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White coating and ulcers on tongue
May 27, 1999

First of all, I want to thank you for providing this very valuable service. So many times people are unable to get the answers they need from their own doctors.

HISTORY: I had protected sex with a female about 15 weeks ago whose HIV status I am not sure about. I've tested negative for HIV five (5) times in a 13 week period (last test was at 13 weeks).

PROBLEM: I've had a white coating on my tongue for about two months now. This white coating is sometime accompanied by frequent ulcers on my tongue. Other mouth problems include hypersensitivity on my tongue, tiny red dots, dry mouth,etc.

I have a history of getting ulcers in my mouths during stressful periods in my life. So, the ulcers are not uncommon for me. However, I've never had ulcers on my tongue. The ulcers were always on the inside of my mouth. My doctor treated me with medication for thrush and this has not helped at all. He also gave me another medication for the ulcers and told me that the ulcers were viral infections.

My question is should I still be concerned about HIV even though I have tested negative five times in the last 13 weeks? If this is not HIV related, what else could be causing these problems? Could this all be caused by stress (because I've been extremely stressed over this entire situation). Thank you for your help.

Response from Dr. Reznik

We know that aphthous ulcers are related to stress and that they have a tendency to present on non-keratinized tissues; therefore having one of these ulcers present on the tongue is not that unusual. What we do not know is what causes these ulcers to appear in the first place. It would be difficult for me to agree with the statement that these ulcers are viral in origin. There are viral infections which do cause ulcers in the mouth, such as herpes, but these ulcers normally present on keratinized tissues such as the roof of the mouth or gingival (gum) tissues. There are several treatments for aphthous ulcers including topical steroids such as Decadron elixir or kenalogue in orabase. I prefer using the topical steroid rinses as they are easy to apply (you swish for 1 minute and then expectorate 3 to 4 times a day for about 7 days).

The white coating on your tongue and the sensitivity you are experiencing are most likely directly related to the dry mouth you are experiencing. Coated tongue, as I have mentioned in this forum before, is usually an overgrowth of the papillae on the tongue which serves as a trap for the normal bacteria in the mouth. The most effective way to manage coated tongue is thoroughly brushing your tongue once a day. Antifungals are sometimes helpful managing coated tongue if an overgrowth of candida is present, but this is usually not the case.

From what you have mentioned in this e-mail, it appears that the likely cause of your problems is stress. A caveat to this discussion would be that this forum is not intended to replace the care you receive at the local level. So please discuss other diagnostic test for HIV with your physician.

Take care,

DR


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