Oral Thrush

Candida is a type of fungus found in the mucous membranes of the mouth and throat. We can see it in about half of the population. Although it is a member of the normal flora of humans, it can cause disease (oral thrush) in some cases. In candida infections, we see candida albicans most frequently (% 80).

Candida causes infections in the mouth, especially in cases where our immune system weakens. Or when we use antibiotics, corticosteroids, and other agents excessively. Accordingly, it is important to rinse the mouth with clean water after taking such drugs.

Oral Thrush Causes

Candida albicans is found in the oral mucosa, especially in the upper posterior region of the tongue. In some cases, it also causes infection of the gums, cheeks, palate, and throat. Candida infection can even go down to the esophagus.

Oral thrush is more common in women, people with O blood type, and those who have a carbohydrate-rich diet. Apart from this, candidiasis is also common among those who have dry mouth, frequent broad-spectrum antibiotics users, dental prosthesis users, smokers, regular alcohol users, frequent oral contraceptive users, immunosuppressed individuals, and hospitalized patients.

Mucosal damage

Oral mucosa forms a physical barrier against candida species. Scratches, cracks, crevices, lesions in the oral mucosa, chronic local irritants in the mouth facilitate candidiasis.

Dry mouth

Our saliva is the natural oral secretion that protects us against diseases. Saliva plays a major role in mechanically cleaning the mouth. Some substances in saliva (lysozyme, lactoferrin, lactoperoxidase, glycoproteins, histatins, secretory IgA, ..) have immune defense properties. In this respect, dry mouth or decreased saliva secretion makes the mouth weak against pathogens, especially candida.

Many drugs cause dry mouth. The best example of these drugs is the commonly used antidepressants. In addition, in patients who receive radiotherapy around the salivary glands, the radiation damages salivary glands and reduces salivary secretion. Dry mouth in such cases can cause candidiasis. In these cases, several oral care products (eg, ADA approved; Biotene Dry Mouth Oral Rinse, or as a different choice: TheraBreath Dry Mouth Oral Rinse, etc.) that are effective against dry mouth may be helpful.

Antibiotics

Broad-spectrum antibiotics disrupt the balance of flora in the mouth and facilitate candida infection. There are many microorganisms (bacteria, fungi, viruses,..) in a normal oral flora. Under normal conditions, these microorganisms do not cause disease. However, broad-spectrum antibiotics change the balance of flora in the mouth by affecting many types of bacteria in the flora. Thus, the flora of the fungi that are not affected by antibiotics expands and reproduces rapidly and causes diseases. Frequent use of antibacterial mouthwashes also disrupts the balance of flora in the mouth, just like antibiotics.

Oral hygiene and dental prostheses

If the oral hygiene is insufficient or the person doesn’t remove the dentures while sleeping and doesn’t clean them regularly, these conditions may lead to candida infection. In particular, ADA approved; Efferdent cleanser series (Complete Clean and Overnight Whitening), Fresh’n Brite Denture Cleaning Paste, Cleanadent Cleansing Wipes, etc. are helpful in these situations.

Immunological factors

Candida infection in the mouth becomes easier in cases of immunodeficiency (especially in childhood), weakened immunity (malabsorption, malnutrition, etc.), and suppressed immunity (corticosteroid therapy, malignancies, chemotherapy, radiotherapy, bone marrow transplantation, HIV). For example, in organ transplants, the patient receives immunosuppressive treatments to prevent the body from rejecting the transplanted organ. This creates the ground for candida infection.

Endocrine factors

Endocrine disorders such as diabetes and hypoparathyroidism increase the risk of candida infections. During pregnancy, the risk of candida infection increases as there are hormonal changes.

Oral Thrush Symptoms

In the case of oral candidiasis, we can see cheesy, white lesions most commonly on the tongue, inner cheeks, gums, palate, and tonsils. Although we don’t see it in everyone, pain in the form of tenderness and burning may be felt in the lesion areas. There may be a feeling of cotton in the mouth and a bad taste. When the infection reaches the tonsils and esophagus, there may be pain and difficulty in swallowing. Oral thrush can cause feeding difficulties, moodiness, insomnia, and irritability in infants and children due to pain while eating.

Types

Pseudomembranous candidiasis is usually the most common type and the most common acute form of oral thrush. The most common chronic forms are prosthetic stomatitis, angular cheilitis, and sometimes candidal leukoplakia. Median rhomboid glossitis, which is less common, is sometimes confused with cancer, based on its appearance. Other types are less common.

Pseudomembranous candidiasis

We usually see acute pseudomembranous candidiasis in young children. If it occurs in adults and the elderly, this indicates another underlying cause. Acute pseudomembranous candidiasis causes easily removable (temporary) white lesions in the mouth, but in chronic forms, we cannot scrape off the lesions.

The lesions are milky foamy and maybe slightly yellow in color with the accumulation of food. We can easily remove these white lesions by scraping them with gauze. After removal, the underlying necrotic, erythematous tissue reveals. In the case of scraping the lesions, there may also be mild bleeding. Although some are difficult to treat, infections caused by candida albicans are usually superficial. Lesions disappear with treatment.

