Factsheet Mouth problems

Michael Carter, Published May 2012

Key points

  • Mouth problems are more likely to occur in people with low CD4 counts.
  • They can be caused by either fungal, viral or baterial infections.
  • You are more likely to get oral infections if you smoke.

Many HIV-related conditions can affect the mouth, causing symptoms such as ulcers, dry mouth and painful lesions. Mouth problems are caused by either fungal infections, viral infections or bacterial infections.

Problems are more likely to occur in people with low CD4 counts. They may be an early sign of damage to the immune system. HIV treatment and specific treatments can fight mouth infections.

Regular medical/dental check-ups may prevent serious mouth conditions, and regular brushing and flossing is advised to ensure good oral and dental health.

Smokers are more likely to get oral infections than non-smokers.

Dry mouth and swollen salivary glands

A dry mouth may be due to HIV-associated salivary disease which causes swollen salivary glands. This condition is particularly common in HIV-positive children. Anti-HIV drugs can reduce swollen glands. Dry mouth may lead to chewing and digestive difficulties, and high levels of mouth acid. This increases the risk of thrush, bacterial infections and tooth decay. Chewing sugarless gum may help a dry mouth.

Dry mouth can also be caused by anxiety; having a blocked nose; and it can be a side-effect of certain medications, including some types of antidepressants.


Mouth or aphthous ulcers are painful sores on the gums, tongue or throat that may deter you from eating and drinking. The cause is unknown, however they may be associated with the herpes family of viruses (e.g. CMV). Small ulcers may heal after the use of mouthwashes, local anaesthetic, or steroid gels. For persistent ulcers, thalidomide may be effective; it is prescribed in the UK on a named-patient basis.

Candidiasis or thrush

Oral candidiasis or thrush causes white blobs in the mouth and throat. Red patches and inflamed cracks in the mouth may occur. Thrush is due to the overgrowth of naturally occurring fungus. Overgrowth may occur when the immune system is damaged (e.g. CD4 count below 400). Thrush may also be related to the use of antibiotics or as a result of conditions such as diabetes.

Several anti-fungal drugs are effective against oral thrush. For mild cases of oral thrush, lozenges, syrups of oral solutions (used as a mouthwash and then swallowed) may be effective. For more severe oral thrush there are several options. The most commonly prescribed is fluconazole, as a tablet or a solution.

"Looking after your teeth and gums is important for everyone."

Drugs may be used at low doses to prevent thrush; however, some doctors advise against this because drug resistance can occur. Treatments for thrush commonly interact with other drugs (e.g. protease inhibitors). It's a good idea to discuss potential drug interactions with your doctor.

Oral cancer

There is some evidence that people with HIV may be more likely to develop cancers of the mouth and throat. These cancers are linked to infection with certain strains of human papillomavirus (HPV). It is a good idea to mention any unusual mouth symtoms to your doctor.

Oral hairy leukoplakia (OHL)

OHL causes white patches with small, hair-like protrusions which usually occur on the side of the tongue. The patches look like thrush, but they can't easily be removed. OHL is caused by the Epstein-Barr virus and may be treated with anti-HIV drugs. Therapy for herpes, warts, thrush and CMV may sometimes be effective against OHL.


Inflamed and painful gums, known as gingivitis, are caused by bacteria in dental plaque. Bacteria infects the gums causing inflammation, swelling, bleeding and bad breath. Regular brushing and flossing helps prevent infection. Antibiotics and mouthwashes can combat the infection, although some washes may be have a strong taste, temporarily stain teeth, or sting.


Cold sores are small, painful lesions on the lips or mouth, caused by the herpes virus HSV-1, which take a number of weeks to heal. Cold sores can be treated with anti-herpes creams; however, some doctors are sceptical about their effectiveness. Drugs such as oral aciclovir and valaciclovir are used to treat and/or prevent outbreaks of herpes.

Looking after your mouth

Looking after your teeth and gums is important for everyone. This includes brushing your teeth, eating a healthy diet, not smoking and having regular dental check-ups. Mention any unusual symptoms to your doctor or dentist.

This factsheet is due for review in May 2015

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.