Mouth Larva (Oral Myiasis): Types, Symptoms, Treatment & Prevention

Mouth larva, or oral myiasis, is an unusual and rare yet critical medical condition that can cause significant discomfort and tissue damage. It occurs due to the infestation of fly larvae in the oral cavity and, if not treated promptly, can lead to various complications.
Learn about the causes, symptoms, and treatments for mouth larvae, and how to manage and prevent it in this blog.

What is Mouth Larvae?

Mouth larvae are parasitic pests that hatch and live within the oral cavities of human and animal hosts, causing a potentially dangerous infection known as oral myiasis. While rare in humans, this condition can occur more frequently in individuals living in or travelling through developing countries. 

Oral myiasis results from fly larvae in the mouth, commonly known as maggots. These maggots are usually born when flies lay their eggs on decaying tissue or open wounds within the oral cavity.

The larvae thrive by feeding on necrotic tissue, and if left untreated, their activity can result in severe pain, swelling, and potential tissue destruction.The condition is more likely to affect individuals with poor oral hygiene, compromised immune systems, or existing oral wounds. Now that we understand what a mouth larva is, let’s discuss its types.

Types of Mouth Larvae

Mouth larvae can be categorised based on the species of flies involved and the specific circumstances leading to the infestation. Here are some common types:

1. Cochliomyia hominivorax:

Known as the primary screwworm, this species is notorious for infesting living tissues, including the oral cavity. It is often associated with significant tissue damage and requires immediate medical attention.

2. Chrysomya bezziana:

This species is commonly found in tropical and subtropical regions and can also cause oral myiasis. It typically infests decaying tissues and can lead to severe complications if not treated promptly.

3. Human botfly (Dermatobia hominis):

This species of fly lives in Southern and Central America and resembles bumblebees. The adults lay eggs that hatch into larvae on mammalian skin, mouth, and other tissues.

Secondary myiasis occurs when larvae infest necrotic or infected tissue, often exacerbating health issues. Addressing the underlying conditions is crucial to preventing this type of infestation.

Early Signs of Mouth Larvae

Recognising mouth larva or oral myiasis early is vital for timely treatment. Here are some early indicators to watch out for:

• Swelling and Redness: You might notice inflammation in the affected area of the mouth. The inflammation can be localised to a specific spot or spread more broadly, depending on the extent of the infestation.
• Discomfort: The patients often report a sensation of discomfort or pain.
• Mild to acute pain: The intensity of the pain can vary greatly, with some individuals experiencing only mild discomfort while others suffer from acute, sharp pain, particularly when attempting to chew food or speak.
• Tissue destruction: As the larvae burrow into the oral tissues and feed, visible damage and destruction of the affected areas become apparent.
• Lesions: Patients may notice the formation of lesions, sores, or ulcers in the mouth, which can serve as an entry point for the fly larvae.

Spotting these signs early on can help one seek immediate medical attention, reducing the risk of complications associated with untreated oral myiasis. Early detection can also make mouth larva treatment organically possible under expert guidance.

Symptoms of Mouth Larvae or Oral Myiasis

Mouth larva symptoms can manifest in various ways and their severity can fluctuate. The most common symptoms include:

1. Severe pain

The affected area may experience intense pain due to tissue damage and inflammation caused by the larvae. This pain can be sharp and persistent, making it difficult for individuals to eat, speak, or maintain normal daily activities. The discomfort often intensifies as the larvae continue to feed on the surrounding tissues.

2. Swelling

There could be noticeable swelling and redness in and around the mouth. This inflammation is a response to the irritation caused by the larvae and can lead to a visibly enlarged appearance of the affected area. The swelling may also contribute to difficulty in fully opening the mouth.

3. Bad breath

Decaying tissue and larva activity could produce a foul smell from the mouth. The presence of necrotic tissue, combined with the larvae’s feeding habits, creates an unpleasant odour that can be distressing for the patient and those around them.

4. Ulceration

Ulcers and sores may appear in the mouth, potentially leading to further complications. These lesions can become painful and may increase the risk of secondary infections, as they provide an entry point for bacteria.

5. Bleeding

As tissues become necrotic, occasional bleeding from the affected sites may occur. This bleeding can be alarming and may indicate that the tissue damage is progressing, necessitating immediate medical intervention.

6. Movement Sensation

Patients may feel a sensation of movement or the presence of a foreign body in their mouth due to the activity of the larvae. This unsettling feeling can be accompanied by anxiety and discomfort, as individuals become aware of the infestation and its implications for their health.

If you observe any of these symptoms, you must consult your doctor immediately. Without treatment, mouth larvae can cause significant tissue damage, secondary infections, and other serious health issues.

Causes of Mouth Larvae

Mouth larva infestation typically results from specific risk factors and underlying conditions. The primary causes include:

1. Poor oral hygiene

Inadequate dental care can create an environment that attracts flies, as trapped food debris can serve as a breeding ground for them.

2. Open wounds

Any injuries or sores in the mouth can draw flies, leading to egg-laying and subsequent larval development.

3. Compromised immune system

Individuals with weakened immune systems are more susceptible to infections, including oral myiasis.

4. Lifestyle factors

Conditions such as alcohol consumption, mouth breathing during sleep, and psychiatric disorders can increase the risk of developing mouth larva.

5. Environmental conditions:

Infestations are more common in tropical and subtropical regions due to the favourable conditions for fly breeding.

Awareness of these causes can help prevent mouth larva infestation and encourage early intervention strategies, reducing the risk of further complications.

