What causes thrush in your mouth

Oral thrush - Symptoms and causes

Overview

Oral thrush

Oral thrush produces slightly raised, creamy white, sore patches in your mouth or on your tongue.

Oral thrush — also called oral candidiasis (kan-dih-DIE-uh-sis) — is a condition in which the fungus Candida albicans accumulates on the lining of your mouth. Candida is a normal organism in your mouth, but sometimes it can overgrow and cause symptoms.

Oral thrush causes creamy white lesions, usually on your tongue or inner cheeks. Sometimes oral thrush may spread to the roof of your mouth, your gums or tonsils, or the back of your throat.

Although oral thrush can affect anyone, it's more likely to occur in babies and older adults because they have reduced immunity; in other people with suppressed immune systems or certain health conditions; or people who take certain medications. Oral thrush is a minor problem if you're healthy, but if you have a weakened immune system, symptoms may be more severe and difficult to control.

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Symptoms

Children and adults

Initially, you may not even notice symptoms of oral thrush. Signs and symptoms may include:

Creamy white lesions on your tongue, inner cheeks, and sometimes on the roof of your mouth, gums and tonsils
Slightly raised lesions with a cottage cheese-like appearance
Redness, burning or soreness that may be severe enough to cause difficulty eating or swallowing
Slight bleeding if the lesions are rubbed or scraped
Cracking and redness at the corners of your mouth
A cottony feeling in your mouth
Loss of taste
Redness, irritation and pain under dentures (denture stomatitis)

In severe cases, usually related to cancer or a weakened immune system from HIV/AIDS, the lesions may spread downward into your esophagus — the long, muscular tube stretching from the back of your mouth to your stomach (Candida esophagitis). If this occurs, you may experience difficulty swallowing and pain or feel as if food is getting stuck in your throat.

Infants and breast-feeding mothers

In addition to the distinctive white mouth lesions, infants may have trouble feeding or be fussy and irritable. They can pass the infection to their mothers during breast-feeding. The infection may then pass back and forth between the mother's breasts and the baby's mouth.

Women whose breasts are infected with candida may experience these signs and symptoms:

Unusually red, sensitive, cracked or itchy nipples
Shiny or flaky skin on the darker, circular area around the nipple (areola)
Unusual pain during nursing or painful nipples between feedings
Stabbing pains deep within the breast

When to see a doctor

If you or your child develops white lesions inside the mouth, see your doctor or dentist.

Thrush is uncommon in healthy older children, teenagers and adults, so if thrush develops, see your doctor to determine if further evaluation is needed to check for an underlying medical condition or other cause.

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Causes

Normally, your immune system works to repel harmful invading organisms, such as viruses, bacteria and fungi, while maintaining a balance between "good" and "bad" microbes that normally inhabit your body. But sometimes these protective mechanisms fail, increasing the number of candida fungus and allowing an oral thrush infection to take hold.

The most common type of candida fungus is Candida albicans. Several factors, such as a weakened immune system, can increase your risk of oral thrush.

Risk factors

You may have an increased risk of oral thrush infection if any of these issues apply:

Weakened immunity. Oral thrush is more likely to occur in infants and older adults due to reduced immunity. Some medical conditions and treatments can suppress your immune system, such as cancer and its treatments, organ transplantation and required drugs that suppress the immune system, and HIV/AIDS.
Diabetes. If you have untreated diabetes or the disease isn't well-controlled, your saliva may contain large amounts of sugar, which encourages the growth of candida.
Vaginal yeast infections. Vaginal yeast infections are caused by the same fungus that causes oral thrush. You can pass the infection to your baby.
Medications. Drugs such as prednisone, inhaled corticosteroids, or antibiotics that disturb the natural balance of microorganisms in your body can increase your risk of oral thrush.
Other oral conditions. Wearing dentures, especially upper dentures, or having conditions that cause dry mouth can increase the risk of oral thrush.

Complications

Oral thrush is seldom a problem for healthy children and adults.

