Thrush (Oral Candidiasis)

  • Medical Author:
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

A woman touches her mouth.

Thrush facts

  • Thrush (oropharyngeal candidiasis) is a medical condition in which a yeast-shaped fungus called Candida albicans overgrows in the mouth and throat.
  • Thrush may be triggered to occur by a variety of factors, including illness, pregnancy, medications, smoking, or dentures.
  • Thrush in newborns and infants is common and usually not harmful.
  • Risk factors for thrush include weakened immune systems, medications, smoking, or stress.
  • Signs and symptoms of thrush include
    • white patches in the mouth, inner cheeks, throat, palate, and tongue, as well as
    • soreness and mouth pain.
  • Thrush is usually diagnosed by clinical examination by a physician or dentist.
  • Treatment for thrush depends on the severity and the cause and can include simple home remedies, oral medications, or systemic medications.
  • The prognosis for mild cases of thrush is good. The outlook for severe cases depends on the underlying cause and the status of the patient's immune system.
  • It's possible to prevent thrush in most cases by risk factor modification.

Quick GuideTop Problems in Your Mouth

Top Problems in Your Mouth

Thrush Symptoms and Signs

White Tongue

A whitening of the top layer of the tongue or the presence of white spots or patches on the tongue can also be seen with infection, irritation, or chronic inflammation of the surface of the tongue. Certain oral infections, notably Candida yeast infections (known as oral thrush), are characterized by a white tongue.

A plate culture of the fungus Candida albicans, strain 7H10, grown at 37 C and Candida albicans at 200X magnification.

What is thrush?

Thrush (oropharyngeal candidiasis) is a medical condition in which a yeast-shaped fungus called Candida overgrows in the mouth and throat. Candida is normally present in the mouth, digestive tract, and skin of most healthy people. The immune system and the body's normal bacteria usually keep Candida in balance. When this balance is interrupted, it can result in an overgrowth of the Candida fungus, causing thrush, a yeast infection of the mouth or throat.

Thrush is not the same as a vaginal yeast infection. However, the Candida fungus also causes diaper rash, but diaper rash occurs on a child's rear end, genitals, and inner thighs, while oral thrush occurs in the mouth and throat. Adults may get yeast infections in areas of overlapping skin, such as underneath breasts or in skin folds like creases in skin due to fatty tissue.

Close-up of oral thrush, showing ulcers inside the mouth of a baby

What causes thrush?

An overgrowth of the Candida fungus in the mouth or throat is what causes thrush. This overgrowth may be triggered to occur when the person experiences changes such as illness, pregnancy, new medications, or changes in the immune system.

Thrush in infants and newborns is relatively common and is only a concern if it causes poor feeding or is associated with weight loss or other symptoms of systemic illness. Consult a pediatrician if thrush in an infant lasts more than a couple of weeks.

Shocking Diseases of the Mouth
A man stands in front of a medicine cabinet containing antibiotics, corticosteroids, and dentures; a sick woman lies in a hospital bed; and a pregnant woman feels ill.

What are risk factors for thrush?

Healthy adults generally do not get thrush without having some risk factors. Patients with weakened immune systems are most at risk for getting thrush. Risk factors associated with thrush include the following:

Is oral thrush contagious?

In general, thrush is not contagious. However, a nursing infant with thrush may transmit it to the mother's breast by contact.

Technically, oral thrush could be transmitted through kissing or oral sex, though this is uncommon. Thrush is an opportunistic infection, and its development depends on the strength of your immune system.

Examples of thrush (oral candidiasis)

What are thrush symptoms and signs?

Thrush is characterized by a white coating or white patches on the tongue, mouth, inner cheeks, and the back of the throat. The tissue under the white patches is often red, raw, and sore. The lesions can be painful and even bleed when scraped. Oral thrush often looks like cottage cheese or milk curds. Some general symptoms and signs of thrush are as follows:

  • Characteristic white patches
  • Redness under the white patches
  • White tongue
  • Cracking at the outer edges of the lips (cheilosis)
  • Dry mouth
  • Feeling of food stuck in the throat or sore throat
  • Soreness in teeth
  • Strange or unpleasant taste in mouth
  • Bad breath

Oral thrush can also lead to a condition called burning mouth syndrome, which can have symptoms of a painful burning sensation, mouth dryness, soreness, tingling or numbness throughout the mouth and tongue, and sometimes an abnormal bitter or metallic taste in the mouth.

