HIV and the mouth

January 2007     View PDF     En español

Other oral conditions of HIV disease

The two most common conditions that may not be caused by an infection include dry mouth and small round mouth sores, called aphthous ulcers.

Dry mouth
Dry mouth, or xerostomia, is a common condition in HIV disease that may have a variety of causes. HIV disease itself may cause dry mouth because HIV-related salivary disease causes swollen salivary glands (glands in the mouth that produce saliva, or spit). That, in turn, reduces the amount of saliva in the mouth. A dry mouth is also a side effect of some anti-HIV drugs and other medicines like antihistamines and antidepressants. Allergies and infections may also cause dry mouth.

Though it may not seem serious, leaving dry mouth untreated may lead to problems. Without enough saliva, food can build up in the mouth, between the teeth and gums and promote tooth decay, periodontal disease and candidiasis. Furthermore, a lower flow of saliva can cause high acid levels to persist long after eating. This can wear out the enamel on the teeth leaving them more susceptible to cavities and other problems. It is common for people with dry mouth to undergo a large number of cavities, so it’s important to visit your dentist regularly if you have dry mouth.

Fortunately, dry mouth is fairly simple to overcome and treat. One easy way is to chew sugarless gum, which stimulates more saliva. Sucking on sugar-free lemon drops, crushed ice or lozenges can produce similar effects. Drinking plenty of liquids at or between meals is a great idea, as is rinsing your mouth often with warm salt water or mouthwash (preferably alcohol-free). Avoid sugar since it can make your mouth even drier and promote the growth of fungus.

Some prescription drugs may help lessen dry mouth. In particular, artificial saliva is available and some people may benefit from pilocarpine therapy designed to stimulate the salivary glands. Herbs like demulcents, chickweed and slippery elm may also help combat dry mouth, though it’s unclear if they interact with commonly used anti-HIV therapies.

Aphthous ulcers
Aphthous means “little round”, so aphthous ulcers are little round sores in the mouth. They tend to form on “soft” tissue in the mouth, like the inside of the cheeks, on the sides of the tongue or into the throat. These ulcers can develop in HIV-negative people, but people living with HIV may suffer from more severe and prolonged ulcers. They may be a side effect of certain anti-HIV therapies, though even people not taking anti-HIV medicines may have them.

The sores are usually very painful when touched or when food or liquids pass over them. They can even be so severe that a person may avoid eating or drinking altogether. A typical ulcer has a red halo and is covered by a grayish layer or membrane. They’re generally mistaken for herpes sores, and what causes them is still not known. Sometimes aphthous ulcers resolve without treatment. However, apthous ulcers that are small (minor) can rapidly become very large (major). So if you’re HIV-positive, treatment for these lesions should be considered.

Treatment can involve using steroids applied directly on the ulcers. A mixture of Lidex (fluocinonide) and Orobase, one of Cormax or Temovate (clobetasol) and Orobase, or a Decadron (dexamethasone) elixir is effective. An experimental therapy, thalidomide, has been very effective in treating aphthous ulcers in studies, though it is not without side effects. Side effects may include fatigue, pain and tingling in the hands and feet (peripheral neuropathy) and rarely, low neutrophil counts (neutropenia). Note: thalidomide should NOT be used by pregnant women or women who are planning to become pregnant while on therapy. It can cause serious birth defects if used even once during the first trimester of pregnancy.