I recently attended a seminar on dental health and HIV where oral disease and xerostomia (dry mouth) were discussed. They were saying that dry mouth is quite common in persons with HIV either secondary to some of the medications and/or possibly to action of the virus on salivary glands. Because of the protective properties of saliva (antimicrobial activity, tissue lubrication) dry mouth is a risk factor for increased oral disease. If this is a problem for someone, there are saliva substitutes that his/her doctor could recommend. Also, some really simple nutritional ideas are to sip water frequently and suck on hard candy/lozenges. (Sugarfree would probably be best..but many of those have sorbitol that can cause diarrhea in some people. If candy with sugar is used, frequent gentle brushing and frequent rinsing of the mouth with plain water is essential.) Another thing that may help is frequent intake of small amounts of yogurt with active cultures (most brands do have these). As far as I have found there are no published studies on the efficacy of this, but the dentist that I spoke with at the conference said they recommend this to their clients with oral thrush. (I didn't ask her about hairy leukoplakia) The premise is that the "positive" probiotic yogurt cultures will "compete" with pathogens. This seems to have some efficacy with yeast organisms, but I don't know if the same would hold true with hairy leukoplakia which I believe is viral in origin. The treatment would be to hold the yogurt in the mouth as long as possible and "swish" it around before swallowing to give the bacteria a chance to work. Good oral hygiene is also essential. If a mouth wash is used, a non-alcohol base brand (like Tom's of Maine) is recommended (alcohol drys the tissues, increasing further the risk of infection and/or damage.) Additional nutrition related ideas are to consume cool or warm (vs scalding hot), soft, non-irritating foods to "rest" the oral tissue as much as possible to promote healing.

(Administrator's note: For some additional tips check out Jennifer's article The Mouth:Its Care and Feeding.)

Q#2: Perleche

What is perleche? Is it related to yeast or thrush?

A: Charlie Smigelski, RD responds:

(Administrator's Note:According to Taber's Cyclopedic Medical Dictionary, perleche is a "disorder marked by fissures and epithelial desquamation at corners of the mouth, esp. seen in children. May be due to oral candidiasis or may be a symptom of dietary deficiency, esp. riboflavin deficiency.")

As noted in the above definition, perleche is often associated with the growth of Candida/yeast cells in the corner of the mouth. Since Candida has been modestly correlated with low selenium levels, I would encourage you to check your supplement intake and be sure you are getting 200 mcg of selenium a day. I recall a conversation with Jennifer when she advocated 400 mcg or more a day. I do suggest the higher amounts for Hep C poz people. Hep C is an RNA virus whose growth is sensive to selenium/glutathioone deficiencies.

B vitamin deficencies (like riboflavin) also produce cracks in the corner of the mouth. This is different in its cause from the yeast-generated condition, but obviously a good B Complex vitamin is in order. I often recommend a Complex 25 or a Complex 50 to get enough.

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