Mouth and throat problems

Problems and possible causes

Soreness in the mouth, usually accompanied by white patches on the tongue, is a common symptom in people with AIDS. Sometimes it progresses into the throat and esophagus, causing painful swallowing, thereby interfering with eating and drinking. Other associated problems are blisters and sores on the lips, and dental problems. The following diseases may cause a sore mouth or throat in people with AIDS:

· thrush (yeast infection), resulting in white patches and surrounding redness, not only in the mouth but possibly in the throat and esophagus

· oral herpes simplex (blisters and sores on the lips)

· malnutrition (cracks and sores on the mouth)

· Kaposi sarcoma of the mouth or throat

· dental problems

· hairy leukoplakia.

What to do at home

Poor nutrition can cause problems in the mouth and can make existing problems worse. Encourage people to eat a healthy diet or take vitamin supplements. For additional information refer to the section on nutrition in this chapter and the section on medicines for nutrition problems in Chapter Seven.

To help prevent problems in the mouth and throat, the mouth can be rinsed with warm salt water (half a teaspoonful of salt in a cupful of water), or with a mouthwash solution after eating and between meals. The wash should be swished gently in the mouth then spat out (not swallowed or it may upset the stomach and cause nausea).

General hints for dealing with a sore mouth:

· Eat soft foods rather than hard or crunchy foods.

· Eat bland not spicy foods.

· Use a straw for liquids and soups. This may help when taking in the food needed while preventing it from touching the sore areas.

· Cold foods, drinks or ice, if available, may help numb the mouth and relieve discomfort.

Thrush

Figure

Thrush is a fungal infection that causes small white patches on the inside of the mouth and tongue. The infection looks like milk curds stuck to raw meat. If the white plaques scrape off with a brush or a fingernail it is probably thrush. If it does not it may be another condition called hairy leukoplakia (described below).

You should advise someone with thrush to:

· gently scrub the tongue and gums with a soft toothbrush at least three or four times per day, then rinse the mouth with dilute mouthwash, or a salt water or lemon water rinse

· suck a lemon if it is not too painful - the acid of the lemon slows down the growth of the fungus

· apply gentian violet solution three or four times a day - gentian violet solution is prepared by dissolving 1 teaspoonful of gentian violet crystals in half a litre of dean water.

If necessary, you may prescribe antifungal oral suspensions or lozenges given three or four times a day. In some people, thrush affects not only the mouth but the entire esophagus causing pain on swallowing and a burning sensation in the chest. See the section on medicines for fungal infections in Chapter Seven for information on the use of these medicines.

Hairy leukoplakia

Hairy leukoplakia may look like thrush. However, it does not cause pain, it will not scrub off the tongue or gums, and it commonly makes vertical ridges on the edges of the tongue. It is mentioned here only so that you know that it can be confused with thrush. There is no need for a specific treatment for this condition. It will not interfere with the ability to eat or with a person's general comfort. The main point is to not use too many medicines for thrush if in fact the problem is hairy leukoplakia.

Herpes simplex sores

These are painful blisters on the lips, which may appear after a fever. In people with AIDS these sores may appear even without a fever and may last a long time. Gentian violet solution (made as described in the previous section on thrush) can be applied to the herpes sores on the lips and mouth. Although the strong purple colour may bother some people, the solution can help in preventing the sores from becoming infected.

Dental problems

Thorough cleaning of the teeth and gums is important. Many people with AIDS suffer from inflammation of the gums, tooth abscesses and infection. For this reason, people should be encouraged to make regular visits to a dentist when possible, and to be particularly careful about oral hygiene, being sure to brush the teeth and clean between the teeth (using dental floss or toothpicks) to remove food particles.

If someone does not have a toothbrush, they can use a tooth-cleaning stick.

Figure

Or, they can tie a piece of towel around the end of a stick, and use it as a toothbrush.

Figure

If toothpaste is not available, a tooth-cleaning powder can be made by mixing salt and bicarbonate of soda (or ashes) in equal amounts. To make it stick, the brush should be wetted before being put in the powder. This mixture works just as well as commercially available toothpaste for cleaning teeth.

Figure

When sick people and their families must seek help

· If the sick person is becoming dehydrated or is unable to swallow properly.

· If there are symptoms of esophageal thrush such as a burning pain in the chest or a deep pain on swallowing.

Notes on sore mouth and throat
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