Nutrition and Oral Medicine (Nutrition and Health)

236 Part IV / Select Diseases and ConditionsStomatitis can cause severe pain and ulceration of the gingiva, oral mucosa, and palate,which makes eating painful. Xerostomia, or dry mouth, secondary to medications or otherconcurrent disease can further compromise intake. Efforts to stimulate saliva productionusing pharmacologic agents and citrus-flavored, sugar-free candies may ease eatingdifficulty (see Appendix B). Dietary guidelines focus on the use of moist foods withoutadded spices, increased fluid consumption with and between all meals and snacks, andjudicious food choices. Problems with chewy (steak), crumbly (cake, crackers), dry(chips), and sticky (peanut butter) foods are common in individuals with severe xerostomia,and avoiding these foods may help a great deal with eating. Water with a lemonlimetwist, citrus-flavored seltzers, and sucking on frozen grapes may help. Good oralhygiene habits are important to reduce the risk of tooth decay and should be practicedafter all meals and snacks. Xylitol-flavored gums and mints may help reduce the risk ofassociated decay.5. CONCLUSIONSOral manifestations are commonly the first signs of an underlying systemic disease ina patient. This chapter discusses some of the more frequently found oral lesions associatedwith HIV disease, their clinical presentations, and current treatment modalities. Theintegration of dental management with nutrition care contributes to improved systemic,oral, and nutritional well-being and response to treatment. Collaboration across disciplinesin detection, referral, and early intervention of oral and nutrition-diet-related problemsare important for comprehensive care of the individual with HIV or AIDS.Guidelines for PracticeOral Health ProfessionalNutrition ProfessionalPrevention • Conduct regular screening examinations • Conduct oral screen as part offor oral disease.comprehensive nutrition assessment;• Assess nutrition risk and provide appro- refer nonnormal findings to a dentist.priate referrals for medical nutrition • Provide MNT to patients along withtherapy (MNT) in all individuals with referrals for dental care on a routineHIV and AIDS.basis.Intervention • Provide dental care and prophyaxis as • Routinely conduct oral screen on allneeded.patients and refer for and reinforce• Review appetite, weight change, intake, importance of dental treatment.and oral factors affecting eating ability • Provide dietary guidelines consistentat all visits and refer as needed for MNT with symptoms to promote attainingby a registered dietitian.and maintaining nutritional well-being.REFERENCES1. Sirois D. Oral manifestations of HIV disease. Mount Sinai J Med 1998; 65(Oct/Nov):322–332.2. Glick M, Muzyka BC, Lurie D, Salkin LM. Oral manifestations associated with HIV-related disease asmarkers for immune suppression and AIDS. Oral Surg Oral Med Oral Pathol 1994; 77:344–349.3. CDC. 1993 Revised classification system for HIV infection and expanded surveillance case definitionfor AIDS among adolescents and adults. MMWR 1992; 41:1–10.4. Anker M, Schaaf D. WHO Report on global surveillance of epidemic-prone infectious diseases.Communicable Disease Surveillance and Response. WHO/CDS/CSR/ISR/2000.1. Available at