Oral Thrush

1 What is oral thrush?

Oral thrush, also called oral candidiasis, is an infection of mouth characterized by accumulation of the fungus Candida albicans on the oral mucosa. 

Candida occurs normally in the mouth, but during certain conditions, it overgrows and causes symptoms like creamy white lesions on your tongue, and redness at the corners of your mouth.

It is not limited to the mouth, and may sometimes spread to the roof of your mouth, your gums, your tonsils, or the back of your throat.

Any person can get oral thrush, but babies, the elderly, and people with compromised immunity or certain health conditions such as HIV are at higher risk of developing symptoms. 

Oral thrush is a minor health condition and generally subsides with antifungal medications in healthy persons. But the symptoms are severe and resistant in people with compromised immunity.

Facts about oral thrush you should know:

  • Oral thrush is nothing but a superficial yeast infection that can affect the tongue, inner cheek, inner lip area, and at times, the gums
  • This infection is very common in young infants, but oral thrush can also affect toddlers, sometimes older children, and rarely adults
  • Oral thrush that affects adults is usually linked to another medical condition that the adult is suffering from, like diabetes, HIV, etc.

2 Symptoms

Initially, you may not even notice symptoms of oral thrush. However, when your immunity becomes weakened, the signs and symptoms may start appearing in progression or all of a sudden. The signs and symptoms may persist for days, weeks or months. 

Signs and symptoms include:

  • Creamy white bumps on your tongue, inner cheeks, and sometimes on the roof of your mouth, gums and tonsils 
  • Pain at the site of bumps
  • Minor bleeding when the bumps are scraped
  • Difficulty eating or swallowing 
  • Slight bleeding if the lesions are scraped 
  • Cracking and redness at the corners of your mouth (especially in denture wearers) 
  • A cottony feeling in your mouth
  • Loss of taste or unpleasant taste in the mouth
  • Pain and burning sensation in the mouth

Severe candidiasis presents with lesions that have spread downward into your esophagus. This is known as Candida esophagitis.

Apart from causing typical white lesions in the mouth, candidiasis in infants makes feeding difficult. It also causes irritability and fussiness.

Infants and the mother can exchange the infection while breast feeding. Women with candida infections in their breasts exhibit symptoms like unusually red, sensitive, cracked or itchy nipples, shiny or flaky areola and pain in nipples during feeding.

When to see a Doctor

If you see creamy white lesions or any of the aforementioned symptoms in your or your child’s mouth, consult your doctor to find out the underlying cause for such symptoms.

If a person develops any of the symptoms mentioned above, it is advisable to meet the doctor immediately, since if these signs and symptoms are left untreated they will get worse with time and the unpleasant feeling inside the mouth will continue.

In cases where oral thrush is severe and left untreated, there is a risk that the infection will spread to the other parts of the body, which can be serious.

If a woman who is breast feeding her child observes creamy white lesions or any of the aforementioned symptoms in their mouth or their child’s mouth, she should consult the doctor to find out the underlying cause for such symptoms.

3 Causes

Oral trush is caused when your immune system is weakened by diseases like HIV/AIDS, or certain drugs like prednisone, or when the normal flora is disrupted.

There are numerous micro-organisms that occur in your mouth and, normally, an optimum balance among micro-organisms in the oral cavity is maintained by our immune system.

Some common causes of oral thrush are:

  • HIV/AIDS: HIV/AIDS affects your immune cells making you more vulnerableto various infections. Frequent oral thrush may be an early symptom of HIV- AIDS. Further tests are required to confirm HIV. However, esophageal candidiasis is an AIDS- defining illness.
  • Cancer: Cancer and its treatments can weaken your immunity and provide room for development of oral thrush.
  • Diabetes mellitus: Uncontrolled diabetes can result in increased sugar content of your saliva which promotes candida growth. 
  • Vaginal yeast infections: Vaginal yeast infections and oral thrush are caused by the same fungus. If a pregnant woman has vaginal yeast infection, she is more likely to pass it to the baby. As a result, the newborn may develop oral thrush.
  • Medications: If a person is taking a specific course of antibiotics for any ailment especially if it s taken for a longer duration or in high dosage, oral thrush may occur. 
  • Wearing dentures: Dentures, when not worn properly, provide room for bacteria to grow and flourish.
  • Lack of oral hygiene: Improper hygiene can be welcoming for incoming bacteria.
  • Dry mouth: A dry mouth is not properly lubricated; therefore it is easier for bacteria to grow.
  • Smoking: Smoking brings unwanted bacteria into the mouth.

