Oral thrush is particularly common in babies. Babies also often suffer from another fungal infection. It manifests itself in the diaper area and is known as "diaper thrush".
Candida fungi can be detected in the mouth of 22 to 24 percent of all babies in the first two months of life. 95% of these cases also show symptoms of oral thrush.
Candida infections have increased over the last ten to twenty years. However, the transition from a harmless to a symptomatic infection is often fluid.
Acute oral thrush usually begins with a reddening of the mucous membrane. The mucous membrane then takes on a dry, shiny and smooth appearance over time.
The papillae of the tongue often disappear with oral thrush. After about three to four days, irregular, whitish specks (deposits) the size of a pin appear. They resemble a grain of semolina and look creamy. The white deposits can be moved.
In addition, a yellowish layer forms and bad breath may occur.
Baby with whitish coating on the tongue, which also occurs with oral thrush © Victoria М | AdobeStock
As soon as the body begins to fight the pathogens, the lymph nodes swell. This is an indication that the immune system is increasingly active.
The damaged oral mucosa causes pain. Infants naturally react more sensitively to this and therefore often refuse to drink.
If oral thrush is not treated at an early stage, the pathogens can spread. Possible subsequent symptoms are vomiting and heartburn.
Oral thrush is mainly caused by Candida fungi, which are opportunistic pathogens. This means that they only trigger an infection if the living conditions are very favorable.
Many healthy adults have Candida fungi without any signs or symptoms of illness. As long as the immune system is intact, it can keep the fungi in check.
In infants and small children, however, the immune system is not yet fully developed. Therefore, the conditions for Candida fungi are very favorable.
Yeast fungi can be found in the birth canal of many pregnant women. This is why newborns often come into contact with fungi during birth. However, they can also be transmitted via
- the hands of the hospital staff,
- the mother's breast or
- from the oral cavities of the parents
be transmitted.
The ingested Candida fungi always settle first in the oral mucosa. Robust newborns excrete the yeast fungi again without contracting oral thrush. Starting from the oral cavity, the fungi then enter the throat
- into the throat,
- the oesophagus and
- the gastrointestinal tract.
There they spread further.
Risk factors for candidiasis are also
- an advanced age,
- immunodeficiency, e.g. AIDS, leukemia or recent chemotherapy,
- various medications such as cytostatic drugs, antibiotics, inhaled glucocorticoids (cortisone sprays for bronchitis and asthma), immunosuppressants
- a caries disease on the teeth,
- dentures,
- dry mouth caused by taking antidepressants, for example,
- virulence of the pathogen, and
- a diet rich in carbohydrates.
Cortisone and antibiotics also kill healthy bacteria and often lead to disturbed oral flora.
In the case of oral thrush infection, the body produces corresponding antigens. These can be detected in the blood so that the diagnosis can be confirmed. To do this, the doctor takes a swab from the white plaque or from tissue under the dentures.
The material is then microscoped with the addition of a saline solution.
However, antibody detection for oral thrush is often unreliable in immunosuppressed patients. The risk of invasive forms and chronic candidiasis should therefore always be assessed as part of oral thrush diagnostics. This includes the search for certain risk factors for oral thrush, such as
- Tumors
- underlying hemato-oncological diseases such as lymphoma or leukemia
- Diabetes mellitus
- Condition after organ or bone marrow transplants
- HIV infection
- Immunodeficiencies
- Long-term treatment with antibiotics
- Long-term treatment with glucocorticoids
- Cytostatic therapies
It also makes sense to clarify possible entry points for the pathogens that cause oral thrush. These include
- ill-fitting dentures,
- erosive diseases of the mucous membranes
- contaminated central venous catheter (CVC)
In addition, a fungal culture can be grown from the material on a suitable culture medium. This allows the exact type of pathogen to be determined.
Medical treatment with antimycotics
Oral thrush can be quite stubborn. For this reason, it is usually treated with antifungal medication (antimycotics). These are available in the form of suspensions or ointments that are applied to the affected areas.
The following are usually used for oral thrush
- Nystatin,
- miconazole or
- amphotericin B
in the form of lozenges or suspensions.
It is also very important to maintain a sufficient duration of treatment. As a rule, treatment is continued even after the symptoms have subsided. This ensures that the pathogens are really destroyed.
Oral thrush cannot always be successfully treated topically (locally). If other organs or the intestines are also affected by thrush, a stronger antifungal agent is used. It acts systemically, i.e. throughout the entire body. One effective medication is fluconazole, which is available as
- dry juice,
- juice or
- in capsule form
is available.
In immunocompetent infants, the polygenic drugs Amphotericin B or Nystatin are very suitable for the treatment of oral thrush.
Only take non-prescription medication after consulting your doctor. This also applies to the use of home remedies.
Supportive measures for the treatment of oral thrush
Those affected can also regularly rinse their mouth with myrrh as a supportive measure. Myrrh tinctures also have an antifungal effect. However, this form of therapy should be used at least one hour away from the antifungal medication. Otherwise irritation could occur.
Rinses with sage or arnica have a similar effect in treating oral thrush. These remedies also have an antiseptic effect.
Fungi feed on sugar. Those affected should therefore avoid foods containing sugar and yeast. Fruit juices and acidic foods also cause pain in the oral cavity with oral thrush. You should also avoid dairy products, as these have a mucus-forming effect.
Candida fungi also use teeth affected by caries as a reservoir. Careful dental hygiene is therefore essential during antifungal therapy. Also change your toothbrush regularly. Clean dentures with suitable antimycotic substances.
For infants, it is advisable to disinfect and boil soothers and teats.
Careful oral hygiene is a good way of preventing oral thrush.
Thorough hygiene and nipple care is recommended for breastfeeding mothers. If a breastfeeding mother suffers from oral thrush herself, she should not come into contact with the baby's oral mucosa. Also disinfect the teat and pacifier frequently!
If you suspect oral thrush, consult a doctor as soon as possible. A quick diagnosis and treatment will prevent the fungus from spreading.