For people with lowered immunity, such as from cancer treatment or HIV/AIDS, thrush can be more serious. Untreated oral thrush can lead to more-serious systemic candida infections. If you have a weakened immune system, thrush may spread to your esophagus or other parts of your body.

Prevention

These measures may help reduce your risk of developing candida infections:

Rinse your mouth. If you need to use a corticosteroid inhaler, be sure to rinse your mouth with water or brush your teeth after taking your medication.
Brush your teeth at least twice a day and floss daily or as often as your dentist recommends.
Check your dentures. Remove your dentures at night. Make sure dentures fit properly and don't cause irritation. Clean your dentures daily. Ask your dentist for the best way to clean your type of dentures.
See your dentist regularly, especially if you have diabetes or wear dentures. Ask your dentist how often you need to be seen.
Watch what you eat. Try limiting the amount of sugar-containing foods you eat. These may encourage the growth of candida.
Maintain good blood sugar control if you have diabetes. Well-controlled blood sugar can reduce the amount of sugar in your saliva, discouraging the growth of candida.
Treat a vaginal yeast infection as soon as possible.
Treat dry mouth. Ask your doctor about ways to avoid or treat your dry mouth.

By Mayo Clinic Staff

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Oral thrush in adults | NHS inform

Oral thrush is a fungal infection of the mouth. It's not contagious and is usually successfully treated with antifungal medication.

It's also called oral candidosis (or candiasis) because it's caused by a group of yeasts called Candida.

Non-urgent advice: Contact your GP practice if:

You develop symptoms of oral thrush, which can include:

white patches (plaques) in the mouth that can often be wiped off, leaving behind red areas that may bleed slightly
loss of taste or an unpleasant taste in the mouth
redness inside the mouth and throat
cracks at the corners of the mouth
a painful, burning sensation in the mouth

In some cases, the symptoms of oral thrush can make eating and drinking difficult.

If left untreated, the symptoms will often persist and your mouth will continue to feel uncomfortable.

In severe cases that are left untreated, there is also a risk of the infection spreading further into your body, which can be serious.

Your GP will usually be able to diagnose oral thrush simply by examining your mouth. Sometimes they may also recommend blood tests to look for certain conditions associated with oral thrush, such as diabetes and nutritional deficiencies.

What causes oral thrush?

Low numbers of the fungus Candida are naturally found in the mouth and digestive system of most people. They don't usually cause any problems, but can lead to oral thrush if they multiply.

There are a number of reasons why this may happen, including:

taking a course of antibiotics, particularly over a long period or at a high dose
taking inhaled corticosteroid medication for asthma
wearing dentures (false teeth), particularly if they don't fit properly
having poor oral hygiene
having a dry mouth, either because of a medical condition or a medication you are taking
smoking
having chemotherapy or radiotherapy to treat cancer

Babies, young children and elderly people are at a particularly high risk of developing oral thrush, as are people with certain underlying conditions, including diabetes, an iron deficiency or vitamin B12 deficiency, an underactive thyroid (hypothyroidism) and HIV.

As most people already have Candida fungi living in their mouth, oral thrush is not contagious. This means it cannot be passed to others.

Treating oral thrush

Oral thrush can usually be successfully treated with antifungal medicines. These usually come in the form of gels or liquid that you apply directly inside your mouth (topical medication), although tablets or capsules are sometimes used.

Topical medication will usually need to be used several times a day for around 7 to 14 days. Tablet or capsules are usually taken once daily.

These medications don't often have side effects, although some can cause nausea (feeling sick), vomiting, bloating, abdominal (tummy) pain and diarrhoea.

If antibiotics or corticosteroids are thought to be causing your oral thrush, the medicine – or the way it is delivered – may need to be changed or the dosage reduced.

Preventing oral thrush

There are a number of things you can do to reduce your chances of developing oral thrush.

