[Question #1974] Mouth exposure and digestion indirect transmission

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85 months ago
Doctor hook I have issue of indirect direct transmission of HIV fluids from mouth using dental retainers and one question on drink digestion . 

Are you available ? I do not want to waste my opportunity on not talking to you are you randomly online ? 

You are amazing specialist on mouth exposure can I try again if I can't connect with you please would love it . 
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85 months ago
I consider dr hook in my opinion the best doc in the world in terms of mouth exposure . I am afraid that I can't repeat a question so that's why did not post my question briefly . It's on dental retainers braces and drink digestion on HIV I will explain I can pay again as donation if this conversation has become invalid but I need dr hook I don't want to lose this opportunity which is dear to me 
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85 months ago
I just need logical answers actually ... so will you experts help ? Can I ask question 
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Edward W. Hook M.D.
85 months ago
This site is not staffed 24/7 and Dr. Handsfield and I answer questions interchangeably.  Clients are not permitted to choose who will be answering their questions.  This is, in part because Dr. Handsfield and I have worked together for over 30 years and are like-minded in the facts of all responses despite differences in verbal style.  You have wasted your first of three questions with this post.  I will be responding to up to follow up questions as my schedule permits but this will not be on "on-line chat".  Please follow the site's guidelines. EWH
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85 months ago
Dear doctor   . I am worried parent have 2boys . Have  worry since one of my family members it's HIV positive  .although this has nothing to do with family member which has HIV . 

My concerns are applying  dental retainers on daily basis which are used for teeth alignment  I will share a link below of transparent  clear path aligner and you have to remove them at lunch ,dinner or whenever you have to drink . In simple terms these are retainers used after braces have been taken off or can replace braces all together .

https://www.clearpathortho.com.au 

I use them also and so do my two boys . My concerns are getting cut from the object aligner inside the mouth  and getting HIV fluids on them from surface of a table , a tissue or whatever  solid surface present .


Q1) cuts : You have stated  that if somebody was to get cut from an object which may HIV on it ,it won't be able to transfer HIV  . So one was to apply an the aligner cuts or nicks to the gums and getting cut inside a mouth would not transmit HIV that is fine . Can you give reasons ? (So that I don't repeat)


Q2) blood or fluids in the mouth  : 
sometimes my boys take off the aligner at Restraunt's tables or when going in public bathrooms next to the sink  
And I worry if any HIV fluids are on a surface they can transfer it on the object (aligner) and then apply them on their mouth . 

Even if HIV fluids  were  get into their mouth you have stated the digestion  doesn't lead to HIV . 
My question is before digestion when the fluids are in the mouth what properties does the mouth possess that kills HIV . Except saliva if one was to get HIV blood or fluids in the mouth . ?  And why tooth conditions (broken tooth ,missing tooth which have poor fillings) ,gums and small cuts in the mouth don't matter ?.   
Even if one were to drink something from a glass unknown at a Restraunt in unlikely scenario.(blood or fluids HIV ) you have always stated not to worry .but why ? (So that I don't repeat myself )


Q3) HIV is fragile : 
I have heard you have said HIV is fragile and dies immediately to exposure to environment or drying . If HIV is outside the environment even a bit wet  it wouldn't matter as you say it has been exposed to the environment and dies within seconds ? . 

I have read that HIV cannot live on objects  .. But can you provide the reasons as to why applying these clear path aligners are no risk if you get cut , and if one has  HIV fluids in mouth without knowing and how the mouth would deactivate the virus before digesting . You have said that HIV blood or fluids in the mouth have never lead to HIV infection .

no sexual activity is included in any of these. 

Thanks 
(A worried parent ) 


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85 months ago
In addition to the question I forgot to add mouth ulcers or mouth sores for q1 and 2 if these were also  present also in  mouth then HIV Won't pass through and it won't matter . 

Sorry for that please don't count this as a question which I have just typed 
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Edward W. Hook M.D.
85 months ago
I understand your apprehensions, particularly as they relate to your children.  that does not change the fact however that the situation that you describe are NO RISK situations.  The basis for this statement comes from an understanding of the biological characteristics of the HIV virus and the experience gained from observations made in the context of caring for literally millions of persons with HIV across the globe.  If HIV were acquired by the sort of incidental contact that you describe such as surface contamination, touching, or ingestion there would have been numerous instances in which such routes of acquisition were described and reported in the medical/scientific literature.  That has not happened, not ever and logically would have occurred and been reported through the experience of non-HIV infected care providers who provide care for and deal with infected patients on a daily basis. 

As for your specific questions:
1.  As noted above- never observed.  For HIV to be transmitted through wounds the virus must be introduced directly and deep into tissue such as when it is injected using a hollow point needle.  Cuts and nicks with solid objects such as you describe have NEVER been reported. 