In severe cases of thrush, the esophagus, which leads down to the stomach, may also be involved. This will cause pain with swallowing. If someone has a weakened immune system (HIV/AIDS, cancer, chemotherapy, etc.), the Candida fungus can spread to other parts of the body and cause a systemic infection. If a person has signs or symptoms of thrush and develops a fever, shaking or chills, or difficulty swallowing, contact a doctor immediately.

A doctor examines a baby's throat and mouth.

How do physicians diagnose thrush?

Thrush is clinically diagnosed by a physician or dentist when the characteristic-looking white patches are found in the mouth or throat.

To confirm the diagnosis, or if there is question about whether the white patches are caused by the Candida fungus, a scraping may be done. The doctor or dentist can scrape off a small amount of the white matter from the mouth or throat and look at it under a microscope and view the characteristic yeast-shaped fungi.

Thrush located farther down the throat or in the esophagus is usually found by doing a procedure called an endoscopy. In this procedure, the doctor passes a small camera through the back of the throat into the esophagus and into the stomach to observe the tissue and take samples. If the white lesions are found, they may be biopsied or scraped to confirm the diagnosis of thrush. This procedure is usually performed by a gastroenterologist.

A baby is given antifungal drops to treat thrush.

What is the treatment for thrush?

Treatment of thrush depends on the cause and severity of the infection.

If thrush is caused by something reversible, such as taking antibiotics, smoking, ill-fitting dentures, or poorly controlled diabetes, these factors must be corrected as part of the treatment.

Infants, toddlers, and children with thrush often do not require treatment. In children who have thrush for more than a few weeks, a child's pediatrician may prescribe antifungal nystatin (Mycostatin, Nilstat, Nystex) drops.

If an adult patient is diagnosed with a mild case of thrush, the doctor may prescribe an antifungal mouthwash (nystatin) or lozenges (clotrimazole [Mycelex]) for short-term use. Miconazole buccal (Oravig) is an antifungal medication that consists of a tablet placed in the upper gum region and dissolved in the mouth to get rid of thrush.

For more severe cases of thrush or if someone has other reasons for a weakened immune system, he or she may need stronger systemic medications, such as fluconazole (Diflucan) or itraconazole (Sporanox). These medications usually work better than ketoconazole (Nizoral). For severe or resistant thrush, amphotericin B may be prescribed.

A mother and daughter brush their teeth; a woman eats yogurt; a boy rinses his mouth; and a boy eats a Popsicle.

Are there home remedies for thrush?

Home remedies for thrush are aimed at decreasing risk factors for thrush as well as preventing overgrowth of Candida yeast.

  • Brush the teeth with a soft toothbrush.
  • Rinse the mouth with a diluted 3% hydrogen peroxide solution.
  • Rinse the mouth with warm saltwater.
  • Avoid mouthwash as it can alter the normal flora of the mouth.
  • Keep dentures clean and see a dentist if they do not fit correctly.
  • Eat unsweetened yogurt while taking antibiotics.
  • Lactobacillus acidophilus supplements may help maintain a healthy balance of Candida.

Home remedies that may reduce the discomfort of thrush include

  • drinking cold liquids, or eating frozen or ice treats;
  • eating soft, easy-to-swallow foods; and
  • drinking from a straw if the patches are painful.

Gentian violet (1%) is an over-the-counter natural treatment that sometimes works as a home remedy for thrush. It is a dye that kills bacteria and fungi, and it is available without a prescription. Talk to a doctor before using gentian violet.

Grapefruit seed extract is sometimes used by nursing mothers who have developed thrush of the nipples. It can be applied topically (on the skin) or taken orally.

Apple cider vinegar has antifungal properties that may help regulate Candida in the body. Mix 1 tablespoon into 8 oz. water and drink daily.

