Oral thrush is an infection in the mouth caused by a yeast germ called Candida spp.

It can usually be cleared with treatment.

What is oral thrush?

Thrush is an infection caused by a yeast germ called Candida spp. The mouth is a common site where Candida spp. causes infection. Candidal infection in the mouth is called oral thrush. Other common sites for thrush to develop are the vagina, nappy area, and nail folds. (See separate leaflets called 'Vaginal Thrush', 'Candidal Skin Infection' and 'Nappy Rash' for more details about these other types of thrush.) Related articles

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Who gets oral thrush?

Small numbers of Candida spp. commonly live on healthy skin and in a healthy mouth. They are usually harmless. Healthy people do not normally get oral thrush. However, certain situations or conditions may cause an overgrowth of Candida spp. which can lead to a bout of oral thrush. These include:

Being a baby. Oral thrush is quite common in young babies. Wearing dentures, especially if they are not taken out at night, not kept clean, or do not fit well and rub on the gums. A course of antibiotics. Antibiotics will kill harmless bacteria which live in the mouth. They do not kill Candida spp. which may multiply more easily if there are fewer bacteria around. Excessive use of antibacterial mouthwash (for similar reasons to above). Taking steroid tablets or inhalers. Having a dry mouth due to a lack of saliva. This may occur as a side-effect from certain drugs (such as antidepressants, antipsychotics, chemotherapy), following radiotherapy to the head or neck, or as a symptom of Sjgren's syndrome. Having diabetes. Having severe anaemia. Lacking iron, folate or vitamin B12. Having a poor immune system. For example, if you are taking medicines that suppress your immune system, if you have certain cancers, or if you have HIV/AIDS. Being frail or in generally poor health. Smoking. Smokers are more likely to develop oral thrush.

Oral thrush is not contagious. You cannot pass on oral thrush to other people.

What are the symptoms of oral thrush?

The classical symptom is white spots that develop in your mouth. The spots may join together to form larger spots called plaques. They may become yellow or grey. If you wipe off a spot, the underlying tissue may be red but it is not usually sore or painful. Often there are no white spots. Areas in your mouth may just become red and sore. This more typically occurs if you get thrush after taking antibiotics or steroids. Denture wearers may develop an area of persistent redness under a denture. You may develop sore, cracked, red areas just outside your mouth. This mainly affects the angle where the upper and lower lips meet (angular stomatitis). Some mild oral thrush infections are painless. However, sometimes oral thrush is quite sore and can make eating and drinking uncomfortable. Some babies with oral thrush may drool saliva, or not be able to feed properly because of soreness. Taste can be affected in some people with oral thrush.

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How is oral thrush diagnosed?

Your doctor will usually diagnose oral thrush by your typical symptoms and the typical appearance in your mouth. No investigations are usually needed to diagnose oral thrush. However, your doctor may sometimes suggest a blood test to look for certain conditions that may make you more likely to develop oral thrush. For example, a blood test to see if you are lacking iron, B12 or folate. If oral thrush does not respond to treatment (see below), your doctor may suggest that they take a swab from inside your mouth. The swab is then sent to the laboratory to be examined under a microscope. They can also try to grow the Candida spp. in the laboratory. Occasionally, a biopsy is needed to confirm a diagnosis of oral thrush. A small sample is taken from the white patches inside your mouth and this can be examined under a microscope.

What is the treatment for oral thrush?

Locally applied treatment
For mild oral thrush, the usual treatment that is tried first is miconazole mouth gel for seven days. Sometimes a two-week course is needed. Nystatin drops are another option if miconazole gel cannot be used (for example, if you are known to be allergic to it). Follow the instructions in the packet. Basically:

The gel or drops should be used after you have eaten or drunk. Smear a small amount of gel on to the affected areas, with a clean finger, four times a day. With the drops, you use a dropper to place the liquid inside your mouth on to the affected areas four times a day. Ideally, you should not eat or drink for about 30 minutes after using either the gel or the drops. This helps to prevent the drug from being washed out of your mouth too soon.

Dr Sarah Jarvis talks about Vaginal Thrush

Anti-thrush tablets
Tablets that contain a drug called fluconazole can also help to clear fungal and thrush infections from the body. Tablets tend to be used in more severe or serious cases. For example, for people with a poor immune system who develop extensive oral thrush. Tablets are usually prescribed for seven days and this will usually clear oral thrush.