Risk & Complications of Mouth Larva

Oral myiasis requires immediate medical attention. If left untreated, it can lead to serious complications. These include:

• Tissue Damage: The larvae feed on your oral tissues, causing significant destruction and necrosis. This can result in permanent damage.
• Infection: The presence of larvae can encourage bacterial growth, leading to secondary infections that may complicate your treatment.
• Tooth loss: In severe cases of oral myiasis, teeth can be lost as the supporting structures become compromised.
• Systemic infections: In rare instances, the toxins produced by the larvae can enter your bloodstream. This can lead to conditions such as sepsis or blood poisoning, which can be life-threatening.
• Chronic pain and discomfort: A prolonged infestation could lead to ongoing pain and discomfort, affecting your quality of life.

These risks highlight the importance of early diagnosis and treatment of mouth larvae.

How to Prevent Mouth Larvae?

Preventing mouth larvae is primarily about maintaining good oral hygiene and reducing risk factors. To protect against this condition, you should:

1. Maintain good oral hygiene

Regular brushing and flossing can help eliminate food debris and bacteria that attract flies.

2. Take care of wounds

Promptly treating open sores or mouth injuries can reduce the likelihood of fly infestations.

3. Control your environment

If you live in areas prone to fly infestations, use insect repellents and maintain cleanliness to minimise exposure.

4. Monitor your health

If you have conditions that impair oral hygiene or mouth closure, make sure to monitor closely for signs of oral myiasis.

Following these preventive measures can significantly reduce your risk of developing mouth larvae.

How are Mouth Larvae Diagnosed?

Diagnosing mouth larvae involves a combination of a clinical examination and laboratory tests. The diagnostic process typically includes:

1. Clinical examination

A healthcare professional will thoroughly examine your oral cavity to identify signs of infestation, such as swelling, lesions, and the presence of larvae.

2. Larval extraction

In some cases, larvae may need to be extracted from the mouth for identification. This is often done using specialised tools under sterile conditions.

3. Microscopic analysis

The extracted larvae will be examined under a microscope to confirm the species and assess the extent of the infestation.

4. Medical history review

Your doctor may ask about your medical history, including any recent dental procedures, injuries, or underlying health conditions that could increase your risk of oral myiasis.

How are Mouth Larvae Treated?

The treatment plan could involve a combination of various methods:

1. Surgical removal of larvae

A crucial step in treating mouth larvae is their surgical removal. This procedure is performed under local anaesthesia to ensure patient comfort. During the surgery, the healthcare provider uses specialised tools, such as forceps or hemostats, to carefully extract the maggots one by one. 

This meticulous approach minimises tissue damage and helps prevent complications associated with the infestation.

2. Debridement of necrotic tissue

In conjunction with larval removal, thorough debridement of necrotic tissue (dead tissue) is essential. This process involves cleaning the affected area to remove dead or infected tissue, which can harbour bacteria and exacerbate the condition. Proper debridement promotes healing and reduces the risk of further complications.

3. Topical applications

In cases where multiple larvae are present or the infestation has reached an advanced stage, topical applications may be necessary. Substances such as turpentine oil, mineral oil, or mercuric chloride can be applied to the affected area. These agents suffocate the larvae, prompting them to surface for easier removal. This method can be particularly effective in managing extensive infestations.

4. Systemic medications

In addition to mechanical removal and topical treatments, systemic medications may be prescribed to support recovery. Antibiotics may be administered to prevent or treat secondary infections, while antiparasitic medicines can help eliminate any remaining larvae in the body.

Systemic Triple Therapy using Ivermectin, Albendazole, and Clindamycin has been shown to enhance the removal of maggots, support early recovery, and relieve distress and other associated symptoms of oral myiasis.

In severe cases, additional surgery may be required to clean out dead tissue and promote healing. This step becomes particularly important in advanced stages of infestation to avoid complications like tissue damage, secondary infections or systemic spread of the infestation.

Key Takeaways

Let’s summarise what we’ve covered in our guide:

• Mouth larvae demand immediate medical attention for effective treatment.
• The primary steps in treatment are mechanical removal of larvae and debridement of necrotic tissue.
• Topical applications and systemic medications, such as Ivermectin, can significantly aid in eliminating the larvae.
• Surgery may be required in severe cases to prevent complications and promote healing.
• Maintaining proper oral hygiene and wound care is a must for preventing this medical condition.

With this knowledge, remember that early detection and timely treatment can save you from unwanted complications. If you observe any mouth larva symptoms, don’t delay consulting your doctor.

Expert Quote:

“Since mouth larvae are rare, it is easy to mistake this condition for another. If you are experiencing one or more signs of mouth larvae, get a consultation with your healthcare provider for an evaluation. Delayed diagnosis in this case can lead to serious complications.”

– Dr. Sachin Singh

FAQs

References

• Patel, B., Shrenik Ostwal, Sanghavi, P. R., Joshi, G. S., & Singh, R. (2018). Management of malignant wound myiasis with ivermectin, albendazole, and clindamycin (triple therapy) in advanced head-and-neck cancer patients: A prospective observational study. 24(4), 459–459. https://doi.org/10.4103/ijpc.ijpc_112_18
• Aggarwal, A., Daniel, M. J., Shetty, R. S., Kumar, B. N., Sumalatha, C. H., Srikanth, E., Rai, S., & Malik, R. (2014). Oral Myiasis Caused byChrysomya bezzianain Anterior Maxilla. Case Reports in Dentistry, 2014, 1–4. https://doi.org/10.1155/2014/518427