Prosthetic stomatitis

Prosthetic stomatitis, is a chronic form of oral thrush. Its main causes are not removing the dentures regularly (especially while lying down), not cleaning them, and poor oral hygiene. In these cases, we can see oral thrush mostly in the upper jaw and roof of the mouth. The reason why we don’t see frequently in the lower jaw and floor of the mouth is that the saliva washes them more.

Angular cheilitis

Angular cheilitis (angular stomatitis), another chronic form of candidiasis, is also common. Candida albicans and staphylococcus aureus both may cause this disease. In this case, there is inflammation of the corners of the mouth. We can generally see it in adults and both sexes.

Prosthesis use, dry mouth, hypersalivation, smoking, iron deficiency, Vit B deficiency, zinc deficiency, malabsorption (especially Crohn’s disease), Down syndrome, HIV positivity, diabetes, cancer, radiotherapy, chemotherapy, immune system disorders facilitate the formation of angular cheilitis. For example, in people with mental retardation, we can cite the flow of saliva from the corners of the mouth as an example of hypersalivation. However, in this case, the saliva secretion is actually not much, but in appearance.

Angular cheilitis is sometimes difficult to treat and the treatment takes a long time. First of all, it is necessary to quit smoking. If there are systemic factors that trigger the disease, elimination, and treatment of them should be first. For example, we should correct vitamin deficiency, if any.

If staphylococcus aureus is isolated from the wound, topical antibiotic therapy is necessary. Apart from these, epithelization-enhancing drugs are useful for angular cheilitis. However, in cases of detection of candida albicans in the lesion, these treatments may not be sufficient. At this time, it is necessary to start treatments for the fungus.

Candidal leukoplakia

Candidal leukoplakia (chronic hyperplastic candidiasis) causes a continuous and unremovable white lesion in the mouth. We can see this disease in both sexes. In the patient’s mouth, there are chronic, slightly elevated, palpable, whitish, sometimes opaque plaques. It usually occurs on the inner cheeks and especially near the corners of the mouth.

Candidal leukoplakia is more common in smokers, those with iron and folate deficiencies, cellular immunity disorders, and blood group O. Chronic hyperplastic candidiasis can sometimes develop into cancer. In this respect, if the risk of malignancy is seen in the biopsy, the surgeon should remove it completely. Tobacco use and alcohol consumption, the degree of dysplasia, and the patient’s adherence to treatment are factors that affect the prognosis of the disease.

Oral Thrush in Babies

Oral thrush can also be seen in newborns. Normally, the baby is born sterile and begins to meet microorganisms as soon as he is born. However, since vaginal candidiasis carriers are high among women, it also transmits to the baby while passing through the birth canal.

Candida infection can also develop in newborns through mouth-to-mouth transmission from the mother’s nipple. In such cases, transmission between mother and baby becomes a cycle.

Since the newborn’s immunity is not yet developed, it is vulnerable to an oral thrush infection. But oral thrush in newborns is easy to treat.

Diagnosis

Diagnosis of oral fungal infections is made based on the patient’s history, clinical presentation, and evaluation of the culture/biopsy taken from the lesions. In general, the doctor first takes a culture from the mouth (from saliva, lesion, or any suspected site) to determine the cause of the infection.

Not every white lesion seen in the mouth is fungal. Therefore, it is necessary to make sure that the white appearance is really candida.

Treatment for Thrush

If candida albicans grows in culture and the growing size is within normal limits, the doctor or dentist performs local drug treatment. But before local treatment, the patient’s oral hygiene should be in good condition. After that, we can treat oral thrush very easily with locally used drugs. If candida growth is severe in culture, it will be necessary to use both local and systemic drugs.

Even if candida is present in the mouth, it is not correct to give systemic drugs in all cases. Because systemic drugs against fungi are very toxic to the liver. Therefore, it is necessary to make a very good diagnosis in all fungal infections, including candida, and if necessary, give systemic medication after that.

It is easy to treat superficial candida albicans infection with nystatin suspensions and clotrimazole. However, in more resistant cases, fluconazole preparations are recommended. If the candida infection leaves the patient, flucytosine preparations can be used.

Treatment of oral thrush with systemic drugs may take 1-2 weeks depending on the type of drug. After simultaneous treatment with both local and systemic drugs, it is necessary to rest for 1 week. Then the patient gives culture again. If there is no candida growth in the culture, the doctor or dentist stops the treatment. If candida reproduces in the culture, then treatment with more effective antifungal drugs continues. In this case, oral hygiene of the patient has importance in the effectiveness of the treatment.

Home Remedies for Thrush

Sodium bicarbonate, a base-based substance used in pastries, is used in the treatment of oral thrush. For this, we put half a teaspoon of sodium bicarbonate in a glass of boiled water and mix it. With this, if the patient gargles his mouth 3-4 times a day, it will relieve the burning and pain in the mouth and will be very comfortable. In the baby, oral thrush will disappear if we wet the sterile gauze with sodium bicarbonate water and wipe the baby’s mouth several times a day.

Conclusion

Many complications can occur if oral candidiasis remains untreated. These can be spleen abscess, arthritis (joint inflammation), esophagitis (inflammation of the esophagus), meningitis (inflammation of the meninges), malnutrition, peritonitis (inflammation of the peritoneum), carditis (inflammation of the heart valves). So, a fungal infection in the mouth can sometimes be fatal. Accordingly, oral candidiasis is a condition that the patient should approach seriously.