2.  As mentioned above, despite the fact that food and liquids (including water) contaminated with HIV has undoubtable been ingested many times, no infection has ever been documented to occur in this way.  This is likely because of several factors including that the virus becomes non-infectious quickly on exposure to air/drying and room temperature.  Further  with each transfer less and less virus is transferred (i.e. the material is effectively diluted with each transfer- this is a microbiological principle).  Finally, the mouth has many innate defenses against infection which prevents people from becoming infected despite the fact that the mouth has higher concentrations of bacteria and more regular exposure to a variety of environmental viruses than any other part of the body.  

3.  See above.  While moisture or high humidity may lightly slow the process of becoming non-infectious, it does not do so meaningfully.   In fact non-physiological liquids such as water are likely to directly kill the virus.

Mouth sores do not change any of the facts or observations noted  above.  HIV has NEVER been proven to be transmitted by kissing, even deep kissing with and exchange of saliva.  Both the CDC and WHO state that there is no risk from kissing of any sort.  EWH
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85 months ago
Thank you for reply doctor

1)In  cuts they have to be introduced into the body from hollow needle  .  it has to be injected meaning taking a needle infused you mean like a regular injection pushed  ? . I was  comparing this to by getting pricked by lancet  . But since it's solid Object  I can assume that HIV blood or bodily fluids cannot be picked up form surface or table and survive on  in the first place  ? . And it will become non infectious immediately this means it dies with in seconds ? 

 if HIV we're present then how is it different as to being pricked by lancet on the finger  as compared to cut or pricked from other objects . thats the confusion or lancet are also no risk since they are solid where fluids cannot survive .

2) in  digestion thank you for clarification you have said mouth has great defences . But if liquids were not diluted You have mentioned that  if pure HIV blood were to get into the mouth directly or in directly no reported cases irrespective of the amount it's the same answer for all other fluids (breast milk , vaginal fluid semen etc ) ? Which did not include sexual activity in adults ?

3)You have also mentioned hiv  breast milk once outside the body even if remains in pure form the HIV virus would die as it won't be able to effect a person  if in a bottle or glass how does it become inactive ? 

Can we  clarify this that once HIV outside the body in blood , bodily secretions (vaginal fluid or semen ) or breast milk Even in there pure Liquid form and one were to somehow drink them without noticing at Restraunt   . Can I assume HIV would be dead because it has come in contact with oxygen and environment after leaving the body  and forget about how wet  blood or  other bodily liquids are ? .because HIV breast milk won't dry up that's the confusion .Is drying important ? 

MOUTH defense :
3)I did not mention kissing but thanks I was referring to contact of HIV fluids outside the body  I spoke to a local doctor before you unfortunately and he said I would be worried if you have  mouth sore or open ulcers and come in contact with HIV fluids (no sexual activity included )   I am assuming I have been misinformed . And you would disagree with this point .?  

4)As for teeth I want to share  .  They are bones and  HIV cannot penetrate them if one were to have a root canal doctor said the blood vessels have been taken out so if ones crown falls and you come in contact with HIV fluids .nothing can go into the blood stream is that correct also ? 

So it's safe to say :root canals tooth , ulcers or mouth do not change anything ? And I can never worry about HIV from indigestion . In adults  in Restraunt's or anywhere .

Will my boys be safe ? Thanks 

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85 months ago
Sorry for the numbering point after point number 3 it's point number 4 where it says "mouth defense " and point number 5 where I start by says "as for teeth ".    I numbered them incorrectly  so please address just incase I don't get confused with the response thanks doctor 
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Edward W. Hook M.D.
85 months ago
Your follow-up questions are repetitive and have no basis in science.  As described in our guidelines, we do not honor or continue to answer repetitive, anxiety-driven questions.  Repeating questions does not change the answers.  I will briefly address some of your questions and this this thread will be closed.  I would also suggest you review earlier posts in the past which have titles like "environmental contamination" to see prior answers on related topics.  For instance, exchange 1887 with another client (or possibly you using a different name) addresses many of the questions you have asked.  Further posts repeating these questions may be deleted without comment and without refund of your payment.

For your questions:
1. Hollow needles have the capacity to transfer blood contained within the needle. Solid objects such as lancets, dental instruments or retainer wires do not.  Hence punctures from these are not meaningful risks for HIV or other blood borne infections.  further as you point out, infectious materials are not transferred by contact with environmental surfaces as already stated.

2.  Diluted or not, there is no evidence that ingestion of contaminated materials by persons over a few weeks or months of age is a meaningful risk for infection.

3.  Whether contaminated breast milk contains infectious virus or not is not relevant as ingestion of contaminated material has not ever been shown to lead to infection in adults.  Food and contaminated liquids are NOT a source of HIV infections

4.  I suspect you took what your doctor said out of context.  Even with mouth sores or ulcers, there is no known risk.

5.  See question 1887.  There are no instances in which HIV have been acquired through mouth ulcers, root canals or other dental procedures or contact.

This thread is over and will soon be closed.  EWH
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