What You Need to Know About Oral Thrush

Oral thrush (aka oropharyngeal candidiasis or oral candidiasis) is an infection in the mouth caused by an overgrowth of the fungus, Candida albicans (a yeast).

While thrush can develop in different parts of the body, oral thrush is the most common fungal infection in babies and adults with suppressed immune systems. 

What causes oral thrush?

It's normal to find small amounts of candida throughout the body; mouth, throat, skin, digestive tract, and vagina. The human immune system fights harmful organisms and keeps good and bad bacteria in harmony. 

However, oral thrush can develop when certain medical conditions, medications, and treatments disrupt that balance in your mouth. 

Who is at risk of developing oral thrush?

People with one or more of the following are at an increased risk of developing oral thrush:

• Weakened immune system in infants and older adults

• Diabetes

• Vaginal yeast infections

• Human immunodeficiency virus (HIV)

• Cancer treatments such as chemotherapy and radiation therapy

• Medications such as steroids, inhaled corticosteroids, antibiotics 

• Immunosuppressive treatment after organ transplantation

• Oral conditions that can cause dry mouth for those who wear dentures, smoke, etc. 

Symptoms of oral thrush

Symptoms of thrush in the mouth can come on suddenly. Signs of oral thrush may include:

• Cottage cheese-like white coating in your mouth - These lesions may appear on your tongue, inner cheeks, gums, tonsils, and on the roof of your mouth

• Raised, red lesions that may bleed if scraped or rubbed

• Dry mouth or cottony-like feeling 

• Painful burning sensation in your mouth

• Difficulty eating or swallowing

• Dry, cracked skin at the corners of your mouth

• Loss of taste

• Redness, irritation, and discomfort under dentures 

• Infants may refuse or have trouble nursing or bottle feeding, as well as become irritable and fussy

Your baby can spread this infection to you when breastfeeding. Moms who develop thrush while breastfeeding may experience:

• Red, cracked nipples

• Shiny or itchy, flaky skin on the areola

• Sharp pain in your breast or nipples during or between feedings 

Candida can also cause conditions like diaper rash and vaginal yeast infections. 

What are the different types of oral thrush?

There are several different ways oral thrush is classified:

• Pseudomembranous - white, creamy surface or patches in the mouth 

• Acute atrophic candidiasis- burning sensation in the mouth, tongue appears red 

• Erythematous - the mouth is red, raw, and painful 

• Chronic Hyperplastic Candidiasis - presents as white plaque-like lesions or speckled red spots

• Chronic atrophic candidiasis (denture stomatitis)

• Median rhomboid glossitis- associated with smoking and the use of inhaled steroids.

• Angular cheilitis - dry, cracked corners of the mouth that become infected 

How is oral thrush diagnosed?

Your doctor will diagnose thrush depending on where it is. For oral thrush, they may:

• Inspect your mouth to look at the lesions/patches/plagues 

• Examine a scraping of the lesion under a microscope

• Perform a physical exam and review your medical history

• Order blood tests to pinpoint any underlying medical conditions that can cause thrush in your mouth 

Treatment of oral thrush

Treatment options for oral thrush usually depend on the source and severity of the infection and your age and current health. 

Treating mild cases of thrush 

For mild cases of oral thrush, your healthcare provider will most likely recommend a topical antifungal medication, such as clotrimazole lozenges and nystatin. 

Options for more severe cases of oral thrush 

In severe cases of thrush, your doctor may prescribe an oral antifungal medication called fluconazole(Diflucan). Itraconazole(Sporanox) and posaconazole (Noxafil) are also options if you have an adverse reaction to fluconazole. 

Treatment for infants and nursing mothers

Sometimes thrush goes away on its own in children, but your baby may need mild antifungal medication in the form of drops or a gel. Always have them seen by their pediatrician right away to determine the best treatment option.

If breastfeeding, the doctor may prescribe an antifungal topical for your breasts to treat and prevent thrush from being transferred back and forth.

At-home remedies for oral thrush 

You can also try a few at-home remedies to help alleviate symptoms. (Always consult with your doctor first before starting at-home treatments)

• Use probiotics to restore the good bacteria in your body. 

• Do a salt water rinse - Mix 1/2 teaspoon of salt into 1 cup of warm water, swish around your mouth, and spit. 

• Maintain good oral hygiene and throw away your toothbrush after the thrush clears up.

Ways to prevent oral thrush

Oral thrush prevention is key, especially if you are high-risk. 

• Brush and floss your teeth at least twice a day.

• Visit your dentist regularly. The American Dental Association (ADA) recommends everyone goes twice a year for dental checkups. 

• Since some chronic medical conditions can lead to thrush, it's essential to manage your illness by taking any ongoing medications regularly and as directed by your doctor or pharmacist. 

• Take care of your dentures. Be sure they fit correctly, remove them at night, and clean dentures daily. 

• If you have a medical condition such as chronic obstructive pulmonary disease (COPD) or asthma, thoroughly clean your inhaler after each use. You may also want to ask your doctor for a prescription spacer for your inhaler. 

• Limit how often you use an antibacterial mouthwash. Overusing can disturb the balance of bacteria in your mouth.

• Avoid or limit foods that contain yeast and sugar, like bread, beer, and wine. They can contribute to the rapid growth of yeast. 

• Quit smoking - Consult your doctor or dentist to learn about ways to stop

Final thoughts

Oral thrush is easily treatable in healthy children and adults. If you have a weaker immune system, symptoms can be painful and treatment more complicated. 

See your doctor immediately if you or your baby show signs of thrush. Left untreated, especially in those who are immunocompromised, it can become a much more severe infection and spread to other parts of the body, like the esophagus, brain, and heart. 

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