Do

rinse your mouth after meals
brush your teeth twice a day with a toothpaste that contains fluoride
floss regularly
visit your dentist regularly for check-ups, even if you wear dentures or have no natural teeth
remove your dentures every night and clean them with paste or soap and water before soaking them in a solution of water and denture-cleaning tablets
brush your gums, tongue and inside your mouth with a soft brush twice a day if you wear dentures or have no or few natural teeth
visit your dentist if your dentures do not fit properly
stop smoking if you smoke
rinse your mouth with water and spit it out after using a corticosteroid inhaler, and use a spacer (a plastic cylinder that attaches to the inhaler) when you take your medicine
ensure that any underlying condition you have, such as diabetes, is well controlled

If you have a condition or are receiving treatment that could put you at a high risk of developing oral thrush, your doctor may recommend taking a course of antifungal medication to prevent this happening.

Last updated:
13 December 2022

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Thrush in the mouth in adults: symptoms, treatment - ROOTT

Causes Types Danger Treatment Remedial measures Drugs against thrush

Oral candidiasis (thrush) is an infectious disease of the mucous membranes. It is caused by a fungus of the genus Candida.

Mucous membranes are covered with whitish plaques resembling curd mass. Patients have unpleasant sensations in the mouth, a burning sensation. Eating, sometimes even speaking, becomes painful. Patients complain of dry mouth and bad breath. nine0003

Thrush is very common in infants but is easily tolerated and heals quickly. It often occurs in people with dentures, those taking corticosteroids, or undergoing chemotherapy.

Causes of the disease

Yeast fungi are present in the body of any person. Under the influence of certain factors, they begin to multiply uncontrollably.

Thrush in the mouth is caused by:

Hormonal changes, e.g. during pregnancy
Taking certain medications
Weakening of immunity due to illness
Inadequate oral hygiene
Mucosal injuries
High carbohydrate diet
Taking contraceptives
Smoking
Candidiasis is contagious, it can be transmitted through shared utensils, kissing.

Classification

Symptoms of thrush manifest themselves in different ways, depending on the form of the disease. In dentistry, the following forms of candidiasis are distinguished:

Acute pseudomembranous - Mild form: the only symptom is the presence of plaque. If you scrape it off, a swollen, reddened mucous membrane is visible. - Moderate: plaque is difficult to remove, there are unpleasant sensations while eating. The submandibular lymph nodes are enlarged. - Severe form: extensive, off-white plaque. Signs of tissue infiltration. Plaques are removed with difficulty, bleeding mucous membrane is visible under them.
Acute atrophic Mucosa red, painful to touch, smooth. The plaque is dense, covers the cheeks from the inside, tongue, palate. The mouth is dry. There are teeth marks on the tongue. There may be a bitter, sour, metallic taste in the mouth. The acute course can become chronic, usually in patients with removable dentures. Therefore, its second name is prosthetic stomatitis. Under the prosthesis, the mucous membrane is dry, red. There is almost no plaque, but the pain syndrome is pronounced. On the back of the tongue papillae atrophy. This leads to a change in taste sensations. Sometimes atrophic candidiasis is called erythematous ("erythema" - redness). nine0018
Chronic hyperplastic It occurs only in adults, mainly in smokers. The coating is dirty gray, located in the corners of the lips, on the tongue. It scrapes off badly, has an unpleasant smell. The plaques merge, covering the mucosa almost completely. Saliva changes: it becomes viscous and foams. The most common such thrush in men.

Why is thrush dangerous? But candida is a yeast-like fungus, and, therefore, is capable of rapid reproduction, like any yeast. From the mucous membranes of the mouth, thrush can spread to the throat. This causes changes in the voice, makes it hoarse. Spreading to the esophagus, it provokes inflammation of the esophageal mucosa (esophagitis), making it painful for food to pass through it. nine0003

Untreated hyperplastic candidiasis develops into malignant neoplasms.

Most importantly, the reproduction of the fungus indicates a malfunction in the body's defenses.

Only a doctor is able to prescribe the necessary examination and, based on its results, prescribe the appropriate treatment for a fungal infection.

