Dec 4, 2000
Hi Dr. P - I ran across a recent answer of yours to a question in reference to a dentist and it triggered a question of my own. I get canker sores pretty regularly - However note that I got them regularly way before I was HIV + also. They are mostly uncomfortable for the first couple of days then go away. Am I more likely to get them now than before and being HIV + should I be more worried or should I be taking something for them?
Response from Dr. Pavia
Canker sores (or apthous ulcers if you want to sound official) are one of the curses of humanity. I have gotten them since I was 6 years old. We do not know what causes them, although most suspect it will prove to be a virus triggering some kind of immune response. Not everyone gets them, and the severity varies among HIV negatives, but one thing is clear, they tend to be worse when you are HIV positive. Occasionally, they can be very severe in HIV positive folks, but usually they follow your pre-HIV pattern, only more frequent and perhaps larger and slower to heal.
Treatment is available, but it is only moderately effective. My wife used to say (my whole family gets apthous ulcers): "how come we can send a man to the moon but you can't tell me what causes canker sores and there are no good cures?" Corticosteroids can help a lot, especially if they are started at the first inkling of a sore. My favorite preparation is Kenalog in orabase, which is a steroid in a dental paste. For more severe cases, I sometimes have my patients use a potent steroid in liquid form as a rinse, twice a day, such as Lidex solution. Another trick that can work very well to head off a canker sore for some people is a prescription antimicrobial mouth wash called Peridex (chlorhexidine solution). You rinse with it for 60 seconds twice a day at the first hint of a sore. It leaves an interesting aftertaste, but for some people it works very well. For giant apthous ulcers, which can sometimes occur in the esophagus or duodenum, a course of prednisone (a systemic corticosteroid) works well. There are some people with refractory giant apthous ulcers, and thalidomide has often been very helpful, although not for everyone, and it can be quite sedating.
Good luck, and I hope this gives you some ideas to talk about with your doctor or dentist (and sometimes the dentists are better at this than we are).
Andrew T. Pavia, M.D.
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