Strictly speaking, watch your mouth.

Strictly speaking, watch your mouth

Sweet nothings and fancy phrases are verbal niceties thatflow from the human mouth. But the mouth also can harbor some nasty viruses, and oral lesions can be the first sign of serious illness. Because of increased concern over AIDS and herpes--and the possible viral causes of certain cancers-- some scientists are calling for more vigilance on the part of dentists and other oral specialists.

Medical awareness among these specialists is particularlycrucial in the case of AIDS, according to John S. Greenspan, chairman of oral biology at the University of California in San Francisco. "Since the beginning of the [AIDS] epidemic in 1981, it's been clear that the mouth is a very important location for the AIDS virus,' he says. "[Oral lesions] can be the very first clinical sign of this infection.' In an otherwise asymptomatic patient, these lesions can go unnoticed, says Greenspan.

In 1984, Greenspan first published the description of an orallesion that was called hairy leukoplakia, a white lesion on the tongue or mouth floor often characterized by rough projections that look like hairs. It has not been found elsewhere in the body. The lesion joins Kaposi's sarcoma in the mouth, oral candidiasis and herpes simplex as another oral disease frequently found in AIDS patients.

Subsequent studies by Greenspan's group showed the virallesion probably contains an unusual mixture of Epstein-Barr and papilloma viruses, both of which have been named as possible cancer agents. Late last year, the California researchers reported that hairy leukoplakia is also a sign of AIDS in high-risk groups other than homosexual men. They report having found such lesions in a blood transfusion recipient, a hemophiliac, a female partner of an AIDS-infected man, and a female partner of an AIDS-infected intravenous drug user.

Having established that the unique oral lesion is related toAIDS and that the majority of patients with the lesion have antibodies to the AIDS virus, Greenspan and his co-workers recently conducted a study to assess whether the lesion could serve as a predictor of the development of AIDS. The study subjects were homosexual or bisexual men with the lesion but without AIDS. Results of that study, to be published in the March JOURNAL OF INFECTIOUS DISEASES, indicate that an average of 48 percent of such patients will develop AIDS within 16 months and 83 percent within 31 months following appearance of the lesion.

Additional data from that study show that AIDS patients withhairy leukoplakia are much more likely to develop a specific type of pneumonia seen in AIDS than are patients in the general AIDS population. Also, those with small lesions are as likely to develop AIDS as those with lesions covering the tongue. On the basis of these results, Greenspan says hairy leukoplakia is "highly predictive' of later development of AIDS, and that medical personnel should be alert to its appearance in at-risk groups--which, he says, "means more or less everybody.'