Oral thrush

Oral thrush can have many symptoms in the mouth, throat, and food pipe. These include:

In adults:

• Thick white or cream-colored deposits on inner cheeks, tongue, the roof of the mouth, and throat
• Redness or soreness of the mouth
• Cracking and redness at the corners of the mouth
• Cotton-like feeling in the mouth
• Loss of taste
• Pain while eating or swallowing (if candidiasis is in the food pipe)

In children:

• Cottage cheese-like white coating that cannot be rubbed off easily
• Difficulty in feeding
• Rashes on the nappy

A species of yeast-like fungus called Candida causes oral thrush. The most common type is Candida albicans, which is isolated from more than 80% of lesions.

Candida normally resides in the following areas of healthy individuals without causing any issues:

• Skin
• Mouth
• Throat
• Gastrointestinal tract
• Vagina

It only attacks the body when the opportunity arises and the immune system is compromised.

Learn more about fungal infections of the private parts.

Though oral thrush is not a life-threatening condition, it is quite common and can affect general well-being. Various risk factors for oral thrush include:

Local Factors

• Saliva: Salivary gland dysfunction predisposes individuals to oral candidiasis. Conditions affecting the quantity (such as xerostomia) and quality of salivary secretions may increase the risk of oral thrush.
• Dentures: Dentures create a favorable environment for Candida organisms to thrive. The majority of individuals wearing complete dentures are predisposed to Candida infection.
• Topical Medications: The use of topical or inhalational corticosteroids and excessive use of antimicrobial mouthwashes can temporarily suppress local immunity and alter the oral flora, thereby increasing the risk of candidiasis.
• Smoking: Studies suggest that smoking, alone or in combination with other factors, significantly affects the oral Candida environment.
• Poor Oral Hygiene: The presence of deposits and tartar on the teeth and gums increases the risk of developing oral thrush. Most patients with oral thrush maintain unsatisfactory oral hygiene.
• Diet: Excessive intake of refined sugars, carbohydrates, and dairy products can enhance the growth of Candida organisms by reducing pH levels.

Systemic Factors

• Age: Extremes of age, such as infancy or old age, may predispose individuals to oral thrush due to immature or weakened immunity.
• Malnutrition: Deficiencies of iron, essential fatty acids, folic acid, vitamins A and B6, magnesium, selenium, and zinc can contribute to the overgrowth of Candida species.
• Medications: Prolonged use of drugs like broad-spectrum antibiotics and immunosuppressants that cause dry mouth (xerostomia) create a favorable environment for Candida to grow.
• Endocrine Disorders: A more aggressive form of oral thrush is prevalent in patients with endocrine dysfunctions such as diabetes and Cushing’s syndrome.
• Immunodeficiency: Conditions such as Acquired Immunodeficiency Syndrome (AIDS) and Severe Combined Immunodeficiency Syndrome (SCID) significantly affect immunity and are major predisposing factors for candidiasis.
• Cancer: Host defense mechanisms are compromised by chemotherapy and radiotherapy for cancer treatment, significantly reducing immunity and leading to oral thrush.
• Congenital Conditions: Individuals with congenital conditions associated with a defective immune system are commonly predisposed to Candida infections.

Oral thrush is easily noticeable as a white patch in and around the mouth. To confirm the diagnosis or to rule out any other underlying health conditions, your doctor may include:

• Physical examination: Your doctor or dentist may examine your mouth to assess the lesions, their location, and whether they are scrapable.
• Blood tests: Your doctor may suggest a blood test to check for certain conditions that may increase the likelihood of developing oral thrush, such as deficiencies in iron, vitamin B12, or folic acid.
• Laboratory tests:
  • Histopathology examination: A small scraping of the active lesions is taken for microscopic examination.
  • Biopsy: Specimens should be sent for histopathological examination when chronic hyperplastic candidosis is suspected.
  • Impression culture technique: An impression of both the upper and lower jaw is taken to estimate the growth of Candida organisms.
  • Saliva collection: This involves collecting saliva from patients who show clinical signs of oral thrush.
  • Paper points test: An absorbable sterile point is inserted to the depth of the pocket and kept there for 10 seconds, then treated with a solution to check for any growth.
• Imaging test: In rare cases, endoscopy may be performed to check for lesions deeper in the throat and esophagus.

A healthy mouth is one of the keys to a healthy body. Fungal infections can be quite troublesome, but they can be prevented with certain simple practices. These include:

• Maintaining proper oral hygiene: Good oral hygiene practices may help to prevent oral thrush in people with weakened immune systems. Careful mechanical cleaning of teeth and dentures with a toothbrush is the cornerstone of the prevention of Candida infections.
• Using medicated mouthwash: Chlorhexidine digluconate and cetylpyridinium chloride are antiseptic mouthwashes that can be used as prophylaxis for patients undergoing both chemotherapy and radiotherapy.
• Rinsing the mouth after using the inhaler: People who use inhaled corticosteroids may be able to reduce the risk of developing thrush by rinsing their mouth with water or mouthwash after using an inhaler.
• Keeping your dentures clean: For susceptible denture wearers, it is advisable to remove the denture at night and soak it in 0.2% chlorhexidine solution or in white vinegar for 15–30 minutes.
• Quit smoking: Smoking is associated with various changes in the mouth that can lead to oral thrush, the most common opportunistic fungal infection. Quitting smoking can help prevent recurrent oral thrush. According to WHO, smoking is one of the leading causes of death in India, causing 1.3 million deaths every year.
• Visit your dentist regularly: Regular oral and dental checkups by your dentist can help in the diagnosis of any early signs of oral thrush. Professional cleaning of the teeth and reiterating oral hygiene tips by the dental professional can help maintain oral health and limit the chances of developing any infection.

