Thrush (Oral Candidiasis)

Thrush in newborns and infants is common and usually not harmful.

Thrush (oropharyngeal candidiasis) is a medical condition in which a yeast-shaped fungus called Candida albicans (the older and less often used name for Candida is Monilia) overgrows in the mouth and throat. C. albicans 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 (esophageal candidiasis).

Thrush infection (oral yeast infection) is not the same as a vaginal yeast infection (also called moniliasis). 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 candidal infections in areas of overlapping skin, such as underneath breasts or in skin folds like creases in skin due to fatty tissue.

An overgrowth of the Candida species of fungus in the mouth or throat is what causes an oral yeast infection. This overgrowth may be triggered to occur when the person experiences changes such as:

• Illness
• Pregnancy
• New medications
• 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.

Healthy adults generally do not get thrush without having some risk factors. Patients with weakened immune systems are most at risk for getting fungal infections such as thrush.

Risk factors associated with thrush include the following:

• Illnesses, including poorly controlled diabetes, HIV/AIDS infection, cancer, and dry mouth
• Pregnancy
• Taking medications such as antibiotics, corticosteroids, chemotherapy or other cancer drugs, radiation, and birth control pills
• Having an organ transplant
• Smoking
• Poorly fitting dentures
• Stress

Thrush is characterized by a white coating or white patches on the tongue, mouth, inner cheeks, and 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
• The feeling of food stuck in the throat or a sore throat
• Soreness in teeth
• Strange or unpleasant taste in the 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.

In general, thrush (or candidiasis) is not contagious. However, a breast-feeding 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.

Healthcare professionals that diagnose and treat oral thrust include the following:

• 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
  • An infectious-disease specialist

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

To confirm the diagnosis, or if there is a question about whether the white patches are caused by the Candida fungus, 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.

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.

Antifungal medications may be used to treat thrush. 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 medicine 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 antifungal medicines, such as fluconazole (Diflucan) or itraconazole (Sporanox).

• These antifungal medicines usually work better than ketoconazole (Nizoral).
• For severe or resistant thrush, amphotericin B may be prescribed instead of fluconazole or itraconazole.

Home remedies for oral candidiasis 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.

Other over-the-counter medications and natural treatments include:

• 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.
• The grapefruit seed extract is sometimes used by nursing mothers who have developed thrush of the nipples. It can be applied topically (on the skin) to the affected area 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 fungal 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 it 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 the 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.

The prognosis of candidiasis 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.

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

Risk factor modifications for the prevention of candidiasis 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 the use of antibiotics. Only use as prescribed by a physician.
• Chlorhexidine (Peridex, Hibiclens) mouthwash may be recommended to 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.