4 Making a diagnosis

Your doctor can diagnose oral thrush by simply looking at the lesions.

Oral thrush is an infection that develops secondary to compromised immunity, which in turn may be a result of some more serious underlying causes.

Before talking to your doctor, prepare yourself to make the conversation clear, concise and productive.

These tips might help you:

  • List out all the symptoms.
  • Gather your entire medical history.
  • Inform your doctor if you have had an antibiotic therapy recently or you are using dentures or inhaled steroids for asthma.

Questions to ask your doctor:

  • What is my condition and how severe is it? 
  • What are the treatment options available and which one might work best for me? 
  • What are the side effects of these treatments? 
  • Do I need to avoid any type of food?
  • Is my condition contagious?
  • What could be the cause for my condition?

What to expect from your doctor

Your doctor is likely to ask you a number of questions like: 

  • When was the first time you noticed the symptoms
  • Have you recently been on antibiotics? If yes, can you name them?
  • Do you have asthma? If so, do you use a steroid inhaler? 
  • Do you have any chronic health conditions? 

Your could look for some underlying causes if no obvious reason is detected. You might have to go some more sets of tests if you have developed thrush in your esophagus.

Esophageal thrush is often a serious condition and an indicative of a more serious problem like HIV/AIDS.

In such case, your doctor can recommend one or both of the following tests:

  • Throat culture: A throat swab is taken and the tissue sample is grown on a cultured medium to determine the type of bacteria or fungi responsible for your symptoms. 
  • Endoscopic exam: This involves examining your esophagus, stomach, and duodenum using a camera fitted on the tip of a lighted, flexible tube (endoscope).

5 Treatment

Oral thrush can be easily treated with antifungal medication. The main objective treatment for oral thrush is aimed at limiting the rapid spread of the fungus to other parts. 

The choice of treatment depends on:

  • Age,
  • Health status
  • The underlying cause of the condition

The antifungal medications are normally available in different forms like gels or liquids that need to be applied directly inside the mouth. But in some cases even tablets and capsules are prescribed to patients. 

The medication in gel or liquid from will have to be applied several times a day depending upon the severity of the oral thrush and the doctor’s prescription.

This topical medication will have to be used for about one to two weeks. On the other hand the tablets or capsules are usually taken once a day. These antifungal medications do not usually have any side effects, but in certain cases a person might have some side effects like nausea, vomiting, bloating, abdomen pain or diarrhea.

In case of healthy adults and children, the disease responds well to antifungal agents. The drug is available in several forms, including lozenges, tablets, or a liquid to swish in your mouth and then swallow. 

Nursing mothers and infants may exchange the disease. Your doctor may prescribe a mild antifungal medication for your baby and an antifungal cream for your breasts. Ask your doctor about the how to clean your breast nipples, bottle nipples, and pacifiers.

In case immunocompromised adults, the fungus is often resistant to medications, especially in people with late-stage HIV infection. When common drugs cannot control the fungus,your doctor may prescribe a drug called amphotericin B.

Home remedies for oral thrush

Here are some simple and reliable remedies for oral thrush.

Salt 

This is one of the best home solutions to treat oral thrush and it also helps relieve symptoms associated with this infection.

  • Mix about a half teaspoon of salt with a cup of warm water and gargle the mouth thoroughly. This can be repeated a few times per day.
  • The other option is to sprinkle some salt on the tongue and inside the mouth and rub with the fingers gently for a few seconds. Then, rinse the mouth thoroughly with warm water. This can be done twice a day. 

