White spots in the mouth are most often a sign of infection, inflammation, trauma, tumour, or other diseases resulting from pathogens, such as bacteria, viruses and fungi.
Some possible causes of white spots in the mouth include:
- Oral herpes
- Strep throat
- Mouth cancer
According to Dr Sindisiwe van Zyl who specialises in HIV and primary healthcare, the most common cause of white spots in the mouth is oral thrush, also known as candidiasis.
“If the spots spread to the back of the mouth and tonsils it is known as oesophageal candidiasis. These spots look like cottage cheese and are difficult to scrape off. They can cover the tongue and the inside of the cheeks. Some people also develop white spots on their tongues. If their mouths get too dry and white spots develop on the side of the tongue, it could be an ulcer or it could be oral hairy leukoplakia.”
Candidiasis is an infection caused by a yeast-like fungus and in the case of the mouth and up to 90% of all people with HIV/Aids develop Candida infections. It is also common in people with weakened immune systems as well as babies and the elderly.
It can have a variety of causes, which include some medications such as antibiotics, corticosteroids, and some birth control pills, pregnancy, carrying excess weight or having pre-existing conditions such as diabetes, and psoriasis. Fortunately the treatment is generally fairly straightforward if you are otherwise healthy and a course of antifungal medications will effectively treat it.
Tonsillitis is the result of either a viral or bacterial infection of the tonsils, which causes them to become red and swollen with white or yellow spots. If it is a viral infection, it is treated with bed rest, hydration and management of the fever. If it is a bacterial infection it will be treated with antibiotics.
Most tonsil infections are caused by the Streptococcus bacterium, which is the same bacterium which causes strep throat.
Strep throat symptoms are similar to those of a sore throat associated with a cold but may also include a loss of appetite, pain when swallowing, inflamed tonsils with white spots and fever. It is caused by an infection in the throat and tonsils caused by group A Streptococcus bacteria and is fairly contagious.
As it is so similar to tonsillitis, the doctor will often perform a test for strep by swabbing the throat to check for the group A streptococcus bacteria. Antibiotics are the most commonly used form of treatment.
Oral herpes is an infection which can be caused by either herpes simplex virus type 1 or type 2. It appears as a cold sore on the lips, fever blisters in the mouth and white spots on the throat. Once you have the virus it often recurs up to four times a year. It is highly contagious and can be spread through oral sex.
Treatment includes prescription medications and topical creams to alleviate symptoms, but the condition itself has no known cure.
White spots and HIV
Oral problems are very common in people with HIV and affect more than a third of HIV+ people due to their weakened immune system. Despite the success that combination antiretroviral therapy has on many oral problems, others are still prevalent with HIV.
Dr Van Zyl says that people with advanced HIV are mostly prone to oral thrush as the body's natural defence mechanism is undermined, leaving you more vulnerable to infections.
Whatever the cause of the white spots however, Dr van Zyl strongly you get them checked out by a health care professional who would examine your mouth to make a diagnosis.
Image: "Pos strep" by James Heilman, MD - Own work. Licensed under CC BY-SA 3.0 via Commons - https://commons.wikimedia.org/wiki/File:Pos_strep.JPG#/media/File:Pos_strep.JPG