Thrush (Oral Candidiasis)
Thrush, or oral candidiasis, is a common yeast infection that develops in and around the mouth. It usually appears as a heavy, whitish coating on the tongue and as creamy patches that resemble milk curds on the mucous membranes of the mouth. The patches may spread to the gums, lips, throat, and skin. In severe cases, thrush may progress to the esophagus, which results in pain and difficulty swallowing. In rare instances, it enters the bloodstream and may affect various organs throughout the body; this serious complication develops mostly in patients with AIDS, cancer, or other disorders marked by reduced immunity.
Although thrush is generally painless, it can cause mouth soreness, especially in babies. Sometimes painful fissures develop on the corners of the mouth, and trying to wipe away the creamy patches may cause small, painful ulcers.
Thrush is caused by the common fungus called Candida albicans. Small numbers of the fungus normally reside in the mouth without creating problems. But if an illness or some other circumstance upsets the body's normal balance of these microorganisms, the yeast can overgrow and result in thrush.
Oral thrush occurs most commonly in newborns, who may pick up the yeast organism during birth or in a hospital nursery. Babies are especially vulnerable because their immune systems are not yet fully developed. It is also a frequent problem for AIDS patients, and may develop as well among people with diabetes and those taking antibiotics, corticosteroids, anticancer drugs, or other medications that suppress the immune system.
Diagnostic Studies and Procedures
An initial diagnosis can be made on the basis of the appearance and location of the creamy patches, but to confirm thrush, a doctor uses a swab to remove a small sample for study under a microscope. In most cases, the reason for the yeast overgrowth is obvious, but in some, tests may be necessary to determine the underlying cause. The testing procedures may include blood, urine, and bone-marrow studies, endoscopy, and testing for HIV, the virus that causes AIDS.
Medical Treatments
Nystatin, an antifungal drug that is available in pill, liquid, cream, ointment, lozenge, and powdered form, is the mainstay for treating oral thrush. A cream or ointment is applied directly to the patches. The oral solution is held in the mouth as long as possible and then swallowed. Lozenges should be allowed to dissolve slowly.
Gotrimazole (Mycelex Troche) lozenges are an alternative to nystatin. If neither of these drugs is effective, a doctor may prescribe a stronger antifungal medication such as ketoconazole (Nizoral). Systemic candidiasis is usually treated with an intravenous antifungal drug such as fluconazole (Diflucan). The complete course of antifungal medication should always be taken, rather than stopped when the symptoms disappear. Even when this procedure is followed, recurrences are common. In such cases, the treatment -- perhaps with a different drug regimen -- will be repeated.
Alternative Therapies
Herbal Medicine. Herbalists recommend alternating pau d'arco and clove tea, drinking three to six cups a day. Taking garlic pills or chewing a clove of raw garlic may also help.
Naturopathy and Nutrition Therapy. Because yeast thrives on sugar, naturopaths stress omitting it from the diet until the thrush subsides. This means avoiding fruit, milk and other dairy products, and the hidden sugar in many foods. The exception to the ban on dairy foods is yogurt made with live lactobacillus cultures. Lactobacillus acidophilus pills also help control yeast.
Self-Treatment
Thrush often results when a person is run-down and thus resistance is low. In general, getting enough sleep, exercising regularly, and maintaining a nutritious, balanced diet helps to prevent thrush and minimize the risk of other health problems that increase vulnerability. If you have a disease or are taking a drug that increases the risk of thrush, be especially scrupulous about dental hygiene. Brush your teeth after each meal and rinse your mouth with a solution of 1 tablespoon of hydrogen peroxide (3 percent strength) in 1/2 cup of warm water.
If you have thrush, you should take care to protect others from contracting it by sterilizing shared household items. Boiling all your eating utensils or using disposable items until the condition is completely cured will help keep the infection from spreading. After treatment, replace your toothbrush to prevent reinfection. To promote healing, rinse your mouth several limes a day with a solution of 1 teaspoon of salt in ft cup of water.
A baby who develops thrush should be given 1/2 ounce of cool, boiled water after each feeding to help rinse away any milk remnants, which may promote yeast growth. A newborn with thrush should be isolated from other babies in a hospital nursery.
Other Causes of Mouth Ulcers
Early oral cancer and a mouth condition called leukoplakia, which is often precancerous, can cause flat, white patches that resemble thrush on the tongue and oral mucous membranes. In children, scarlet fever produces a strawberry-colored tongue sometimes with overlying white patches.