Types of Mouth Infections and How to Treat Them

In children and adults who are immunocompetent, primary herpetic infections may be annoying and uncomfortable, but they rarely cause significant morbidity or mortality.

ORAL & MAXILLO-FACIAL SURGERY

Members of the human herpesvirus (HHV) and human papillomavirus (HPV) families are the most common causes of primary viral infections of the oral cavity. Nonetheless, many other viral infections can affect the oral cavity in humans, either as localized or systemic infections. This article discusses viral conditions of the oral cavity, including HHV infection, HPV infection, coxsackievirus infection, mumps, measles (rubeola), and rubella. See Cutaneous Manifestations of HIV Disease and Cutaneous Manifestations of Hepatitis C for information on these viral infections.

For excellent patient education resources, visit eMedicine’s Teeth and Mouth Center and Bacterial and Viral Infections Center. Also, see eMedicine’s patient education articles Oral Herpes, Canker Sores, Measles, Mumps, Chemical Burns, and Allergic Reaction.

Human Herpesvirus

Background

HHV infections are common in the oral cavity. They may be primary or recurrent infections. Eight types of HHV have been linked with oral disease. These types have different disease patterns in their hosts.

• HHV-1, also known as herpes simplex virus (HSV)–1, causes primary herpetic gingivostomatitis, or oral herpes. In some hosts, it becomes latent and may periodically recur as a common cold sore.
• HHV-2, also known as HSV-2, causes genital herpes and occasionally causes oral disease that is clinically similar to that of HHV-1 infection.
• HHV-3, also known as varicella-zoster virus (VZV), causes the primary infection chickenpox and the secondary reactivation disease herpes zoster.
• HHV-4, also known as Epstein-Barr virus (EBV), causes the primary infection infectious mononucleosis, and it is implicated in various diseases, such as African Burkitt lymphoma, other immunoproliferative disorders, and nasopharyngeal carcinoma. HHV-4 causes oral hairy leukoplakia in patients who are immunosuppressed. 1
• HHV-5, also known as cytomegalovirus (CMV), causes a primary infection of the salivary glands and other tissues, and it is believed to have a chronic form.
• HHV-6, which can produce acute infection in CD4 + T lymphocytes, causes roseola infantum, a febrile illness that affects young children. It is believed to chronically persist in salivary gland tissue in some hosts, and oral shedding is the probable route of disease transmission.
• HHV-7 has been isolated from the saliva of healthy adults and has been implicated as one cause of roseola infantum and febrile seizures in children.
• HHV-8 is associated with Kaposi sarcoma (KS), and evidence links it with body-cavity lymphomas and Castleman disease.

Pathophysiology

Herpesvirus family members are icosahedral DNA viruses. A herpesvirus measures approximately 100 nm without an envelope or 150 nm with an envelope. HHVs replicate in the host cell nucleus. Infected saliva or droplets spread the viruses in the oral cavity. The viruses also may be transmitted via oral-genital contact. Viral shedding has been detected before, during, and after the appearance of clinical lesions in patients with recurrent HHV-1 and HHV-2 infections; therefore, lack of visible lesions does not correlate with lack of potential infectivity. In a localized primary infection, the virus penetrates the mucosal epithelium and invades the cells of the basal layer, where the viral DNA inserts into the host DNA.

In HHV-1 and HHV-2 oral infections, viral replication within the oral epithelium may cause lysis of epithelial cells, with vesicle formation. Shallow ulcers with scabs that then heal without scarring follow the formation of vesicles. Herpesviruses establish latent permanent infections in their hosts, although clinical signs of disease may not be detected.

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Frequency

• HHV-1: The seroprevalence is approximately 80% in North American adults.
• HHV-2: The seroprevalence is approximately 20% in North American adults.
• HHV-3: The seroprevalence is approximately 95% in North American adults.
• HHV-4: The seroprevalence is approximately 90% in North American adults.
• HHV-5: The seroprevalence is approximately 70% in North American adults.
• HHV-6: The seroprevalence approaches 100% in North American adults.
• HHV-7: The seroprevalence is approximately 85% in adults.
• HHV-8: The global seroprevalence is estimated at 2-10%, although it has been demonstrated to be greater than 28% in Albanian adults, 25% in Albanian children, 18% in Kosovar adults, and greater than 16% in Kosovar children. 2

Mortality/morbidity

In children and adults who are immunocompetent, primary herpetic infections may be annoying and uncomfortable, but they rarely cause significant morbidity or mortality.

In individuals who are immunosuppressed, primary herpetic infections can be severe, and, occasionally, they can cause esophagitis, encephalitis, keratoconjunctivitis, and other diseases. The other forms of HHV can result in death. Herpes infections occasionally trigger erythema multiforme.

