Hepatitis C and Dental Care

Alan Franciscus,
Editor-in-Chief, HCV Advocate

Poor dental health is a rising problem among people living with hepatitis C.  Hepatitis C is associated with a wide range of dental problems ranging from dry mouth, tooth decay, gum infections, tooth sensitivity and mouth infections which can dramatically affect one’s quality of life. 

The majority of patients with hepatitis C experience periods of having a dry mouth.  The degree of dry mouth can also be made worse with medications that many patients with hepatitis C are taking including, but not limited to, anti-depressants and interferon.  Saliva plays a key role in lubricating the mouth and is important in speaking, tasting and chewing the food that we eat.  Saliva can also prevent viruses, fungus and bacteria from causing infections in our mouths that can lead to tooth decay and gum disease.  A dry mouth in of itself can be frustrating and can be improved by frequently sipping water, chewing sugarless gum that will stimulate the salivary glands in your mouth to release saliva or by using a saliva substitute which can be purchased in your local pharmacy.

As a result of dry mouth and lack of saliva for protection, patients with hepatitis C need to be concerned about tooth decay.  Tooth decay in the early stages is reversible so regular dental check-ups are important especially while on HCV medications.  Other things that you can do to prevent tooth decay is to include good oral hygiene, using a soft toothbrush and fluoride toothpaste.  Also reduce your carbohydrate (sugar) consumption, cut back on your intake of sweetened foods and beverages high in sugar.  Again, chewing sugarless gum is good as it helps with saliva production and can also neutralize the acid that causes the tooth decay.

The first sign of a gum infection is most likely to be bleeding from the gum margin usually as a result of brushing your teeth, which can increase the risk for transmission.  Other signs which would indicate more advanced gum infection include swelling and redness of the gums, receding gums, loose teeth, a bad taste or halitosis (bad breath).  The main cause of gum infection is plaque which is a colorless sticky film of bacteria that forms on the teeth, produces toxins and causes inflammation.  Patients with hepatitis C who are taking interferon therapy or those with cirrhosis have a much lower resistance to gum infection than others.  In addition, hepatitis C patients who smoke worsen this gum condition.  Gum infection can be reduced with appropriate thorough tooth brushing with a soft toothbrush angled at 45 degrees to the gum margin, as well as dental floss use.  Dental floss should be passed gently between the teeth and rubbed up and down to the gum margin. 

People with hepatitis C will sometimes complain of having sensitive teeth.  If enamel is lost from the surface of the tooth or if the root surface is exposed this can cause sharp pain when exposed to hot or cold extremes.  Causes of sensitive teeth include poor brushing, erosive foods (including lemons, grapefruit, vinegar and soda) frequent vomiting or gastric reflux and grinding of teeth most commonly during sleep.  There are desensitizing toothpastes on the market as well as gum guards for people who are prone to grinding their teeth.

As discussed earlier, patients with hepatitis C often experience dry mouth due to lack of saliva production.  This lack of saliva production can also cause mouth infections as bacteria, viruses and fungus can flourish, resulting in patients with hepatitis C being more prone to mouth ulcers and thrush.  Thrush is an overgrowth of a yeast (fungus) called "candida." The medical name for thrush is candidiasis. In the mouth, thrush looks like creamy white patches or small red spots on the tongue, roof of the mouth (also called the hard palate), gums or throat. Crusting on the corners of the mouth is also a symptom of thrush. Thrush can make it difficult or painful to swallow and can cause chest pain. It can cause nausea and make your food taste different. This is further exacerbated when on interferon therapy.  Daily intake of natural yogurt may help with thrush but, if that is not effective, thrush can be resolved by using a medicine called nystatin.

Learn how to protect yourself from dry mouth which can cause tooth decay: http://www.hcvadvocate.org/Oldsite/200004/page5.htm

 

Copyright 2002 – Hepatitis C Support Project – All Rights Reserved. Permission to reprint is granted and encouraged with credit to the Hepatitis C Support Project

October 2002