An Overview of Thrush

Oral Candidiasis in Babies and Adults

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Thrush is a common oral yeast infection that affects many newborns and younger children, as well as adults with weakened immune systems. It is caused by Candida albicans, a yeast that can also cause vaginal yeast infections and yeast diaper rashes, and is known to prompt symptoms such as white patches or coating in the mouth, as well as redness and burning. While thrush can resolve on its own, and certain over-the-counter options can help it along, it may need to be treated with antifungal prescription drugs.

Symptoms

The most common symptom of thrush is having white patches or a white coating inside your mouth. This may look like yogurt or cottage cheese. There may also be redness and soreness inside the mouth, specifically at the corners. You may have a burning sensation in your mouth or throat. In more severe cases, you may have a deadening of your sense of taste and it may be painful to eat or swallow.

In infants, you may see white patches on the insides of the cheeks, on the tongue, on the roof of the mouth, and on the lips and gums as it spreads. These patches can bleed if you try to wipe them away.

Causes and Risk Factors

The organisms typically seen in thrush are Candida albicans and other species of Candida, which is why the condition is named oral candidiasis. While you typically have yeast and bacteria in your mouth, your immune system prevents overgrowth. Saliva carries antibodies and other substances that keep yeast under control. If your immune system or your production of saliva is impaired by health conditions, medications, or treatments, yeast can overgrow and oral thrush can develop.

Medications and treatments that can increase the risk include oral corticosteroids, inhaled steroids (used for asthma and other respiratory conditions), chemotherapy, radiotherapy to the head and neck, immunosuppressive therapy for an organ transplant, antibiotics, and any medication that results in a dry mouth.

Conditions and concerns that increase the risk include HIV/AIDS, diabetes mellitus, chronic illness, leukemia, lymphoma, cancer, poor oral health, and ill-fitting dentures. You may also be at increased risk if you smoke. Newborns may develop oral thrush because of their immature immune systems.

Diagnosis

Thrush is usually diagnosed by the appearance and pattern of symptoms. No culture or testing is typically required, but sometimes a doctor will take a small scraping of sores in the mouth and look at it under the microscope to see if large amounts of yeast are present.

Blood tests may be done to check your overall health and to screen for conditions that increase your risk of thrush, such as diabetes. If your child is fussy and refuses to eat, your pediatrician may do more to investigate whether your child has a condition (in addition to thrush) that is causing these symptoms.

Treatment

There are options for treating thrush infections. Mild cases often resolve if you keep your mouth clean. Eating cold food and drinks and rinsing with warm salt water can help relieve discomfort.

Gentian violet is an older over-the-counter treatment that is safe and effective but doesn't require a prescription. However, it's a purple dye and it can be messy to use. Probiotics may be helpful to restore friendly bacteria when thrush develops after taking antibiotics.

The first line of treatment, when needed, is with prescription oral antifungal lozenges, suspensions, or mouthwashes. Mycelex (clotrimazole) or Mycostatin (nystatin) are taken a few times per day. If these are not effective, the next resort is Diflucan (fluconazole). It only needs to be given once per day.

The doctor may turn to other antifungal drugs if thrush does not respond to fluconazole. These drugs include itraconazole, posaconazole, voriconazole, and amphotericin B — all part of a new class of antifungal medications (echinocandins), which are administered intravenously for serious cases.

Breastfeeding mothers who have a baby with thrush may get a yeast infection on their breasts and nipples, causing pain while breastfeeding. In addition to getting treatment for her baby, the mother also needs to be treated by her doctor with an antifungal cream. A baby will be more prone to yeast diaper rash if he has thrush, so be sure to use a barrier cream when diapering and keep the baby's bottom dry.

A Word From Verywell

The pain and irritation of thrush can be frustrating, especially if you are dealing with it in addition to dry mouth, cancer, HIV, asthma, diabetes, or other conditions. It is important to discuss treatment with your doctor so you can keep up good nutrition and not get dehydrated.

If your baby gets thrush, be aware that it's nothing you are doing wrong as yeast are everywhere, no matter how carefully you clean and sterilize what goes into your baby's mouth. Your pediatrician can reassure you as to what steps to take.

Thrush: Signs, Symptoms, and Complications
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