How HIV can affect your tongue and oral health

Common tongue and mouth conditions linked to HIV

• Canker sores (aphthous ulcers): These small, painful sores appear as round or oval ulcers with a red border and a yellow or gray center. They often show up on the tongue, inside the cheeks, or along the lips. For people with HIV, canker sores can be more frequent and severe. While mild ulcers usually heal on their own, severe cases may need prescription medications such as corticosteroid mouth rinses.
• Oral thrush (candidiasis): According to a study published in NIH, this is the most common fungal infection among people with HIV. Thrush looks like creamy white or yellow patches on the tongue and can spread to the throat, tonsils, or roof of the mouth. It may cause pain, burning, or bleeding when scraped. Since HIV weakens the immune system and often causes dry mouth, the natural balance of fungi in the mouth is disrupted, allowing yeast to grow unchecked. Antifungal medications are effective, but thrush can return if the immune system remains suppressed.
• Oral hairy leukoplakia (OHL): Caused by the Epstein-Barr virus, OHL produces white, fuzzy patches on the sides of the tongue. These patches may be painless but can sometimes affect taste or cause sensitivity. While not dangerous on its own, OHL is usually a sign of advanced immune suppression and is more common in untreated HIV. Antiviral drugs or topical treatments may help, but the underlying viral infection cannot be cured.
• Oral herpes: The herpes simplex virus can flare up more often in people with HIV. Painful blisters or clusters of sores appear on the tongue, lips, or roof of the mouth. These sores are contagious and may spread through kissing or sharing utensils. There is no cure for herpes, but antiviral medicines can shorten outbreaks and reduce recurrence.
• Oral warts: Caused by human papillomavirus (HPV), oral warts may appear as small, raised bumps or flat, cauliflower-like growths on the tongue or inside the mouth. They are usually painless but can be persistent. Cryotherapy or surgical removal can help, although warts may return. People aging with HIV or those on long-term antiretroviral therapy are at higher risk.
• Oral melanin hyperpigmentation: Dark brown or black patches may develop inside the mouth, especially on the tongue and gums. These patches are usually harmless and are often linked to certain HIV medications such as zidovudine (AZT). While treatment is not usually required, medication changes can sometimes reduce pigmentation.

Why oral health is important in HIV management

Preventing oral health complications with HIV

• Stick to HIV treatment: Antiretroviral therapy strengthens the immune system and reduces the risk of oral complications.
• Prevent dry mouth: Dryness increases the chance of infections. Avoid tobacco, alcohol, and overly salty foods, and drink plenty of water. Specialized mouth rinses or toothpastes can also help.
• Limit triggers: Smoking, poor diet, and lack of hydration make oral problems worse. Using a humidifier at night may also help maintain moisture in the mouth.