your mouth feed on the sweet sugary stuff and they produce acids and it’s these acids that eat up the teeth and cause tooth decay.

Busisiwe Maqungo: But doesn’t sugar give you energy?

Jason Wessenaar: No but that’s another story, we talking about the mouth now.

Busisiwe Maqungo: Yes you eat sugar through your mouth Jason. Do you take it through your ears? It has to go through the mouth and it gives energy.

Prof. Sue Naidoo: The issue is really to limit the amount of sugar. I’m not saying no sugar, never eat sugar it’s bad for you, but to limit the amount of sugar you eat. And certainly the sticky sweet things that are going to stay longer on your mouth and if you don’t brush your teeth regularly obviously they gonna be there and available for the bacteria to work on it, eat on it and to produce the acids.

Jason Wessenaar: What are some of the things we exposed to when we having oral sex?

Prof. Sue Naidoo: Ja, that’s another contentious issue in the press about oral sex and whether there’s transmission via the mouth. And theoretically there can be transmission via oral sex and if you’ve got cuts and ulcers on your mouth, on your lips on your tongue theoretically there is a possibility that there can be transmission of HIV and that setting, but obviously rare. And the mouth is interesting because it’s got a lot of natural protection in the mouth. Saliva is particularly important in the mouth for giving protection. It lubricates the mouth and it has a lot of properties to kill germs and bugs in the mouth. One of the problems people with HIV have is that they don’t produce enough saliva. And that’s because HIV virus itself seems to attack the salivary glands in and around the mouth. So it damages the glands and the glands produce less saliva. So a common complaint a lot of HIV, I’m sure you’ve experienced it as well, complain about a dry mouth. And sometimes a dry mouth can be so serious that they need some kind of substitute for a dry mouth and you get fake saliva .You can buy fake saliva. Or they use something called methyl cellulose and that’s really the closest equivalent to saliva to lubricate the mouth. Because we take it for granted that you can swallow and it’s all saliva to do the swallowing and eating and keeping your mouth, you able to talk and chew and enjoy food et cetera.

Lihle Dlamini: Would you say using a mouth wash does really help?

Prof. Sue Naidoo: Yes, people with HIV that’s one of the good ways of ensuring that your mouth is really clean. But you need to use a mouth wash when your mouth is clean. So if you have got hard dirt in your mouth and hard plague and that’s cleaned away and you go for treatment they clean it away. Part of the treatment there after, apart from brushing, is to give you a mouth wash.

Busisiwe Maqungo: I am using salt water to gargle, is…can that...

Prof. Sue Naidoo: That’s absolutely right, just a basic salt mouth water rinse also is very soothing and helpful.

Busisiwe Maqungo: The salt we have at home?

Prof. Sue Naidoo: Yeah, exactly. Salt and then water, a glass of water and one teaspoon of salt and you use it to gargle your mouth. Sometimes even for a painful throat, if that’s all you have it will certainly help.

Jason Wessenaar: Re saya papatsong {Sesotho} [We are going for an ad break], we’ll be right back.

Jason Wessenaar: Re ya le amohela hape mona ho Siyayinqoba Beat It! Support Group. {Sesotho} [Welcome back to the Siyayinqoba Beat It! Support Group.] Professor Naidoo is talking to us about oral health and HIV. Prof what are some of the common problems you see in HIV positive people especially with regards to oral health?

Prof. Sue Naidoo: Alright, people with HIV have the same problems as people without HIV. That’s the first thing. But what is the difference with people with HIV is obviously they’re immuno compromised so they cannot fight the infections as easily and quickly as people without HIV. So some of the common manifestations we see in the mouth with people who have HIV are things like thrush, which is a white fungal infection. I’m sure some of you have experienced it at some stage or the other. And that’s also one of the first lesions we tend to see in people with HIV. The other common lesion we see in the mouth are ulcers, again I’m sure all of us has had ulcers at some stage in our lives. You get a cold sore which is also the kind of ulcer we see in people which HIV but we often see it recurs and so it’s much more often. But in people with HIV we find with the ulcers they also tend to become chronic, much more difficult to heal. And in children if we let that happen, children then find it very difficult to drink or to eat and swallow. And those are all the kinds of things we want to avoid. As soon as you find something wrong that doesn’t look right you need to go and seek treatment for it.

Melinda van Wyngaard: Sometimes you get thrush, how do you treat that?

Prof. Sue Naidoo: There are various ways to treat thrush. It’s a fungal infection and we can start just by using something topical, a mouth wash, a gargle or a lozenge. But then you also get antifungal agents and now I’m sure you know at some of the public clinics you get fluconazole and that too would be a systemic way of and a way of taking medication to clear the thrush. So that you can get, I’m sure many of you have been able to access it from the public clinics.

Jason Wessenaar: Siyabonga Dr Naidoo, the support group nani babukeli emakhaya. Namhlanje sifunde ukuthi izimpilo zethu singazenza ngcono ngokunakekela amazinyo nezintsini zethu. {isiZulu} [Thank you Professor Naidoo, the support group and the viewers at home. Today, we have learned that we can better our lives by taking care of our oral health.]

Things to remember:

1. Kubalulekile ugquba njalo nokuflosa ubese ubona udokotela wamazinyo kanye ngonyaka. {isiZulu} [It’s important to brush and floss our teeth everyday and go to the dentists every year.]

2. Akulula uthola udokotela wamazinyo, emthola mpilo nasesibhedlela emphakathini kodwa kukhona iindawo ezithile lapho ungathola usizo khona. {isiZulu} It’s not easy to fins a dentist at our local clinics or hospitals, but there are places where you can get help.

Jason Wessenaar: We hope that you have enjoyed the show and are feeling the Siyayinqoba Spirit that together we can beat HIV. If you have any questions, views or comments about the show please contact us on the numbers on your screen. Join us again next week in the Siyayinqoba Beat It! Support Group. Till then, stay healthy and remember we can beat HIV. Salani Kahle. {isiZulu} [Stay well.]

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