Adjustment of other medication

If you are taking other medication that may have caused oral thrush, such as steroids or antibiotics, your doctor may need to change this medication or reduce the dose to help clear up your thrush.

Referral to a specialist

If the above measures do not help to clear your oral thrush infection, or if you have particularly severe infection or other health problems (for example, you are undergoing chemotherapy or are taking other drugs that weaken your immune system), your doctor may suggest that they refer you to (or ask the advice of) a specialist. The specialist may suggest other treatments for oral thrush. For example, drugs such as itraconazole, ketoconazole or amphotericin. Current discussions Get help and support from hundreds of other people like you in our discussion forums:

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Can oral thrush be prevented?

It may be possible to alter one or more of the situations mentioned above to help prevent further bouts of oral thrush. For example:

If you have diabetes - good control of your blood sugar level reduces the risk of thrush and other infections. If you use steroid inhalers - having a good inhaler technique and using a spacer device may reduce the risk of thrush. Also, rinse your mouth after using the inhaler, to help remove any drug particles left in your mouth. Ask your doctor about reducing your dose of steroid in your inhaler to the lowest level needed to control your asthma. If you wear dentures: o Leave your dentures out overnight, or for at least six hours daily. Constant wearing of dentures, and not taking them out at night, is thought to be one of the most common causes of oral thrush. o Clean and disinfect dentures daily. To clean, use soapy water and scrub the dentures with a soft nailbrush on the fitting surface - that is, the non-polished side. Then soak them in a disinfecting solution. The type of solution and the time they should be soaked for will be advised by your dentist. Rinse the dentures after disinfecting them, and then allow the dentures to air dry before wearing them

again. Drying like this helps to kill any Candida spp. that might be stuck to the dentures. o Clean the inside of your mouth (where the dentures sit) with a soft brush. o See a dentist if the dentures do not fit well. If you take medication which causes a dry mouth - take frequent sips of water. (See separate leaflet called 'Dry Mouth' for more details.) Tips to prevent oral thrush in babies are included in the separate leaflet called 'Thrush Oral in Babies'. If you are found to have anaemia or low levels of vitamin B12, folate or iron, treating this may help to prevent oral thrush in the future. If you are a smoker, quitting smoking may help to prevent further bouts of oral thrush. (See separate leaflet called 'Smoking - Tips to Help You Stop' for more details.) Certain groups of people may be given anti-thrush tablets to help to prevent oral thrush. For example, people who are on medication to suppress their immune system or who are receiving chemotherapy for cancer.

Oral thrush (fungal infection in the mouth)

Reviewed by Dr John Pillinger, GP
427

What is oral thrush?

Oral thrush is an infection of yeast fungus, Candida albicans, in the mucous membranes of the mouth. Strictly speaking, thrush is only a temporary candida infection in the oral cavity of babies. But we have, for this purpose, expanded the term to include candida infections occurring in the mouth and throat of adults, also known as candidiasis or moniliasis.

How do you get oral thrush?

Candida is present in the oral cavity of almost half of the population. Everyone who wears dentures will have candida, without necessarily suffering any ill effects. Candida doesn't become a problem until there's a change in the chemistry of the oral cavity that favours candida over the other micro-organisms that are present.

These changes can occur as a side-effect of taking antibiotics or drug treatment, such as chemotherapy. These changes can also be caused by certain conditions such as diabetes, drug abuse, malnutrition and as a consequence of immune deficiencies relating to old age or infection such as AIDS. Furthermore, people whose dentures don't fit well can sustain breaks in the mucous membranes in their mouth, which can act as a gateway for candida. People who suffer from this problem often have moist, pale pink spots on their lips, known as angular cheilitis, which is an indication of a candida infection.

What are the symptoms of oral thrush?

White, cream-coloured, or yellow spots in the mouth. The spots are slightly raised. There is normally no pain in the area underneath the spots. If you scrape off these spots, they leave small wounds that bleed slightly. In adults, thrush can cause an uncomfortable burning sensation in the mouth and throat.

Who is at special risk?