Candida infections are highly prevalent today, especially with the increase in individuals wearing removable dentures and a general rise in poor oral hygiene habits. The drugs of choice are antifungal agents, which can be classified into:

Topical Antifungal Agents

Topical antifungals are typically the first choice for uncomplicated, localized forms of oral thrush in patients with normal immune function. They include:

• Nystatin
• Amphotericin B
• Fluconazole
• Miconazole

Systemic Antifungal Agents

Systemic antifungals are usually indicated in cases where there is widespread disease or in patients with a compromised immune system. These drugs include:

• Fluconazole
• Itraconazole
• Voriconazole
• Ketoconazole
• Posaconazole

General treatment guidelines include an early diagnosis, correction of predisposing factors or underlying diseases, and maintaining good oral hygiene. In addition to these, there are certain home remedies that you can try to relieve the symptoms of oral thrush. They include:

• Lukewarm salt water rinses: Salt is believed to have antifungal properties, making a lukewarm salt water rinse soothing for oral thrush symptoms and other oral problems.
• Probiotics: These are beneficial bacteria that provide numerous health benefits. Studies show that probiotics restore the balance of flora in your mouth, preventing the overgrowth of Candida albicans. Unsweetened yogurt should be consumed while taking antibiotics, and Lactobacillus acidophilus supplements can help maintain a healthy level of Candida.
• Apple cider vinegar: This fermented apple juice has natural antifungal properties and may combat the growth of Candida. Always dilute apple cider vinegar, as it is acidic and can damage the outer layer of the teeth. Consuming it with a metal straw can minimize exposure to teeth.
• Lemon (Nimbu): Lemon juice is considered a natural antifungal. A mixture of lemon juice and water can be used as a mouth rinse. While more research is needed, lemon juice may be beneficial for individuals with HIV-related oral thrush.
• Gentian violet (1%): This over-the-counter antiseptic dye is used to combat bacteria, fungi, and parasites. Studies have shown its effectiveness against Candida albicans due to its antifungal properties. Apply it with a cotton swab on the affected area, but consult your doctor before use.
• Baking soda: It can kill Candida albicans and help maintain a healthy pH in the mouth. Mix 1-2 tablespoons of baking soda with water to form a paste, apply it with a cotton ball on affected areas, let it sit for a few minutes, and then rinse with warm water. Repeat this three times a day for several days. Alternatively, mix ½ teaspoon of baking soda into a glass of water and use it as a mouth rinse twice daily.
• Essential oils: Some essential oils may serve as potential remedies for oral thrush. Notable options include:
  • Clove oil: A natural painkiller, beneficial when used as a mouth rinse.
  • Lemongrass oil: Has antimicrobial properties that can inhibit the growth of Candida albicans.
  • Tea tree oil: Rinsing with a solution of 1 tablespoon tea tree oil four times daily effectively treats oral thrush in AIDS patients.
• Coconut oil (Nariyal ka tel): Raw virgin coconut oil is known to inhibit the growth of Candida. An Ayurvedic practice called oil pulling may be helpful in combating oral fungus. Nursing mothers can apply it on their nipples and the baby’s mouth to prevent the spread of this condition.
• Pomegranate (Anar): Studies indicate that pomegranate peel possesses antifungal activity against Candida albicans.

Oral thrush is not a very serious condition and can be managed easily in healthy individuals. However, it poses a significant concern for immunocompromised patients, who are at a greater risk of widespread disease leading to complications. These complications include:

• Dysphagia: This refers to difficulty in swallowing. The throat develops multiple white patches, leading to pain while swallowing, as well as burning or itching in the throat or back of the mouth.
• Respiratory distress: Thrush can easily spread to other parts of the body, including the lungs, which may lead to difficulty in breathing and distress.
• Candidal esophagitis: Candidiasis in the esophagus (food pipe) is known as esophageal candidiasis or candida esophagitis. This is a common complication of oral thrush in individuals with HIV/AIDS.

Oral thrush can be irritating, but mild cases generally do not cause significant problems. In addition to maintaining rigorous oral hygiene and using antifungal medications, certain alternative therapies have shown promising results for recurrent infections. Some of these include:

• Traditional Chinese Medicine: The use of Chinese herbs is a time-honored approach to strengthen the body and treat disease. A study discovered that a Chinese herbal formula (Cao Huang Gui Xiang-CHGX) exhibited potent antifungal activities against the major human fungal pathogen Candida albicans and other clinical Candida species.
• Homeopathy: Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopathic doctors may consider remedies based on their knowledge and experience in treating candidiasis.