How to treat thrush

Successful treatment requires an accurate diagnosis. For this, a number of laboratory tests are prescribed. Bacteriological culture is mandatory. He will not only confirm the thrush, but also determine which type of fungus caused it. This is important when prescribing drugs. After a clinical examination, the dentist may recommend blood glucose or HIV tests. nine0003

Recommended consultations with narrow specialists:

Endocrinologist To make sure there are no endocrine disorders.
Allergist To detect sensitivity to dentures.
Therapist To clarify the nature of somatic diseases.

Treatment of thrush in adults and children should be comprehensive and include activities aimed at strengthening general immunity, teaching adequate oral hygiene, and changing the diet. nine0003

Algorithm of therapeutic measures

For the best result, the intervention begins with the sanitation of the oral cavity. Carious teeth are treated by replacing the affected tissues with filling material. Remove hard plaque and tartar from enamel. Plaque is a hotbed of infection, it is necessary to get rid of it.
Eliminate the factors provoking candidiasis. Replace dentures if they cause an allergic reaction or do not fit well. Stop the exacerbation of common diseases. Take steps to improve your hormone levels. Conduct activities that increase immunity. nine0018
Administer antifungals based on culture results. Prescribed antihistamines, restorative agents, immunomodulators.
Give recommendations on the normalization of the microflora in the oral cavity.

To prevent relapses, it is useful to establish regular hygiene, to exclude foods rich in fast carbohydrates and sugars from the diet. Restorative activities include physical activity and stress-reducing activities (hobbies). It is important not to take medicines uncontrollably, according to recommendations from the Internet or from friends. nine0003

Thrush medicines

Candidiasis medicines come in various forms:
Suspensions (Diflucan, Amphotericin B)
Tablets (Nystatin, Flucanosole, Itriconazole)
Gels (Mikanozol)

A good effect in candidiasis is brought by rinsing with antiseptic agents: Chlorhexidine, Miramistin. This is especially important if the patient wears removable dentures or, for various reasons, cannot maintain adequate hygiene. nine0003

Patients should be advised to regularly disinfect their prostheses.

Physician's opinion: Most drugs for the treatment of thrush are prescription drugs. Their independent use can cause serious complications. Therefore, do not self-medicate, contact your dentist. The doctor will prescribe treatment only after determining the sensitivity of the fungus to certain drugs. This will increase the effectiveness of the intervention and prevent relapses.

Candidiasis (thrush) of the oral cavity - symptoms and treatment

Oral candidiasis is an inflammatory disease that develops against the background of damage to the mucous membranes by fungi of the genus Candida. This is usually associated with a deterioration in local and general immunity. According to studies, up to 90% of the adult population is carriers of this fungus, but the disease most often does not develop, since under normal conditions the pathogen does not act aggressively.

Causes of candidiasis

Thrush in the mouth in an adult is a mucosal lesion that may indicate serious health problems. For the reproduction of the fungus, special conditions are necessary. Most often, the disease occurs in patients who neglect oral hygiene. The presence of caries, inflammatory gum disease increases the chances of developing fungal inflammation. This is due to the fact that a large number of pathogenic microorganisms depletes the defense mechanisms. nine0003

The second group of reasons is the weakening of the immune system due to a number of diseases and conditions:

HIV, diabetes mellitus;
oncological diseases;
dystrophy, deficiency of vitamins, minerals;
surgeries, severe infections, etc.

There are also specific reasons for the development of thrush. It may appear after prolonged and powerful antibiotic therapy. The use of antibiotics leads to the destruction of beneficial flora and imbalance. This causes the active reproduction of Candida. nine0003

Oral candidiasis also develops against the background of inhaled corticosteroids. Usually the lesion has the appearance of erythema and appears in areas where the drug has come into contact with the mucosa: in the palate, tongue.

Features of the diet affect the likelihood of developing candidiasis. So, the predominance of carbohydrates predisposes to the activity of the fungus. The growth of Candida and its attachment to the mucosa are enhanced in the presence of sugars.

