Oral Thrush: Information & Doctors Specializing in Oral Thrush

Oral thrush is particularly common in babies. Infants also often suffer from another fungal infection, which manifests in the diaper area and is known as “diaper thrush.”

In 22 to 24 percent of all babies, Candida fungi can be detected in the mouth during the first two months of life. 95% of these cases also exhibit symptoms of oral thrush.

Candida infections have increased over the past ten to twenty years. However, the transition from a harmless infection to a symptomatic one is often gradual.

Acute oral thrush typically begins with redness of the mucous membrane. Over time, the mucous membrane takes on a dry, shiny, and smooth appearance.

Often, the papillae on the tongue also disappear with oral thrush. After about three to four days, pinhead-sized, irregular, whitish specks (deposits) appear. They resemble grains of semolina and have a creamy appearance. The white coatings can be moved around.

In addition, a yellowish layer forms, and bad breath may occur.

Baby with a whitish coating on the tongue, which also occurs with oral thrush © Victoria М | AdobeStock

As soon as the body begins to fight off the pathogens, the lymph nodes swell. This is a sign that the immune system is working harder.

The damaged oral mucosa causes pain. Infants are naturally more sensitive to this and therefore often refuse to drink.

If oral thrush is not treated in its early stages, the pathogens can spread. Possible complications include vomiting and heartburn.

Oral thrush is mainly caused by Candida fungi, which are classified as opportunistic pathogens. This means they only cause an infection when conditions are very favorable.

Many healthy adults carry Candida fungi without experiencing any signs or symptoms of illness. As long as the immune system is functioning properly, it can keep the fungi in check.

In infants and toddlers, however, the immune system is not yet fully developed. This makes conditions very favorable for Candida fungi.

Yeast fungi are found in the birth canal of many pregnant women. As a result, newborns often come into contact with these fungi during birth. They can also be transmitted via

• the hands of hospital staff,
• the mother’s breast, or
• the parents’ mouths

.

Once ingested, Candida fungi always first colonize the oral mucosa. Healthy newborns excrete the yeast without developing oral thrush. From the oral cavity, the fungi then travel

• into the throat,
• the esophagus, and
• the gastrointestinal tract.

There, they continue to spread.

Risk factors for candidiasis also include

• advanced age,
• immunodeficiency, e.g., AIDS, leukemia, or recent chemotherapy,
• various medications such as cytostatics, antibiotics, inhaled glucocorticoids (cortisone sprays for bronchitis and asthma), and immunosuppressants
• dental caries,
• dental prostheses,
• dry mouth, caused, for example, by taking antidepressants,
• the virulence of the pathogen, as well as
• a high-carbohydrate diet.

Cortisone and antibiotics also kill healthy bacteria and often lead to an imbalance in the oral flora.

In the case of an oral thrush infection, the body produces corresponding antigens. These can be detected in the blood, allowing for a definitive diagnosis. To do this, the doctor takes a swab, for example, from the white patches or from tissue under the dentures.

The sample is then examined under a microscope after adding a saline solution.

However, antibody detection for oral thrush is often unreliable in immunocompromised patients. As part of the diagnosis of oral thrush, the risk of invasive forms and chronic candidiasis should therefore always be assessed. This includes screening for specific risk factors for oral thrush, such as:

• tumors
• underlying hematological malignancies such as lymphomas or leukemia
• Diabetes mellitus
• Condition following organ or bone marrow transplants
• HIV infection
• Immune deficiencies
• Long-term antibiotic therapy
• Long-term treatment with glucocorticoids
• Cytostatic therapies

It is also advisable to investigate possible entry points for the pathogens that cause oral thrush. These include:

• ill-fitting dentures,
• erosive diseases of the mucous membranes
• contaminated central venous catheters (CVCs)

Furthermore, a fungal culture can be grown from the specimen on a suitable culture medium. This allows the exact type of pathogen to be identified.

Medical treatment with antifungal medications

Oral thrush can be quite persistent. For this reason, treatment typically involves antifungal medications (antimycotics). These are available as suspensions or ointments that are applied to the affected areas.

Nystatin is usually prescribed for oral thrush

• nystatin,
• miconazole, or
• amphotericin B

in the form of lozenges or suspensions.

It is also very important to complete the full course of treatment. As a rule, treatment is continued even after the symptoms have subsided. This ensures that the pathogens are completely eliminated.

Oral thrush cannot always be successfully treated topically (locally). If other organs or the intestines are affected by thrush, a stronger antifungal medication is used. It acts systemically, meaning throughout the entire body. One effective medication is fluconazole, which is available as

• dry syrup,
• syrup, or
• capsules

.

For immunocompetent infants, the polygenic drugs amphotericin B and nystatin are very well-suited for treating oral thrush.

Do not take over-the-counter medications without first consulting a doctor. This also applies to the use of home remedies.

Supportive Measures for Treating Oral Thrush

To support treatment, those affected can also regularly rinse their mouths with myrrh. Myrrh tinctures also have antifungal properties. With this form of therapy, however, you should wait at least one hour after taking the antifungal medication. Otherwise, irritation may occur.

Rinses with sage or arnica also have a similar effect in treating oral thrush. These remedies also have antiseptic properties.

Fungi feed on sugar. Therefore, those affected should avoid foods containing sugar and yeast. Fruit juices and acidic foods can also cause pain in the mouth when oral thrush is present. You should also avoid dairy products, as they can increase mucus production.

Candida fungi also use teeth affected by cavities as a reservoir. Therefore, careful oral hygiene is essential during antifungal treatment. Be sure to replace your toothbrush regularly. Clean dentures with suitable antifungal agents.

For infants, it is recommended to disinfect and boil pacifiers and nipples.

Thorough oral hygiene is an effective way to prevent oral thrush.

For breastfeeding mothers, thorough hygiene and care of the nipples is recommended. If a breastfeeding mother has oral thrush herself, she should avoid contact with the infant’s oral mucosa. Also, disinfect the nipple and pacifier frequently!

If you suspect oral thrush, see a doctor as soon as possible. A prompt diagnosis and treatment prevent the fungus from spreading.