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This article will address the symptoms, diagnosis, management, and prevention of oral thrush in children and adults. Symptoms include white patches on the inner cheeks and tongue, a feeling of having cotton inside your mouth, changes in taste, and pain with eating and swallowing, among others.
What is oral thrush?
Oral thrush is the result of the overgrowth of the fungal species candida in the mouth. This fungus normally exists within the mouth and the rest of the GI tract as well as on the skin. Oral thrush can develop when larger amounts of the fungus are present than normal.
The characteristic finding of oral thrush is white plaque on the tongue and inside of the mouth. Clinical suspicion for the condition is high when these white plaques are present, and the diagnosis is confirmed by scraping one of these plaques off of the mouth and examining it under the microscope. This condition is usually seen in babies or adults with compromised immune systems.
Topical anti-fungals are used for the treatment of this condition.
You can safely treat this condition on your own by administering nystatin oral which is an over-the-counter liquid antifungal medication.
Symptoms of oral thrush
The symptoms of oral thrush are as follows:
- White patches on the inner cheeks and tongue
- Feeling of having cotton inside the mouth
- Changes in taste
- Pain with eating
- Pain with swallowing
- Redness inside the mouth
- Cracking and redness at the corners of the mouth
Babies, especially those under 1 year of age, are particularly at risk of oral thrush. This condition is less common among adults. Adults at risk for this condition include individuals who:
- Have diabetes
- Wear dentures
- Have HIV/AIDS: This condition occurs in adults with HIV/AIDS and CD4 counts < 200.
- Are taking antibiotics
- Are taking steroids: This condition can occur in people taking oral steroids or inhaled steroids (like albuterol for asthma).
The diagnosis of oral thrush can be confirmed in the clinic setting with the right equipment present. If you have white plaques on the inside of your mouth, your healthcare provider will likely scrape one of these plaques off with a tongue depressor. The scraping is then placed on a microscope slide and a solution of potassium hydroxide (KOH) is added to the slide. Your healthcare provider will look for budding yeasts, a hallmark feature of the fungus causing this condition, to confirm the diagnosis.
What causes oral thrush?
Oral thrush, also known as oral candidiasis, is caused by the overgrowth of the fungus candida along the lining of the inside of the mouth. Candida fungus occurs naturally along this inside of the mouth and along the rest of the GI tract. This naturally-occurring fungus does not usually cause any problems as long as there is not overgrowth of the fungus. When your normal makeup of bacteria is altered by taking antibiotics or your immune system is compromised (by conditions like HIV), this fungus can multiply, and larger amounts lead to the development of symptoms. Oral thrush in someone with HIV is called an “AIDS-defining illness.” You can be diagnosed with AIDS when your CD4 t-cell count, the cells affected by HIV, drops below 200. Oral thrush is called AIDS-defining because it usually only occurs in people with CD4 counts <200.
Treatment options and prevention for oral thrush
The treatment of oral thrush is aimed at restoring the normal amounts of candida fungus present naturally in the mouth and GI tract. The treatment of this condition depends on your medical history and the severity of the infection. For people presenting with oral thrush with no history of HIV/AIDS, a topical antifungal, usually clotrimazole, miconazole, or nystatin, is prescribed for seven to 14 days. People with HIV who are experiencing their first presentation of thrush can also usually be treated with topical treatments as well. For people with recurrent oral thrush or severe infections, oral or intravenous antifungal therapy may be necessary.
While there are no specific measures to prevent the development of oral thrush, minimizing and controlling risk factors can help thwart this condition. This includes maintaining good blood glucose control in people with diabetes, elevated CD4 t-cell counts in people with HIV, and avoiding smoking. People who wear dentures or take inhaled steroids should be sure to maintain good oral hygiene.
Babies are at risk for oral thrush through different feeding mechanisms. If a baby is formula-fed, care should be taken to thoroughly clean the nipple of the bottle with hot water or in the dishwasher. Milk and prepared feeds should be kept in the fridge until given to the child to prevent the growth of yeast. If a mother is breastfeeding her baby and has noticeable redness around her nipples, she may have a yeast infection. This infection can then be transmitted to the inside of the baby’s mouth when he or she feeds and produce oral thrush.
When to seek further consultation for oral thrush
If you detect white plaques along the inside of your mouth or experience extended courses of the symptoms described above, you should consult your healthcare provider. Oral thrush can be the result of medication use or underlying conditions, so your doctor may do further testing to determine the underlying cause of the condition.
Dr. Henry is a first-year resident in the Department of Otolaryngology-Head & Neck Surgery at the University of Pennsylvania. She received her medical degree from the University of Pennsylvania and her BA in political economy from Williams College. As a medical student, she was the editorial manager of an otolaryngology publication and has extensive experience with medical writing. She is currently working on research projects for publication in the sub-specialty fields of otology, head and neck cancer, and facial plastics. Outside the hospital she enjoys fly fishing, squash, hiking, and watching pro tennis.
- Candida infections of the mouth, throat, and esophagus. Centers for Disease Control and Prevention. Updated Aug. 4, 2017. CDC Link
- Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. U.S. Dept. of Health and Human Services: AIDSinfo. AIDSinfo Link
- AIDS Signs and Symptoms. University of California San Francisco Health. UCSF Health Link
- Ben-Joseph EP. Oral thrush. Nemours: KidsHealth. Updated June 2018. KidsHealth Link