More Oral Manifestations
Apthous Ulcers (Canker Sores)- The cause of apthous ulcers is not well understood but many possible causes have been theorized. They include:
- vitamin deficiencies
- faulty immune system
- autoimmune inflammation
- various disease states (HIV included)
- injury to the mouth and gums from brushing or poor fitting dentures
- emotional stress
- hormonal changes in women (outbreaks during menstruation and improvement during pregnancy)
- Ulcers are not contagious and are not spread orally from person to person.
- The frequency of outbreaks can be diminished by avoiding things that may cause gum injury such as rough, sharp food that scratches the gum, vigorous brushing that results in an injury to the gums, or spicy and acidic foods.
- In patients with HIV, some apthous ulcers can be severe, very large, involve the esophagus, or fail to resolve which requires more intensive therapy such as steroids or Thalidomide.
- Treatment of canker sores depends a great deal on the cause; some examples of treatment include:
- changing to a milder tooth paste
- antibiotic mouth rinses
- pain relief from topical numbing agents
- steroids for severe and recurrent cases
- antifungal medications if the canker sores are related to a candida infection (thrush).
Xerostomia (Dry Mouth)
Xerostomia is a fancy name for dry mouth. It is a major source of tooth decay in the HIV positive person. The condition is a result of changes in the quantity and quality of saliva. There are a number of possible causes for these changes. They include:
- side effect of various medications, including some HIV medications
- changes in salivary gland production;
- a complication of certain illnesses, infections, and diseases, including HIV and AIDS;
- any condition that causes fluid loss and eventual dehydration including vomiting, diarrhea, poor fluid intake, and profound blood loss;
- a very common side effect of radiation therapy used in the treatment of head and neck cancers;
- blocked salivary glands after glands have been removed due to tumor growth.
The Role of Saliva
Changes in saliva production can lead to illnesses other than dry mouth. For instance, because saliva is an important part of tooth decay prevention, decreased saliva production can lead to more rapid and extensive tooth decay. Saliva is constantly rinsing the mouth of sugars left over from eating. These sugars can settle on teeth, eventually causing tooth decay. Saliva also has antimicrobial properties, meaning it rids the mouth of harmful bacteria. Without the saliva, the unchecked bacteria can cause severe and rapid tooth decay. Experts believe that the severe tooth decay commonly seen in the methamphetamine user is in a large part due to abnormally dry mouth.People with Xerostomia have several complaints related to their dry mouth:
- difficulty speaking, swallowing, chewing, or wearing dentures;
- sores under and around dentures;
- a painful tongue that sticks to the palate;
- a change in or the absence of taste;
- the need to drink increased amounts of water;
- cracking of the lips, tongue, and oral mucosa;
- parotid gland inflammation and swelling
Sometimes the cause of Xerostomia is not easily removed. In these cases, stimulating the salivary glands may be the answer. Certain chemicals such as those containing citric acid can stimulate the salivary glands to produce saliva. Electrical stimulation using small electrical impulses have been known to work as well. Finally, medications such as salivary substitutes and oral moisturizers may be of some benefit as well.
Sources:
McBride, D.R.; "Management of Aphthous Ulcers"; American Family Physician; 1 Jul 2000. Wilder, T.L.; "Maintaining Good Dental Health"; AIDS Survival Project; December 2000.