Newborn babies. Denture users. Adults with diabetes or other metabolic disturbance. People with a dry mouth relating to side-effects of their medication (eg anti-psychotics) or medical conditions (eg Sjgrens Syndrome). People undergoing antibiotic or chemotherapy treatment. People prescribed oral steroid medication or steroid metered dose inhalers. Drug users. People with poor nutrition. People with an immune deficiency.

How does the doctor diagnose oral thrush?

In babies, thrush is usually diagnosed on the basis of the clinical picture. Occasionally, in order to make a diagnosis, the doctor will scrape the baby's tongue and send the sample for analysis. In adults, many other diseases and illnesses, including very early stages of cancer, can have similar symptoms. Therefore it's important to consult your doctor and get a thorough check-up. In cases where thrush occurs as the result of disease or illness in other organs or systems, like AIDS, sudden and very intense thrush can be a sign of a general aggravation of the main illness. This makes it all the more important to pay attention to this and similar changes, so you can get help in time.

How is oral thrush treated?

In Babies, oral thrush may clear spontaneously without treatment and may be prevented by sterilising all feeding equipment and mouth toys. It's been suggested that by giving the child sterilised water immediately following a milk feed, residual milk in the mouth is rinsed away, reducing the population of candida within the oral cavity. In other circumstances, the condition that caused the thrush must be brought under control. This might involve investing in new and better fitting dentures, or adjusting diabetes treatment. For AIDS patients, it's not always possible to correct the immune deficiency. A course of oral treatment, using antifungal drugs, has to be used. Once the condition that caused the oral thrush has been treated, the thrush itself can be cured. Treatment is with antifungal medicines, in the form of pastilles that are sucked or oral suspensions that are held in the mouth before swallowing. These allow the antifungal agent to act locally in the mouth. Examples include nystatin (eg Nystan oral suspension), amphotericin (eg Fungilin lozenges) or miconazole (eg Daktarin oral gel). In certain complicated cases, or if the infection spreads, systemic treatment will be necessary in the form of antifungal tablets, or perhaps in the form of injections.

Coping with the symptoms of oral thrush

Thrush can make the mouth so sensitive that it's impossible to perform regular oral hygiene. Use a very soft toothbrush. It can often help to rinse the mouth with a diluted solution of 3 per cent hydrogen peroxide. Ask your pharmacist which mouthwash is most appropriate for this purpose.

Outlook
If whatever caused the thrush can be brought under control, the infection is likely to go away after a few days of treatment with a fungicide.

Read more: http://www.netdoctor.co.uk/diseases/facts/oralthrush.htm#ixzz2fubBaJN7 Follow us: @NetDoctor on Twitter | NetDoctorUK on Facebook

Definition
By Mayo Clinic staff Oral thrush

Oral thrush is a condition in which the fungus Candida albicans accumulates on the lining of your mouth. Oral thrush causes creamy white lesions, usually on your tongue or inner cheeks. The lesions can be painful and may bleed slightly when you scrape them. Sometimes oral thrush may spread to the roof of your mouth, your gums, your tonsils or the back of your throat. Although oral thrush can affect anyone, it's more likely to occur in babies and in people who wear dentures, use inhaled corticosteroids or have compromised immune systems. Oral thrush is a minor problem if you're healthy, but if you have a weakened immune system, symptoms of oral thrush may be more severe and difficult to control.

Symptoms
By Mayo Clinic staff Oral thrush

Children and adults Initially, you may not even notice symptoms of oral thrush. Depending on the underlying cause, signs and symptoms may develop suddenly and persist for a long time. They can include:

Creamy white lesions on your tongue, inner cheeks and sometimes on the roof of your mouth, gums and tonsils Lesions with a cottage cheese-like appearance Pain Slight bleeding if the lesions are rubbed or scraped Cracking and redness at the corners of your mouth (especially in denture wearers) A cottony feeling in your mouth Loss of taste

In severe cases, the lesions may spread downward into your esophagus the long, muscular tube stretching from the back of your mouth to your stomach (Candida esophagitis). If this occurs, you may experience difficulty swallowing or feel as if food is getting stuck in your throat.