Baking soda may also help kill the yeast that causes the infection and maintain healthy pH levels in the mouth. Mix 1-2 tablespoons baking soda with water until it forms a paste. Apply the paste with a cotton ball onto the tongue and inner cheeks. Let it sit for a few minutes, then rinse with warm water. Repeat three times a day for several days. Alternately, mix ½ teaspoon baking soda into a glass of water and use as a mouth rinse twice daily.

Raw virgin coconut oil has antifungal properties. Nursing mothers sometimes use it on their nipples and the baby’s mouth to prevent spread of thrush.

Methylene blue oral is an antiseptic that is reported to help relieve oral candidiasis. Consult a doctor before using this or any supplement.

A doctor talks with a patient.

What types of doctors treat oral thrush?

A primary-care provider (PCP) such as a family practitioner, internist, or child's pediatrician may diagnose and treat oral thrush. Oral thrush may also be treated by a dentist. Severe infections usually require consultation with an immunologist and/or an infectious-disease specialist.

What is the prognosis of thrush?

The prognosis of thrush and how long it will last depends on the severity of the infection and the status of the immune system of the patient.

Mild cases of thrush caused by some of the reversible risk factors are generally easily treated, and the prognosis is good. Once you have started treatment for oral thrush, symptoms generally go away in about two weeks. In some cases, thrush will last for weeks even with treatment. Recurrent thrush can happen if thrush is not properly treated in the first place.

Thrush in infants and children is rarely serious or life-threatening and often goes away on its own without any need for medical treatment. If a child's thrush does not improve within two weeks, consult the child's pediatrician.

Patients with weakened immune systems are at risk for severe and life-threatening complications. These patients can become critically ill or die from severe Candida infections. Candida can spread throughout the body to other organs and can cause severe dysfunction. Systemic antifungal treatment in addition to long-term hospitalization may be necessary.

Quick GuideTop Problems in Your Mouth

Top Problems in Your Mouth
A mother and daughter floss their teeth; a dentist examines a patient; a man breaks a cigarette; and a woman eats a salad.

Is it possible to prevent thrush?

Thrush can be easily prevented in healthy adults by modifying risk factors that contribute to Candida fungus overgrowth.

Risk factor modifications for prevention of thrush include the following:

  • Brush and floss teeth and gums regularly, and maintain proper oral hygiene.
  • See a dentist regularly.
  • Make sure dentures are clean, properly maintained, and fit well.
  • Keep diabetes under control.
  • Quit smoking.
  • Eat a balanced, healthy diet low in sugar and yeast.
  • Limit use of antibiotics. Only use as prescribed by a physician.
  • Chlorhexidine (Peridex, Hibiclens) mouthwash may be recommended prevent thrush in people who take immunosuppressant medications.

To prevent thrush in babies or nursing infants, keep pacifiers and bottle nipples clean and sterilized. Nursing mothers should discuss the use of any over-the-counter or prescribed medications with their doctor before breastfeeding as some medications may increase the risk of causing thrush.

Reviewed on 11/30/2016
References
REFERENCES:

American Dental Association. "Burning Mouth Syndrome." JADA 136 August 2005: 1191. <http://www.ada.org/~/media/ADA/Publications/Files/patient_53.pdf?la=en>.

Kumar, Mudra. "Thrush." Medscape.com. June 17, 2015. <http://emedicine.medscape.com/article/969147-overview>.

Newman, Jack. "Grapefruit Seed Extract for Treatment of Thrush." Canadian Breastfeeding Foundation. Jan. 2005. <http://www.canadianbreastfeedingfoundation.org/basics/grapefruit_seed.shtml>.

Pammi, Mohan. "Treatment of Candida Infection in Neonates." UpToDate.com. February 2016. <http://www.uptodate.com/contents/treatment-of-candida-infection-in-neonates?source=search_result&search=thrush+newborn&selectedTitle=1~150>.

Tonn, Elverne M., ed. "Dental Health and Thrush." WebMD.com. May 8, 2012. <http://www.webmd.com/oral-health/guide/dental-health-thrush>.

United States. Centers for Disease Control and Prevention. "Oral Candidiasis." Mar. 25, 2013. <http://www.cdc.gov/fungal/candidiasis/thrush/>.

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