What's Wrong with my Mouth?

Posted by Pozziepinoy on 8:16 AM

(Source: 100 Questions & Answers About HIV and AIDS, 2nd Edition, by Joel Gallant, MD, MPH)

 The most common cause of mouth and throat problems is oropharyngeal candidiasis ("thrush"), a buildup of Candida (a common yeast or fungus). Thrush is easy to diagnose with a mirror and a flashlight. You'll see whitish-yellow curd-like patches, especially on the roof and sides of the mouth, the back of the throat, and the gums. These patches can be easily scraped off. Don't confuse a white coating on the tongue with thrush. The tongue is usually the last part of the mouth to be infected, and a white coating on the tongue, with no other evidence of thrush is usually just ... a white coating on the tongue.


Thrush can be confused with oral leukoplakia (OHL), a condition caused by Epstein-Barr virus (EBV) that looks like a white racing stripe down both sides of the tongue. Unlike thrush, it can't be scraped off. Candida can cause other nmouth problems besides thrush - erythematous candidiasis (redness on the roof of the mouth that is sometimes painful) and angular cheilitis (cracks at the corners of the lips).

 Painful ulcers in the mouth can be caused by viruses, but they're often aphthous ulcers, which essentially means that we have no idea what causes them. The diagnosis of most of these conditions is usually based on appearance alone; special tests aren't necessary.

 Thrush and OHL are fairly benign conditions, but they both indicate that something's wrong with your immune system and that you should be on ART. Thrush is treated with anti fungal medication. Fluconazole, an oral anti fungal drug, is very effective, but repeated use can lead to infection with drug-resistant fungus, which is why we sometimes use medications that treat only the surfaces, such as clotrimazole troches (lozenges) or cystitis mouth rinses. Because it's harmless, we don't usually treat OHT except with ART.

 People with low CD4 counts are at risk for serious mouth infections. Brushing, flossing, and seeing a dentist and oral hygienist on a regular basis are important to keep your teeth and gums in good shape.








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