Age

Primary herpes infections typically occur during childhood or youth, although occasional cases are observed in older individuals. Recurrent HHV-1 infections typically occur throughout life and are particularly triggered by stress, illness, immune compromise, or other factors. Herpes zoster usually affects patients older than 40 years.

Clinical history

When HHV-1 infection recurs, it has different and distinct oral and perioral presentations from primary herpetic gingivostomatitis.

Primary herpes infection (primary herpetic gingivostomatitis) usually occurs in children or adolescents who have not been previously exposed to the virus. Many primary infections are asymptomatic. Symptomatic primary infection, with multiple, small, clustered vesicles in numerous locations, can occur anywhere in the oral cavity, on the perioral skin, on the pharynx, or on the genitalia. Headache, fever, painful lymphadenopathy, and malaise are common. Antibody production follows, and the virus may become latent in sensory ganglia, often the trigeminal ganglion. Primary herpetic gingivostomatitis usually resolves within approximately 14 days.

Recurrent herpes lesions are commonly referred to as cold sores. Recurrent herpes occurs in approximately one third of patients who have experienced primary herpetic gingivostomatitis. When the disease manifests extraorally, prodromal burning or itching often precedes vesicle formation. Recurrent herpes is a more limited disease than primary herpes. Unlike primary herpes, it occurs on keratinized mucosa (usually the lips, attached gingiva, and/or the hard palate). Vesicles are present in one discrete area, typically the same site every time in any given patient. Such sites include the vermilion border of the lips, the perioral skin, the hard palate, or, occasionally, the gingiva or the dorsal aspect of the tongue. Because vesicles can easily rupture intraorally, only an ulcer may be observed in some cases. Lymphadenopathy and systemic manifestations are much milder than in the primary disease. One case report describes HHV-1 infection manifesting as a mass in the piriform sinus. 3

Triggers for recurrence may include sunlight exposure, physical or emotional stress, or systemic illness for extraoral lesions and trauma (eg, a dental procedure) for intraoral lesions.

In immunosuppressed individuals, recurrent herpes lesions may occur on any oral mucosal surface, including nonkeratinized sites. They also may manifest solely as lesions on the dorsal aspect of the tongue. Such a presentation has been variously reported as red or white nodules, painful nonvesicular ulcerations, fissured, and, rarely, as a tongue mass. 4 Herpes lesions in immunocompromised individuals are often severe. Such atypical presentations in an individual who is immunocompetent may lead the clinician to further investigate the patient’s immune status.

Types of Mouth Infections and How to Treat Them

Yvelette Stines, MS, MEd, is an author, writer, and communications specialist specializing in health and wellness.

Published on May 03, 2021

John Carew, MD, is board-certified in otolaryngology and is an adjunct assistant professor at New York University Medical Center.

Table of Contents
Table of Contents

There are a number of infections that can affect the mouth. These may be caused by bacteria, viruses, or fungi. With any condition, it is important to contact your healthcare professional to get the proper treatment that will help your specific condition.

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Thrush

Thrush is a fungal infection in the mouth. It is usually located in the lining of the mouth and tongue. It can also appear in the throat and on other areas of your body.

When thrush occurs in the mouth, symptoms include:

• Raised white lesions on the (inner) cheeks and tongue
• Redness and pain in the mouth
• A cottony feeling
• Loss of taste

Thrush is caused by an overgrowth of Candida or other fungi and is diagnosed by a throat culture. It can be treated with anti-fungal medication.

It is important to check with a healthcare provider to get the proper diagnosis and treatment.

Cavities

A cavity is a common occurrence among both adults and children. It develops from tooth decay and forms a hole in the tooth. This happens when acids and bacteria in the mouth erode the tooth enamel, or hard outer layer.

To prevent cavities, it is important to get regular dental checkups and cleanings, as well as to brush and floss properly and regularly.

Symptoms of a cavity include:

• Toothache
• Redness inside the mouth
• Bleeding gums
• Sensitivity to hot or cold drinks or foods
• Bad breath

The causes of a cavity include consuming too many sugary foods and drinks, as well as improper brushing and flossing.

The bacteria in the mouth are known to feed on foods that have a lot of sugar and starch, which convert into acids. The acids will in turn start to erode the tooth enamel and create holes and cavities.

When an individual has a cavity, the treatment options include:

• Filling
• Root canal
• Tooth extraction

If the decay is in its early stages, a remineralization treatment can help repair the tooth enamel. This process includes fluoride treatments at the dentist. It also may require a prescription mouthwash and toothpaste.

It is important to get regular checkups with the dentist to keep the teeth healthy. Regular checkups can also prevent potential issues in the future.