Yogurt 

Make use of plain and unsweetened yogurt for treating oral thrush. It consists of live or active cultures of lactobacilli species that are beneficial for treating this infection.

  • Eat around two to three cups of yogurt every day for a couple of weeks.
  • Place yogurt on the fingers and rub it on the tongue and inside the mouth and leave it for 5 – 10 minutes. After, rinse the mouth properly with warm water. This can be done once or twice every day for a few days.

Coconut oil 

This is good to fight any oral infection, eradicate the yeast, and reduce the discomfort that is linked with oral thrush.

  • Apply extra-virgin coconut oil with the help of a cotton swab on the tongue and inside the mouth. This can be repeated a few times in a day at least for a week.
  • Every morning, you can do oil pulling on empty stomach. Swish one tablespoon of extra-virgin coconut oil around the mouth for ten minutes and then spit it out. After, rinse the mouth with warm water and brush your teeth. This can be done every day to maintain good oral health.

Apple cider vinegar

This consists of specific enzymes that are good to control the candida infection. It is also beneficial in restoring the pH level in the body to help fight against rapid growth of yeast that cause infection. It also boosts the immune system of the body.

  • Mix about 2 tablespoons of unfiltered apple cider vinegar and half a teaspoon of salt in warm water. Rinse the mouth thoroughly with this solution a few times a day and continue for a few days.
  • Also, you can mix 2 tablespoon of unfiltered apple cider vinegar and some honey in warm water and drink it twice a day.

Cinnamon

This in another effective ingredient that can be used to fight oral yeast infections and control the growth of candida albicans.

  • Drink about one or two cups of cinnamon tea every day.
  • Dilute a few drops of cinnamon oil with about one tablespoon of extra-virgin olive oil or coconut oil and apply it on the white patches that are caused by the oral thrush. Leave it for about 10-15 minutes and then rinse.

6 Lifestyle and coping

Here are some lifestyle tips that may help you control oral thrush:

  • Good oral hygiene is the key to good oral health. Brush at least twice a day with a soft bristled brush and toothpaste that contains fluoride.
  • Brush the tongue, gums, and inside of the mouth with a soft brush twice a day if you are wearing dentures, or have very few or no natural teeth.
  • Rinse well after meals.
  • Don’t use mouthwash unless recommended as some mouthwashes can alter the normal flora in your mouth. 
  • Don't share toothbrushes. 
  • Visit the dentist on a periodic basis even if one has natural teeth or wearing dentures.
  • Consult the dentist if your dentures don’t fit properly.
  • Disinfect your dentures regularly. Talk to your dentist about proper disinfection techniques.
  • Remove dentures every night and properly clean with paste or soap and wash thoroughly with water before soaking it in a cleaning solution.
  • Dissolve 1/2 teaspoon (2.5 milliliters) of salt in 1 cup (237 milliliters) of warm water. Swish the rinse and then spit it out, but don't swallow. 
  • Use nursing pads to prevent the fungus from spreading to your clothes. Use pads that don't have a plastic barrier. 
  • Quit smoking.
  • Rinse mouth well with water and spit it out after using corticosteroid inhaler.
  • Ensure keeping any medical conditions like diabetes in control with proper medication and diet to avoid the risk of oral thrush and any other complications
  • For expecting mothers who have a vaginal yeast infection should treat it correctly and on time

7 Risks and complications

There are several risks and complications associated with oral thrush.

Risks

  • Infancy or old age
  • Compromised immune system 
  • Use of dentures 
  • Presence of chronic illnesses like diabetes 
  • Treatment on antibiotics or oral or inhaled corticosteroids 
  • Cancer therapy, such as chemotherapy and radiation

Complications

Oral thrush is normal and responds well to medication in healthy children and adults. However, there is always a chance of relapse. Therefore, maintain proper oral hygiene to prevent relapse.

In patients with compromised immunity, oral thrush can progress to serious systemic infections including infections of your digestive tract, lungs, liver, and heart valves.

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