Bad habits increase the chances of developing leukoplakia, lichen planus and other diseases. Especially when it comes to smoking. Candidiasis often develops in patients with tongue piercings. nine0003

The presence of removable dentures is also a risk factor if the patient does not follow the rules of hygiene. In the absence of high-quality cleansing, the prosthesis is covered with a biofilm, which contains a lot of fungi. Disinfection is the main measure for the prevention of the disease and part of the complex treatment for progressive oral candidiasis. If the patient does not remove the structure at night, this also increases the likelihood of developing the disease. The mucous membrane remains without oxygen for a long time, is not washed by saliva - these conditions are suitable for the development of fungi and anaerobic microorganisms. The prosthesis can injure the mucous membranes if it does not fit. Microtraumas weaken local defenses and contribute to the onset of the development of a fungal infection. Injuries can also be associated with sharp chipped teeth and fillings, chemical and thermal burns. nine0003

Dryness of the oral cavity due to decreased salivation, changes in the viscosity of saliva, its composition is one of the causes of candidiasis. This may be due to other diseases, so it is important to find out the causes of dryness in order to effectively deal with the consequences.

Oral candidiasis is more common in children. The immaturity of the immune system, the colonization of the oral cavity by Candida from the vaginal canal of the mother during natural childbirth lead to the fact that the disease develops in early infancy. However, older children can also suffer from an illness, which is associated with a weakening of the immune forces. nine0003

Types of oral candidiasis and symptoms

Manifestations of oral candidiasis may vary from patient to patient. This is due to the degree of damage to the mucous membranes, as well as the specific type of disease. There are four forms:

acute pseudomembranous;
acute atrophic;
chronic atrophic;
chronic hyperplastic. nine0003

Despite the fact that the treatment regimen for all forms is almost the same, the symptoms can vary significantly. Let's consider them in more detail.

Acute pseudomembranous candidiasis

This form of oral candidiasis may be asymptomatic. There is slight discomfort due to a white film or small plaques rising above the mucosa. With a mild course, one or more plaques appear, they are easily removed by scraping, and the mucosal area under them has a bright red color. In severe cases, large plaques appear in large numbers. They can merge, forming large areas of damage. Sometimes the symptoms cover the entire mucous membrane. When the plaques thicken, their removal becomes problematic. A severe course is more typical for infants, as well as in adult patients after antibiotic therapy, corticosteroids, immunosuppressants. nine0003

Acute and chronic atrophic candidiasis

Acute atrophic candidiasis is accompanied by severe burning. There may be no white plaque, and the mucous membrane becomes bright red. Many patients report a metallic, sour, salty, or bitter taste in their mouths. A characteristic manifestation of the disease is dry mouth. This form of the disease is often associated with drug therapy.

In chronic atrophic candidiasis, redness and burning are less pronounced. Usually the disease develops against the background of the installation and wearing of prostheses. nine0003

Chronic hyperplastic candidiasis

This form of the disease is characteristic of adults. Oral thrush can spread to the mucous membranes of the cheeks, the corners of the mouth and lips, the back of the tongue, and the soft palate. One of the symptoms is the appearance of white plaques that tend to merge with each other. As the disease progresses, their surface becomes rough, rough. Over time, the elements may turn yellow. Formations merge with mucous membranes and it is impossible to remove them.

Diagnostic methods

Treatment by a general dentist. Diagnosis begins with an examination and a detailed survey: the doctor will find out what drugs you have taken recently, whether there are chronic and infectious diseases. A cytological examination of plaque taken from the mucosa is mandatory. This is important because the accumulation of non-fungal flora can be easily confused with a fungal infection.