Infants and breast-feeding mothers In addition to the distinctive white mouth lesions, infants may have trouble feeding or be fussy and irritable. They can pass the infection to their mothers during breast-feeding. The infection may then pass back and forth between mother's breasts and baby's mouth. Women whose breasts are infected with candida may experience the following signs and symptoms:

Unusually red, sensitive or itchy nipples Shiny or flaky skin on the darker, circular area around the nipple (areola) Unusual pain during nursing or painful nipples between feedings Stabbing pains deep within the breast

When to see a doctor If you or your baby develops painful white lesions inside the mouth, see your doctor or dentist. If thrush develops in older children or adolescents, seek medical care. An underlying condition such as diabetes may be the cause.

Causes
By Mayo Clinic staff

Oral thrush and other Candida infections can occur when your immune system is weakened by disease or drugs such as prednisone, or when antibiotics disturb the natural balance of microorganisms in your body. Normally your immune system works to repel harmful invading organisms, such as viruses, bacteria and fungi, while maintaining a balance between "good" and "bad" microbes that normally inhabit your body. But sometimes these protective mechanisms fail, which can allow an oral thrush infection to take hold. These illnesses may make you more susceptible to oral thrush infection:

HIV/AIDS. The human immunodeficiency virus (HIV) the virus that causes AIDS damages or destroys cells of your immune system, making you more susceptible to opportunistic infections that your body would normally resist. Repeated bouts of oral thrush may be the first sign of an HIV infection. Cancer. If you have cancer, your immune system is likely to be weakened from the disease and from treatments, such as chemotherapy and radiation. Both the disease and treatments can increase your risk of Candida infections such as oral thrush. Diabetes mellitus. If you have untreated diabetes or the disease isn't well controlled, your saliva may contain large amounts of sugar, which encourages the growth of candida. Vaginal yeast infections. Vaginal yeast infections are caused by the same fungus that causes oral thrush. Although a yeast infection isn't dangerous, if you're pregnant you can pass the fungus to your baby during delivery. As a result, your newborn may develop oral thrush.

Risk factors
By Mayo Clinic staff

Anyone can develop oral thrush, but the infection is more common in some. Risk factors include:

Being an infant Having a compromised immune system Wearing dentures Having other health conditions, such as diabetes or anemia Taking certain medications, such as antibiotics, or oral or inhaled corticosteroids Undergoing chemotherapy or radiation treatment for cancer Having conditions that cause dry mouth (xerostomia) Smoking

Complications
By Mayo Clinic staff

Oral thrush is seldom a problem for healthy children and adults, although the infection may return even after it's been treated. For people with compromised immune systems, such as from HIV or cancer, however, thrush can be more serious. If you have a compromised immune system:

Thrush is more likely to spread to other parts of your body, including your digestive tract, lungs and liver. You may have especially severe symptoms in your mouth or esophagus, which can make eating painful and difficult. The infection can spread to the intestines, making it difficult to receive adequate nutrition.

Treatments and drugs

By Mayo Clinic staff

The goal of any oral thrush treatment is to stop the rapid spread of the fungus, but the best approach may depend on your age, your overall health and the cause of the infection. For infants and nursing mothers If you're breast-feeding an infant who has oral thrush, you and your baby will do best if you're both treated. Otherwise, you're likely to pass the infection back and forth.

Your doctor may prescribe a mild antifungal medication for your baby and an antifungal cream for your breasts. If your baby uses a pacifier or feeds from a bottle, rinse nipples and pacifiers in a solution of equal parts water and vinegar daily and allow them to air dry to prevent fungus growth.

If you use a breast pump, rinse any of the detachable parts that come in contact with your milk in a vinegar and water solution.

For healthy adults and children Adults or children who have oral thrush but are otherwise healthy can try one of these:

Eating unsweetened yogurt Taking acidophilus capsules or liquid

Yogurt and acidophilus don't destroy the fungus, but they can help restore the normal bacterial flora in your body. If your infection persists, your doctor will prescribe an antifungal medication. For adults with weakened immune systems Most often, your doctor will recommend the following:

Antifungal medication. This comes in several forms, including lozenges, tablets or a liquid that you swish in your mouth and then swallow. Amphotericin B. Candida albicans can become resistant to antifungal medications, especially in people with late-stage HIV infection. This drug may be used when other medications aren't effective.

Some antifungal medications may cause liver damage. For this reason, your doctor will likely perform blood tests to monitor your liver function, especially if you require prolonged treatment or have a history of liver disease.