Oral Thrush (Oral Candida)

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What is oral thrush?

Thrush is an infection caused by a yeast germ called Candida. The mouth is a common site where Candida causes infection. This is called oral thrush. Other common sites for thrush to develop are the vagina, nappy area, and nail folds. (See separate leaflets about these other types of thrush.)

Who gets oral thrush?

Small numbers of Candida commonly live on healthy skin and in a healthy mouth. They are usually harmless. However, certain situations or conditions may cause an 'overgrowth' of Candida which may lead to a bout of oral thrush. These include:

• Babies. Oral thrush is quite common in young babies. See separate leaflet called 'Oral Thrush in Babies'.
• 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 which may multiply more easily if there are less bacteria around.
• Excessive use of antibacterial mouthwash (for similar reasons to above).
• Taking steroid tablets or inhalers.
• A dry mouth. 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 or diabetes.
• Iron or folate deficiency.
• A poor immune system. For example, if you are taking medicines that suppress the immune system, or if you have HIV/AIDS.
• If you are frail or in general poor health.

What are the symptoms of oral thrush?

• The classical symptom is for white spots to develop in the mouth. The spots may join together to form larger spots or 'plaques'. They may become yellow or grey. If you wipe off a spot the underlying tissue may be red and raw.
• Often there are no white spots. Areas within the mouth may just become red and sore. This more typically occurs if you get thrush after a course of antibiotics or steroids.
• Denture wearers may develop an area of persistent redness and swelling under a denture.
• You may develop sore, cracked, red areas just outside the 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. Some affected babies may drool saliva, or refuse to feed properly because of soreness.

What is the treatment for oral thrush?

Locally applied treatment
Most cases are treated with drops, lozenges or gel which contain anti-thrush drugs such as nystatin, amphotericin or miconazole. You apply these to affected areas in the mouth. Follow the instructions in the packet. Basically:

• With drops, you use a dropper to place the liquid inside the mouth onto affected areas.
• With lozenges, you suck them as they dissolve in the mouth.
• With gel, you smear it onto the affected areas.

Keep the drops, lozenges or gel in your mouth as long as possible before swallowing. The aim is for the active ingredient to be in contact with affected areas to kill the Candida germs. Ideally, you should not eat or drink for about 30 minutes after each dose. This helps to prevent the drug from being washed out of the mouth too soon.

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 - if you use a spacer device it may reduce the risk of thrush. Also, gargle and rinse your mouth after using the inhaler.
• If you wear dentures:
  • Leave the dentures out overnight, or for at least six hours daily. Constant wearing of dentures, and not taking them out at night, is thought to be one of the commonest causes of oral thrush.
  • Clean and disinfect dentures daily. To clean, use soapy water and scrub the the dentures with a soft nailbrush on the fitting surface, that is the non-polished side. Then soak them in a disinfecting solution. The type of solution and the time they should be soaked will be advised by your dentist. Rinse the dentures after disinfecting them, and then allow the dentures to air dry before wearing them again.
  • 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. (See a separate leaflet called 'Dry Mouth' for more details.)
• Your doctor may advise a blood test if conditions such as diabetes, folate deficiency, etc, are suspected.
• Tips to prevent oral thrush in babies are included in a separate leaflet called 'Oral Thrush and Babies'.

References

1. Prodigy Guidance Candida - oral 2006

© EMIS and PIP 2007   Updated: February 2007   PRODIGY Validated

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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