Oral thrush (fungal infection in the mouth)

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?

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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 Sj grens 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 includenystatin (eg Nystan oral suspension), amphotericin (eg Fungilin lozenges) ormiconazole (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.