Oral thrush

Oral thrush, also called oral candidiasis (kan-dih-DIE-uh-sis), is a condition in which the fungus Candida albicans builds up in the mouth. It's natural for candida, a yeast, to live in the mouth. But sometimes it can grow too much and cause symptoms.

Oral thrush causes creamy white patches or spots, usually on the tongue or inner cheeks. Sometimes oral thrush may spread to the roof of the mouth, 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 lower immunity. It's also more likely to occur in other people with weakened immune systems or certain health conditions or people who take certain medicines. Oral thrush is a minor problem if you're healthy. But if you have a weakened immune system, symptoms may be more serious and harder to control.

Children and adults

Symptoms of oral thrush may include:

• Creamy white patches or spots on your tongue, inner cheeks and sometimes on the roof of your mouth, gums and tonsils.
• Slightly raised patches that look like cottage cheese.
• Redness, burning or soreness that may be serious enough to cause a hard time eating or swallowing.
• Slight bleeding if the patches or spots 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 your dentures.

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

Babies and breastfeeding mothers

In addition to the distinctive white mouth spots, babies may have trouble feeding or be fussy and irritable. They can pass the infection to their mothers during breastfeeding. Then the infection may pass back and forth between the mother's nipples and the baby's mouth.

Women whose breasts are infected with candida may have these symptoms:

• Unusually red, sensitive, cracked or itchy nipples.
• Shiny or flaky skin on the darker, circular area around the nipple, called the 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 gets white patches or spots inside the mouth, see your medical or dental professional. Thrush is uncommon in healthy older children, teenagers and adults. So if you get thrush, see your healthcare professional to find out if you need to be checked for an underlying medical condition or another cause.

A healthy immune system works to get rid of harmful invading organisms, such as viruses, bacteria and fungi. This maintains a balance between "good" and "bad" microbes in your body. But sometimes these protective measures fail. Then candida fungus grows and allows 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 raise your risk of oral thrush.

You may have a higher risk of oral thrush infection if you have any of these issues:

• Weakened immunity. Oral thrush is more likely in babies and older adults due to lower immunity. Some medical conditions and treatments can weaken your immune system. They include cancer and its treatments, an organ transplant, medicines that weaken the immune system, and HIV/AIDS.
• Diabetes. If you have diabetes that isn't treated or the disease isn't well controlled, your saliva may contain large amounts of sugar. This sugar causes candida to grow.
• Vaginal yeast infections. The same fungus that causes oral thrush causes vaginal yeast infections. You can pass the infection to your baby.
• Medicines. Medicines such as prednisone, inhaled corticosteroids or antibiotics that disturb the natural balance of microorganisms in your body can raise your risk of oral thrush.
• Other oral conditions. Wearing dentures, especially upper dentures, or conditions that cause dry mouth can raise the risk of oral thrush.

Oral thrush usually isn't a big concern for healthy children and adults. But for people with lowered immunity, such as from cancer treatment or HIV/AIDS, thrush can be more serious. Oral thrush that isn't treated 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.

These measures may help lower your risk of getting 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 medicine.
• 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 how much sugar you eat, including foods that contain sugar. These foods may cause candida to grow.
• Control your blood sugar if you have diabetes. Well-controlled blood sugar can lower the amount of sugar in your saliva. This keeps candida from growing.
• Treat a vaginal yeast infection as soon as possible.
• Treat dry mouth. Ask your healthcare professional about ways to avoid or treat your dry mouth.

The methods used in diagnosis depend, in part, on whether thrush is limited to your mouth or may have spread to your esophagus.

If thrush is limited to your mouth

To diagnose oral thrush, your medical or dental professional may:

• Look in your mouth to see the white patches or spots.
• Take a small scraping of the areas to study under a microscope.

If needed, your healthcare professional will do a physical exam and order blood tests to try to find any underlying medical condition that may be causing the oral thrush.

If symptoms also seem to come from your esophagus

If you have trouble swallowing and feel pain or feel as if food is getting stuck in your throat, your healthcare professional can find out if thrush has spread to your esophagus. Your healthcare professional may recommend:

• An endoscopic exam. Your healthcare professional checks your esophagus, stomach and upper part of your small intestine using a lighted, flexible tube with a camera on the tip, called an endoscope.
• A biopsy. If the endoscopic exam shows thrush or other unusual findings, your healthcare professional takes a tissue sample and sends it to the lab. This helps figure out which bacteria or fungi, if any, are causing symptoms.
• A physical exam and more tests. If the biopsy results show thrush, a physical exam and more tests may be done to try to find any underlying medical condition that could cause thrush in the esophagus.

The goal of any oral thrush treatment is to stop the fast spread of the fungus. But the best approach may depend on your age, overall health and what's causing the infection. Eliminating underlying causes, when possible, can prevent thrush from returning:

• Healthy adults and children. Your healthcare professional may recommend antifungal medicine. This medicine comes in several forms, including lozenges, tablets, or a liquid that you swish in your mouth and then swallow. If these medicines don't work, medicine may be given that works throughout your body.
• Babies and nursing mothers. If you're breastfeeding and your baby has oral thrush, you and your baby could pass the infection back and forth. Your healthcare professional may prescribe a mild antifungal medicine for your baby and an antifungal cream for your breasts.
• Adults with weakened immune systems. Most often, your healthcare professional will recommend antifungal medicine.

Thrush may return even after it's been treated if you don't deal with the underlying cause, such as poorly disinfected dentures or inhaled steroid use.

These suggestions may help during an outbreak of oral thrush:

• Practice good oral care. Brush and floss regularly. Replace your toothbrush often until your infection clears up. Don't share toothbrushes.
• Disinfect dentures. Ask your dental professional for the best way to disinfect your dentures to avoid reinfection.
• Try warm saltwater rinses. Dissolve about 1/2 teaspoon (2.5 milliliters) of salt in 1 cup (237 milliliters) of warm water. Swish the rinse and then spit it out. But don't swallow it.
• Use nursing pads. If you're breastfeeding and get a fungal infection, use pads to help prevent the fungus from spreading to your clothes. Look for pads that don't have a plastic barrier that can encourage candida to grow. Wear a clean bra every day. Ask your healthcare professional about the best way to clean your breast nipples, bottle nipples, pacifiers and any parts of a breast pump that detach, if you use one.

You're likely to start by seeing your family healthcare professional or pediatrician. But if you have an underlying condition that is part of the problem, you may be referred to a specialist for treatment.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

• Any symptoms, including any that don't seem to be related to the reason for the appointment.
• All medicines, vitamins, herbs or other supplements you're taking, including the doses. Also, let your healthcare professional know if you've recently used antibiotics or if you take oral or inhaled corticosteroids such as those used to treat asthma.
• Questions to ask your healthcare professional to help make the most of your appointment.

Some questions to ask your healthcare professional may include:

• What caused this condition?
• Do I need any additional tests?
• What treatments are available, and which do you recommend?
• Do these treatments have any side effects?
• Is there a generic option to the medicine you're prescribing?
• How can I manage this condition along with my other medical issues?
• Are there any dietary limits that I need to follow?
• How can I prevent this from happening again?
• Do I need to be tested for other diseases linked to thrush?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

The healthcare professional is likely to ask you several questions, such as:

• When did you start having symptoms?
• Have you recently taken antibiotics for an infection?
• Do you have asthma? If so, do you use a steroid inhaler?
• Do you have any long-term health conditions?
• Do you have any other new symptoms of illness?

Be ready to answer questions to reserve time to go over any points you want to focus on.