People living with HIV are more likely to develop oral health problems because the virus can weaken the immune system, which makes it harder to fight infection.
According to the World Health Organization (WHO), around 40–50 percent of people living with HIV have oral infections that can cause complications in the mouth, including sores.
Mouth sores can be painful and make eating, swallowing, and taking medications more challenging.
In this article, we look at the causes and treatment of mouth sores in people living with HIV. We also cover some general prevention tips and when to see a doctor.
Image credit: CDC/ Sol Silverman, Jr., DDS, 1999.
Image credit: Dr. Dentist DDS, 2013.
Image credit: National Cancer Institute, 2008.
Oral herpes can cause painful red sores on the lips, gums, tongue, and inside of the cheeks. These lesions are commonly known as cold sores or fever blisters, and they result from infection with the herpes simplex virus (HSV).
Additional symptoms may include:
- muscle aches
- swollen or painful lymph nodes
- a burning or tingling sensation near the sores
Anyone can get oral herpes, but HIV increases the risk for opportunistic infections, such as HSV. People with untreated HIV may experience more prolonged and severe outbreaks of cold sores.
HSV is a common and highly contagious infection. It is possible to contract oral herpes through direct contact with the saliva or cold sores of someone with the infection. Transmission is more likely to occur during an outbreak of sores.
People can reduce their risk of contracting HSV by not kissing or sharing foods with someone with oral herpes, especially during an outbreak.
HSV can also cause genital herpes, which a person can transmit during vaginal, anal, or oral sex.
Herpes is treatable. Doctors may prescribe oral antiviral medications, such as acyclovir or valacyclovir.
Human papillomavirus (HPV) infections are prevalent among people living with HIV. An Italian study found that 48 percent of women living with HIV had an HPV infection compared with 28 percent of women without HIV.
HPV can cause small white bumps, or warts, on and around the mouth and lips. These warts are usually not painful, but they may bleed if a person picks at them.
HPV can also cause genital warts, which are highly contagious. A person can contract oral HPV during oral sex if the virus enters the bloodstream through a cut or tear in the mouth.
Most people who have oral HPV do not experience any symptoms. If symptoms do occur, they can include:
- painful sores inside the mouth
- difficulty swallowing
- swollen tonsils
- a sore throat
Ways to reduce the risk of oral HPV include:
- getting the HPV vaccine
- using a condom during sex
- limiting the number of sexual partners
- quitting smoking and other tobacco products
There is no known cure for HPV. It is difficult to treat HPV warts with topical medications, so doctors may need to remove them surgically.
Canker sores, also known as aphthous ulcers, are painful ulcers that can develop on the soft tissue inside the mouth. They are typically small and either white or gray.
Doctors do not fully understand what causes canker sores, but various factors, such as mouth injuries, stress, vitamin deficiencies, and weakened immune function, may play a role in their development. Canker sores are not contagious.
People can help reduce their risk of canker sores by doing the following:
- avoiding and managing stress
- avoiding spicy or acidic foods and beverages
- chewing carefully to avoid injuring the mouth
- eating a balanced and healthful diet
For mild canker sores, rinsing the mouth with an over-the-counter mouthwash can reduce inflammation and keep the ulcers clean. In severe cases, a doctor or dentist may prescribe medicated ointments and mouthwash to minimize pain and promote healing.
People with a compromised immune system may be at greater risk of developing oral thrush.
Anyone can get oral thrush, but infants, older people, and individuals with a weakened immune system have a higher risk.
Other symptoms can include:
- a burning sensation that may cause difficulty swallowing
- loss of taste
- dry mouth
People can treat oral thrush with antifungal mouthwash and medications.
HIV can cause the salivary glands to swell, which can lead to reduced saliva production and dry mouth. Saliva protects the teeth and gums from plaque and helps fight off infection. Dry mouth can also be a side effect of HIV medications.
Symptoms of dry mouth include:
- trouble chewing and swallowing dry foods
- difficulty speaking
- a painful tongue
- inflammation of the tongue
- ulcers on the tongue
- bad breath
People can treat dry mouth by keeping their mouth clean and staying hydrated. If dry mouth persists, a person may want to consider seeking advice from a healthcare professional. Dry mouth can lead to other complications, such as gum disease.
Gum disease is an infection that results in swollen, painful gums. In severe cases, gum disease can lead to tooth loss. It can also be a sign of inflammation in other parts of the body.
Symptoms of gum disease include:
- red, swollen, or tender gums
- bleeding gums
- loose or sensitive teeth
- pain when chewing
People can prevent and treat gum disease with good oral hygiene practices, which include:
- brushing the teeth twice a day with a fluoride toothpaste
- flossing daily
- using mouthwash
- having regular dental checkups
For severe gum disease, a dentist may prescribe antimicrobial mouthwash, antibiotic gels, or oral antibiotics.
Symptoms of KS may include:
- difficulty eating or swallowing
- abdominal pain
- an unexplained cough
- chest pain
- swelling of the extremities
People living with HIV have a much higher risk of developing KS than people without HIV. However, KS is becoming less common now that effective HIV treatments are available.
The treatment for people with KS depends on the number of tumors, their location, and the condition of the immune system. Treatment options include:
General prevention tips
Using mouth wash and practicing good oral hygiene may help prevent mouth sores.
Going to a dentist for regular checkups is a good way to prevent mouth sores. Dentists can help people manage symptoms of existing mouth sores and prevent future sores from developing.
Some other ways to prevent mouth sores include:
- taking HIV medications consistently
- practicing good oral hygiene
- quitting smoking
- staying hydrated
- avoiding spicy and acidic foods and beverages
- eating a balanced and healthful diet
When to see a doctor
It is advisable to see a doctor for mouth sores that:
- are very painful
- last for more than 1–2 weeks
- make it difficult to take medications
- affect a person's ability to eat, swallow, or talk
- occur alongside other symptoms
Mouth sores are a common symptom of HIV, and they have several possible causes. People can manage most types of mouth sore with proper oral hygiene.
It is also important to see a dentist for regular checkups. Dentists can help manage symptoms of oral infections and prevent recurring mouth sores.