Oral Thrush

candida oral

Oral thrush is an infection in the mouth caused by a Candida(yeast). Other common sites for thrush to develop are the vagina, nappy area, and nail folds.

Who gets oral thrush?

Small numbers of Candida spp. commonly live on healthy skin and in a healthy mouth. They are usually harmless. Healthy people do not normally get oral thrush. However, certain situations or conditions may cause an overgrowth of Candida spp. which can lead to a bout of oral thrush. These include:

Being a baby. Oral thrush is quite common in young babies.
Wearing dentures, especially if they are not taken out at night, not kept clean, or do not fit well and rub on the gums.
A course of antibiotics. Antibiotics will kill harmless bacteria which live in the mouth. They do not kill Candida spp. which may multiply more easily if there are fewer bacteria around.
Excessive use of antibacterial mouthwash .
Taking steroid tablets or inhalers.
Having a dry mouth due to a lack of saliva. This may occur as a side-effect from certain drugs (such as antidepressants, antipsychotics, chemotherapy), following radiotherapy to the head or neck, or as a symptom of Sjögren's syndrome.
Having diabetes.
Having severe anaemia.Lacking iron, folate or vitamin B12.
Having a poor immune system. For example, if you are taking medicines that suppress your immune system, if you have certain cancers, or if you have HIV/AIDS.
Being frail or in generally poor health.
Smoking. Smokers are more likely to develop oral thrush.

Oral thrush is not contagious. You cannot pass on oral thrush to other people.

What are the symptoms of oral thrush?

The classical symptom is white spots that develop in your mouth. The spots may join together to form larger spots called plaques. They may become yellow or grey. If you wipe off a spot, the underlying tissue may be red but it is not usually sore or painful.

Often there are no white spots. Areas in your mouth may just become red and sore. This more typically occurs if you get thrush after taking antibiotics or steroids.

Denture wearers may develop an area of persistent redness under a denture.

You may develop sore, cracked, red areas just outside your mouth. This mainly affects the angle where the upper and lower lips meet (angular stomatitis).

Some mild oral thrush infections are painless. However, sometimes oral thrush is quite sore and can make eating and drinking uncomfortable. Some babies with oral thrush may drool saliva, or not be able to feed properly because of soreness.

Taste can be affected in some people with oral thrush.

How is oral thrush diagnosed?

Your doctor will usually diagnose oral thrush by your typical symptoms and the typical appearance in your mouth. No investigations are usually needed to diagnose oral thrush. However, your doctor may sometimes suggest a blood test to look for certain conditions that may make you more likely to develop oral thrush. For example, a blood test to see if you are lacking iron, B12 or folate.

Occasionally, a biopsy is needed to confirm a diagnosis of oral thrush. A small sample is taken from the white patches inside your mouth and this can be examined under a microscope.

What is the treatment for oral thrush?

Locally applied treatment

For mild oral thrush, the usual treatment that is tried first is antifungal mouth gel/drops for 1-2 weeks. Follow the instructions in the packet. Apply a small amount of gel /drops on to the affected areas, four times a day,after you have eaten or drunk. You should not eat or drink for about 30 minutes after using either the gel or the drops so that the drug is not washed out of your mouth too soon.

Anti-thrush tablets

Tablets that contain a drug called fluconazole can also help to clear fungal and thrush infections from the body. Used in more severe or serious cases .Tablets are usually prescribed for seven days and this will usually clear oral thrush.

Adjustment of other medication

If you are taking other medication that may have caused oral thrush, such as steroids or antibiotics, your doctor may need to change this medication or reduce the dose to help clear up your thrush.

If the above measures do not help to clear your oral thrush infection, or if you have particularly severe infection or other health problems (for example, you are undergoing chemotherapy or are taking other drugs that weaken your immune system), your doctor may suggest .may suggest other treatments for oral thrush.

Can oral thrush be prevented?

It may be possible to alter one or more of the situations mentioned above to help prevent further bouts of oral thrush. For example:

If you have diabetes - good control of your blood sugar level reduces the risk of thrush and other infections.
If you use steroid inhalers - having a good inhaler technique and using a spacer device may reduce the risk of thrush. Also, rinse your mouth after using the inhaler. Ask your doctor about reducing your dose of steroid in your inhaler to the lowest level needed to control your asthma.
If you wear dentures-Remove dentures at night, or for at least six hours daily. Clean and disinfect dentures daily. Clean the inside of your mouth (where the dentures sit) with a soft brush.See a dentist if the dentures do not fit well.
If you take medication which causes a dry mouth - take frequent sips of water.
If you are found to have anaemia or low levels of vitamin B12, folate or iron, treating this may help to prevent oral thrush in the future.
If you are a smoker, quitting smoking may help to prevent further bouts of oral thrush

Certain groups of people may be given anti-thrush tablets to help to prevent oral thrush. For example, people who are on medication to suppress their immune system or who are receiving chemotherapy for cancer

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