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Definition

Thrush is an infection of the mouth caused by a fungus. It usually begins on the tongue and inside of the cheeks, and spread to the roof of the mouth, gums, tonsils, and throat.

Thrush

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Causes

Thrush is caused by a fungus. The immune system can normally fight off this fungus but the fungus can grow and spread if the immune system is weakened.

Risk Factors

Certain situations can weaken the immune system either in the body or locally in the mouth. A weakened immune system increases your risk for thrush. Factors that can weaken your immune system include:

  • Certain medications such as:
    • Corticosteroid inhalers
    • Medications that treat psychiatric conditions
    • Antibiotics
  • Imbalance of healthy microorganisms in the mouth which can be caused by:
    • Wearing dentures
    • Prolonged illness
    • Conditions that cause a dry mouth
Symptoms

In some cases, you may not have symptoms. In those that have symptoms, thrush may cause:

  • White or red patches on the inside of the cheeks or tongue that may or may not come off when rubbed
  • Sore mouth or throat
  • Difficulty swallowing
  • Differences in taste
  • Fissures or cracks in the mouth

Thrush can spread beyond the mouth. Complications include infections that spread to the:

  • Esophagus—the tube that carries food from the mouth to the stomach
  • Urinary tract
  • Whole body—systemic infection causes multiple organ failure and death
Diagnosis

Your doctor will ask you about your symptoms and medical history. A physical exam will be done, including an inspection of your mouth. Diagnosis can usually be made based on your symptoms. Your doctor may take a sample of cells from the affected area to examine under a microscope.

Treatment

The goal of treatment is to restore the normal balance of bacteria and yeast in the mouth. If any underlying conditions contribute to thrush, they will also be treated.

Treatments include:

Medications

Antifungal medications are used to treat thrush. Medications come in the form of tablets, rinses, or lozenges that dissolve in the mouth.

If you wear dentures, clean and brush them daily. You also need to clean the inside of your mouth and tongue with a soft-bristled toothbrush.

Proper Oral Hygiene

Oral hygiene practices may aid in healing. This includes:

  • Rinsing your mouth out with salt water
  • Gently scraping off patches with a toothbrush
  • Brushing your teeth at least twice per day
  • Flossing your teeth at least once per day
Prevention

To help reduce your chance of getting thrush, take these steps:

  • Maintain proper oral hygiene.
  • If you have a condition that affects your immune system, ask your doctor about taking antifungal medication as a preventive measure.
  • Limit your use of mouthwashes and mouth sprays. These can upset the normal balance of yeast and bacteria in your mouth.
  • If you use a corticosteroid inhaler, rinse your mouth thoroughly after each use.

RESOURCES:

Centers for Disease Control and Prevention
http://www.cdc.gov

National Foundation for Infectious Disease
http://www.nfid.org

CANADIAN RESOURCES:

Canadian Dental Association
http://www.cda-adc.ca

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

References:

Adults healthy habits. American Dental Association Mouth Healthy website. Available at: http://www.mouthhealthy.org/en/adults-under-40. Accessed December 9, 2013.

Dentures. American Dental Association Mouth Healthy website. Available at: http://www.mouthhealthy.org/en/az-topics/d/Dentures. Accessed December 9, 2013.

Greenspan D, Greenspan JS. HIV-related oral disease. Lancet. 1996;358:9029).729-733.

Oral candidiasis. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/fungal/Candidiasis/thrush. Updated May 6, 2013. Accessed December 9, 2013.

Oral candidiasis in children and adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 1, 2013. Accessed December 9, 2013.

A prospective, randomized, double-blind, placebo-controlled trial evaluating the effects of nystatin on the development of oral irritation in patients receiving high-dose intravenous interleukin-2. J Immunother. 2001;24(2):188-192.



Last reviewed December 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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