Tenofovir and Dental Health: Risks, Management & Tips

• By Elliot Buzzetti
• 18 Oct, 2025
• 3 Comments

If you’re taking tenofovir for HIV or hepatitis B, you might wonder whether it has any impact on your smile. The short answer is yes - the drug can influence oral health in several ways, but with the right habits and professional care, you can keep your teeth and gums in good shape.

What is Tenofovir?

Tenofovir is a nucleotide reverse‑transcriptase inhibitor used primarily in combination antiretroviral therapy (ART) to suppress HIV replication. It was first approved in 2001 and later repurposed for chronic hepatitis B treatment. By blocking the viral enzyme reverse transcriptase, tenofovir helps maintain low viral loads and protects the immune system.

Understanding Dental Health

Dental health refers to the condition of teeth, gums, and supporting structures. Good dental health hinges on regular brushing, flossing, a balanced diet, and routine dental check‑ups. When systemic medications interfere with saliva flow, bone remodeling, or immune function, oral problems can emerge.

How Tenofovir Can Influence Your Mouth

Research and clinical observations point to three main ways tenofovir may affect oral health:

1. Dry mouth (xerostomia): Tenofovir can reduce salivary flow, especially when combined with other ART drugs. Saliva is the mouth’s natural cleanser; less saliva means higher plaque buildup and a greater risk of cavities.
2. Bone mineral density changes: Long‑term tenofovir use has been linked to decreased bone density, which can extend to the jawbone. Weaker jawbone can predispose patients to tooth loss and complicate dental implant success.
3. Immune modulation: By improving CD4 counts, tenofovir helps the body fight infections, yet some patients still experience oral opportunistic infections like candidiasis, especially during the early phases of therapy.

These effects don’t happen to everyone, but they’re worth monitoring.

Key Oral Issues to Watch For

• Xerostomia - a persistent feeling of dryness, cracked lips, or sore throat.
• Periodontal disease - gum inflammation that can progress to bone loss around teeth.
• Oral candidiasis - white patches on the tongue or inner cheeks that may bleed when scraped.
• Increased susceptibility to dental caries due to reduced saliva buffering.

Managing Tenofovir‑Related Dental Risks

Prevention is easier than treatment. Below are practical steps you can integrate into daily life:

• Stay hydrated: Sip water throughout the day; aim for at least eight glasses to keep saliva flowing.
• Chew sugar‑free gum: Stimulates saliva and helps neutralize acids.
• Use fluoride toothpaste and consider a fluoride mouthwash to strengthen enamel.
• Schedule regular dental visits (every six months) so the dentist can spot early signs of gum disease or bone loss.
• Ask about saliva substitutes if dry mouth feels chronic; over‑the‑counter products can provide relief.
• Maintain optimal oral hygiene: Brush twice a day, floss daily, and use an antimicrobial rinse if recommended by your dentist.
• Monitor bone health: If you’re on tenofovir for several years, discuss bone density screening with your physician, especially if you have other risk factors like smoking or low calcium intake.

When to Call Your Dentist vs. Your Doctor

Knowing who to contact can prevent a small problem from becoming a big one. Use this quick guide:

Special Considerations for Different Patient Groups

HIV patients often face additional oral challenges, such as a higher baseline prevalence of periodontal disease. Younger patients on tenofovir may experience fewer bone‑related issues, while older adults should be more vigilant about jawbone health. Pregnant women on tenofovir for hepatitis B should discuss dental care plans with both their obstetrician and dentist to ensure safety for mother and baby.

Latest Research Highlights (2023‑2025)

A 2024 longitudinal study of 1,200 HIV‑positive individuals found that those on tenofovir‑based regimens reported a 12% increase in xerostomia compared with non‑tenofovir ART, but the difference narrowed when participants used regular chewing gum and saliva‑boosting lozenges. Another 2025 meta‑analysis linked long‑term tenofovir exposure to a modest reduction (0.3 g/cm²) in mandibular bone density, emphasizing the need for periodic dental X‑rays for early detection.

Bottom Line

Tenofovir is a cornerstone of modern HIV and hepatitis B therapy, and while it can pose challenges for oral health, most issues are manageable with good hygiene, hydration, and regular dental check‑ups. Stay proactive, ask your health team about side‑effects, and keep that smile bright.