Mononucleosis, commonly known as mono or “the kissing disease,” is a widespread viral infection. It is caused by the Epstein-Barr virus (EBV), a member of the herpesvirus family. While many people associate mono with extreme fatigue and a sore throat, the infection can present with a variety of symptoms, including specific manifestations within the mouth.
How Mononucleosis Affects the Mouth
Mononucleosis can cause mouth ulcers and other oral changes. The Epstein-Barr virus primarily infects B cells of the immune system and epithelial cells, particularly those in the oropharynx and salivary glands. Viral replication in these tissues, combined with the body’s immune response, triggers inflammation that can result in painful sores.
Specific oral findings in mono include small red spots, called petechiae, which can appear on the soft or hard palate. These spots are present in about 50% of young adults during the first few days. The tonsils often become swollen and may display a whitish or grayish-yellow covering, known as exudate, which is a collection of white blood cells responding to the infection. Individuals can also develop aphthous-like ulcers, similar to common canker sores, which are painful and can make eating and speaking uncomfortable. Secondary bacterial or fungal infections may also arise due to a temporary weakening of the immune system, further contributing to oral discomfort.
Other Common Symptoms of Mononucleosis
Beyond oral issues, mononucleosis presents with a range of systemic symptoms that can vary in severity. Extreme fatigue is a prominent and often lingering symptom, which can last for weeks or even months. Fever is also common, lasting around two weeks and sometimes reaching 100.4°F (38°C) or higher.
A severe sore throat, often accompanied by swollen tonsils, is characteristic of mono. Swollen lymph nodes, particularly in the neck and armpits, are common due to the body’s immune response. Headaches and general body aches are also common complaints. Less frequently, a pink, measles-like skin rash can develop, especially if certain antibiotics like ampicillin or amoxicillin are taken. In some cases, the spleen or liver may become enlarged, though this is less common than other symptoms.
Relief and Recovery for Oral Symptoms
Managing mouth ulcers and other oral discomforts associated with mononucleosis focuses on alleviating symptoms and promoting healing. Maintaining good oral hygiene is important, including gentle brushing. Rinsing the mouth several times a day with warm salt water can help soothe a sore throat and oral sores.
Over-the-counter pain relievers such as acetaminophen or ibuprofen can reduce pain and fever. Topical oral gels containing ingredients like benzocaine or phenol can also provide temporary relief from localized pain. Staying well-hydrated by drinking plenty of fluids supports the healing process. Consuming soft, bland foods can help prevent further irritation to sensitive oral tissues, making eating more comfortable during recovery.
When to Consult a Healthcare Professional
While mononucleosis typically resolves on its own, certain symptoms warrant medical attention to prevent complications. Seek immediate medical care if there is severe difficulty swallowing or if breathing becomes difficult. Persistent high fever that does not improve, or worsening or non-healing mouth ulcers, should also prompt a visit to a healthcare provider.
Severe abdominal pain, particularly in the upper left side of the abdomen, may indicate a swollen spleen that is at risk of rupture, which is a rare but serious complication requiring emergency surgery. Any symptoms that do not improve after a reasonable period, or the development of new or concerning symptoms like yellowing of the skin or eyes (jaundice), should be evaluated by a medical professional.