Periodontal Disease

Periodontal disease is an advanced form of gingivitis. When the gums and bones that support the teeth are infected, they can become inflamed and red. They also start to pull away from the
structure of the bones and teeth. When this happens, the teeth may loosen or fall out.

This condition primarily happens to adults. Symptoms of periodontal disease include:

• Tender, swollen, or bleeding gums
• Loose and sensitive teeth
• Gums that are pulling away from the teeth
• Change in the fit of dentures
• Bad breath or taste in the mouth

When plaque is formed in the mouth from bacteria staying on the teeth too long, it will harden to tartar. The buildup of tartar can spread below the gum line. When this happens, it makes it difficult to remove the tartar and clean the teeth.

It is important to have a dental professional clean the teeth, remove the tartar, and give proper suggestions and treatment to help decrease the process/the progression of periodontal disease.

Treatments of this condition include preventive measures such as brushing and flossing regularly and visiting the dentist at the recommended appointment times.

Other treatments include:

• Prescribed medication that can be placed directly under the gum or taken orally
• Deep cleaning of the tooth and root surfaces below the gum
• Surgery

Gingivitis

Gingivitis is an early stage of gum disease. This condition occurs when bacteria infect the gums, making them red, swollen, and frequently bleeding. Gingivitis is manageable with regular dental checkups, brushing, and flossing at the recommendation of a dental professional.

Some of the symptoms include:

• Bad breath
• Pain when chewing foods
• Red and swollen gums

Overall, having bacteria in the mouth is normal and safe. However, some bacteria can create plaque, which can cause an infection in the areas where the teeth meet the gums; this is when gingivitis occurs. It can potentially worsen when the plaque hardens and turns into tartar, which is more difficult to remove from the teeth.

• Antimicrobial mouth rinse
• A specific dental hygiene plan
• Scaling, a process that removes bacteria and tartar from underneath the gums and teeth

Some conditions and lifestyle habits could increase the chances of getting gingivitis. These include:

• Diabetes
• Family history
• Smoking and other forms of tobacco use

Oral Herpes

Oral herpes is an infection on the mouth area that is caused by the herpes simplex virus. Once an individual is infected with herpes, they will have the virus for life. It can lie dormant within nerve cells.

Some individuals never develop symptoms, and others may have outbreaks periodically. Symptoms include sores throughout the mouth and around the lips.

The sores are known to be contagious, painful, fluid-filled blisters. Some of the symptoms can also mimic other conditions, so it is important to contact a healthcare professional to get a proper diagnosis and treatment.

The signs and symptoms of an oral herpes outbreak may look like other conditions or medical problems. Always consult your healthcare provider for an accurate diagnosis.

Herpangina

Herpangina is a contagious illness that incudes ulcers and sores in the mouth.

• Fever
• Ulcers in the throat and mouth
• Headache
• Sore throat
• Loss of appetite

This condition is common among children between the ages of 3 and 10, although it is known to occur at any age.

• Ibuprofen
• Ice pops
• Increase of fluids
• Avoiding acidic, spicy, and citrus foods and beverages

There are also topical medications. It is important to check with a healthcare professional for the proper treatment and care.

Syphilis

Syphilis is a sexually transmitted infection that can occur and spread through sexual contact with someone who has the condition.

If the infection is left untreated, syphilis can lead to serious health issues, including:

• Damage to the brain, eyes, and heart
• Mental health disorders
• Blindness
• Death

The symptoms are dependent on the stages. It typically starts as a small sore that is painless, then a bumpy rash may appear on the body (typically the hands or soles of the feet or palms). Other symptoms include flu-like ones such as muscle aches, fever, sore throat, or fatigue.

If someone comes in contact with the rash by chance or during sex, the infection can spread. Treatment includes antibiotics and preventive behavior.

It is important to speak with a healthcare professional to get the proper treatment and education regarding the infection.

A Word From Verywell

It is extremely important to contact a healthcare provider at the first onset of any unusual bump, scar, or pain. Mouth infections can be extremely painful and can lead to other illnesses.

Regular checkups with your healthcare provider and/or dentist and a treatment plan can help with both preventive measures and effective treatment of the infection. Your healthcare professional can help with the proper information and care that is needed for the specific condition presented.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Cleveland Clinic. Thrush.
2. Cleveland Clinic. Cavities.
3. Centers for Disease Control and Prevention. Periodontal disease.
4. Cleveland Clinic. Gingivitis.
5. Johns Hopkins Medicine. Oral herpes.
6. MedlinePlus. Herpangina.
7. Cleveland Clinic. Syphilis.

By Yvelette Stines
Yvelette Stines, MS, MEd, is an author, writer, and communications specialist specializing in health and wellness.

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