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Maggots in the Mouth: The Rare but Hidden Peril of Oral Myiasis

Oral myiasis is a rare but serious condition caused by parasitic infestation of living or dead tissue, bodily fluids, or ingested food. Myiasis occurs when fly larvae infest human tissue, using it as an intermediate host. It primarily affects individuals living in rural areas with close contact with cattle. However, it can also occur in urban populations, particularly among those with poor oral hygiene and sanitation or individuals with cognitive disabilities. More common in hot and humid climates, oral myiasis is associated with healthcare-associated infections, tooth extractions, recent travel to tropical countries, excessive alcohol consumption, mouth breathing, oral cancer, ventilator-dependent breathing, cerebral palsy, and untreated mandibular fractures.

While very rare — especially in the northern hemisphere — two cases have recently been reported. The first case involves a 67-year-old woman living in India with end-stage ovarian cancer who was receiving chemotherapy. The patient exhibited generalized body weakness and had severely compromised oral hygiene, characterized by extensive plaque deposits, gingival inflammation, and a strong odor in the oral cavity. These conditions created an environment conducive to the development of oral myiasis.

Upon examination, maggots were found in the patient’s oral cavity. The standard treatment involves the immediate mechanical removal of the maggots. In this case, the initial treatment included thorough mechanical extraction of all visible larvae. However, due to the high likelihood of residual larvae, follow-up visits are crucial.

Despite the complete mechanical removal of maggots during the first visit, larvae were found again during a subsequent visit. This underscores the importance of a comprehensive treatment protocol, which includes repeated mechanical removal of maggots over multiple sessions to ensure complete eradication; and administering ivermectin, an antiparasitic medication, 12 mg per day for 3 days and adjuvant clindamycin 300 mg three times per day for 5 days, particularly in cases with significant tissue damage or a large number of larvae. The patient also received nutritional support and the use of a chlorhexidine mouthrinse was recommended.

An additional case of oral myiasis was found in a 45-year-old Pakistani woman who had epilepsy and presented with oral bleeding. Upon examination, a fungating mass was discovered with a maggot infestation. The maggots were removed during a surgical procedure and the wound was debrided. The patient was put on a regimen of itraconazole (anti-fungal agent) 200 mg twice daily, intravenous (IV) metronidazole (antibiotic) 500 mg three times per day, and IV colistin (polymyxin antibiotic used to treat bacterial infections caused by Gram-negative bacteria) 4.5 mg twice daily. The patient was advised on how to maintain good oral hygiene.

In general, once the parasites are removed and the appropriate medication regimen has been completed, prevention hinges on regular irrigation of the oral cavity with saline and chlorhexidine mouthrinse; nutritional support, including multivitamin supplements and a balanced diet; and additional use of antibiotics if applicable.

Oral myiasis, though rare, poses a significant threat to individuals with poor oral hygiene and compromised health. By understanding the causes, symptoms, and comprehensive treatment approaches, dental professionals can effectively manage this condition. Emphasizing preventive measures and regular follow-ups ensures the well-being of patients and reduces the risk of recurrence. More can be read on the first case study here and the second one here.

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