Scraping is performed in the morning, on an empty stomach, it is not necessary to brush your teeth before the procedure. On the eve, it is important to refuse to eat foods rich in carbohydrates so as not to provoke the growth of pathogenic flora. Studies allow not only to accurately determine the pathogen and type of Candida fungus, but also to find out the sensitivity of fungi to the main antifungal drugs. Based on the results of the tests, the doctor will determine the fungus in the oral cavity and prescribe medication. nine0003

Features of treatment

The basis of treatment is systemic and local antifungal drugs. Today they are widely represented on the pharmaceutical market, but it is important to know that the level of Candida fungus resistance to fixed assets is growing every year. For example, resistance to drugs such as Fluconazole is almost complete. Previously, this remedy was used in almost all cases of the disease, but today doctors are forced to revise standard treatment regimens.

Treatment of thrush in the mouth in adults is selected individually. The choice of a systemic antifungal agent is based on the type of pathogen, the patient's condition and the individual characteristics of his health. There are agents to which the infection has minimal resistance. The doctor may prescribe drugs based on nystatin, imidazole derivatives, etc.

In addition, local funds must be used:

mouth rinses;
gels and suspensions for application to affected areas;
topical lozenges and lozenges;
irrigation solutions and aerosols;
ointments for laying in the oral cavity on a cotton-gauze swab, etc.

Your healthcare professional may prescribe an over-the-counter antiseptic or mild saline rinse. Usually, solutions based on iodine, chlorhexidine, potassium permanganate, gentian violet, sodium tetraborate in glycerin are used. Some pills the doctor may recommend laying on the cheek.

Conditions for effective treatment

Effective treatment for oral thrush involves addressing the underlying cause. It is very important to sanitize the oral cavity: to cure teeth destroyed by caries, to remove non-viable teeth and roots that can no longer be restored. These are chronic foci of inflammation, so simultaneous sanitation will shorten the treatment time. Tartar and plaque should also be removed. This is especially true in cases of candidal stomatitis associated with trauma to the gums with sharp edges of hard dental deposits. nine0003

Patients with removable dentures should be retrained in hygiene and disinfection of prosthetic structures. If the time of using the prosthesis comes to an end, it is important to replace it in a timely manner. Treatment of candidiasis will be useless if a person uses the prosthesis incorrectly and again creates conditions for the reproduction of fungi in the oral cavity.

Unsuitable crowns, bridges and other structures are also subject to replacement. It is also important to eliminate enamel chips, which become a source of injury to the gums, mucous membranes of the cheeks and tongue. nine0003

Smokers should, if possible, reduce their smoking episodes or give up smoking habits. If the disease developed while taking corticosteroids, it is important to explain the rules of treatment: you should rinse your mouth with plenty of warm water after spraying the drug.

In the treatment of oral candidiasis that has developed against the background of antibiotic therapy, measures should be taken to restore the normal microflora of the intestine and oral cavity. It may be necessary to consult another narrow specialist or therapist: you will need to take probiotics and prebiotics. nine0003

For all patients treated for candidiasis, a few general guidelines apply:

maintaining oral hygiene;
refusal of food rich in carbohydrates;
Refusal of sugary drinks.

It is necessary to exclude from the diet food that can irritate the mucous membranes: dishes cooked with vinegar, marinades, spicy, peppery foods, smoked meats, sour fruits and berries. Also, you can not eat confectionery, pastries with yeast, sugar. It is better to give preference to warm dishes. It is necessary to observe such a diet for another 1.5-2 months after recovery. nine0003

In some cases, it is advisable to use toothpastes with glucose oxidase, lysozyme, lactoferrin. They improve the protective forces of the oral mucosa and can be part of a comprehensive prevention of inflammation. The choice of toothpaste must be agreed with the doctor, he will recommend the best remedy, and also tell you which brush is suitable.

Prevention of candidiasis

Specific prophylaxis of oral candidiasis is performed only in the presence of HIV infection, the patient undergoing radiation therapy, immunosuppressive or antibiotic therapy. In the absence of these risk factors, the doctor will make recommendations for a specific case. nine0003

Prevention of fungal diseases in patients with diabetes mellitus, bronchial asthma, chronic systemic diseases involves control of the underlying pathology.

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