• Thrush

    (Oral Candidiasis)

    Definition

    Thrush is a fungal infection of the mouth caused by an overgrowth of the yeast organism Candida albicans. Thrush usually begins on the tongue and inside of the cheeks and may spread to the palate, gums, tonsils, and throat. In severe cases, the infection may spread to the larynx (voice box), digestive tract, respiratory system, or skin.
    Thrush
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    Causes

    Many microorganisms live in the mouth, including yeast and bacteria. Thrush occurs when the normal balance of these organisms is upset. This allows an overgrowth of Candida (a form of yeast) to occur.

    Risk Factors

    A risk factor is something that increases your chance of getting a disease or condition. In this case, your risk factors are:
      Age:
      • Infants and toddlers
      • Elderly
      Weakened immune system due to:
    • Stress
    • Prolonged illness
    • Use of antibiotics
    • Use of corticosteroids, oral or inhaled
    • Diabetes
    • Hormonal changes, such as pregnancy or use of birth control pills
    • Dentures
    • Conditions that cause a dry mouth
    • Smoking

    Symptoms

    The symptoms of thrush occur in the mouth. Symptoms include:
    • White, raised patches
    • Red, slightly raised patches
    • Discharge with a curd-like appearance (like cottage cheese)
    • Thick, dark brownish coating in the mouth
    • Dry mouth
    • Fissures or cracks in the mouth
    If the infection spreads down your esophagus, you may also experience:
    • Difficulty or pain with swallowing
    • Sensation of something “stuck” in your throat
    If thrush spreads systemically, you may develop a fever.

    Diagnosis

    The doctor will ask about your symptoms and medical history, and examine your mouth. A sample of cells from the affected area may be scraped off and examined under a microscope.

    Treatment

    The goal of treatment is to restore the normal balance of bacteria and yeast in the mouth. Treatments may include:

    Antifungal Medication

    Thrush may be treated with lozenges, troches (a type of lozenge that dissolves in your mouth), tablets, or oral rinses, which you swish around your mouth and then swallow. Medications that are active against yeast include:
    • Nystatin (Bio-Statin, Nilstat)
    • Clotrimazole (Lotrimin, Mycelex)
    • Miconazole
    • Gentian violet (occasionally)
    Breastfeeding mothers of babies with thrush can use a topical antifungal medication on their nipples to reduce the baby's infection.

    Treatment of Underlying Medical Conditions

    Underlying conditions that may contribute to thrush can be identified and treated.

    Proper Oral Hygiene

    Oral hygiene practices that may aid in healing include:
    • Rinsing your mouth with warm salt water
    • Gently scraping off patches with a toothbrush
    If you are diagnosed with thrush, follow your doctor's instructions.
    If you are diagnosed with thrush, follow your doctor's instructions.

    Prevention

    Some preventive measures can be taken to reduce your risk of thrush.
    • Thrush in adults is associated with AIDS. Obtain a blood test for HIV and follow recommended prevention guidelines: use condoms and other protection and avoid needles except under sterile conditions.
    • If you are at high risk or prone to thrush, you may be given an antifungal medication as a preventive measure.
    • If you are prone to thrush, avoid overuse of mouthwashes and mouth sprays. These can upset the normal balance of yeast and bacteria in your mouth.
    • If your baby is prone to thrush and drinks from a bottle, use disposable nipples.
    • Avoid unnecessary use of antibiotics.
    • If you must take antibiotics, consider eating yogurt or using acidophilus tablets during antibiotic treatment and for several weeks thereafter.
    • Decrease intake of sugar and yeast-containing foods and beverages, such as bread, wine, and beer.
    • If you use a cortisone inhaler, rinse your mouth thoroughly after each use.

    RESOURCES

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

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

    CANADIAN RESOURCES

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

    Canadian HIV/AIDS Information Centre http://www.cpha.ca/

    References

    Beers MH. The Merck Manual of Medical Information—Home Edition . 18th ed. Pocket Books; 2006.

    Berkow R. The Merck Manual of Medical Information—Home Edition . Pocket Books; 1999.

    Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov . Accessed July 7, 2009.

    Cohen & Powderly: Infectious Diseases . 2nd ed. Mosby; 2005.

    Greenspan D, Greenspan JS. HIV-related oral disease. Lancet ; 1996.

    National Foundation for Infectious Diseases website. Available at: http://www.nfid.org . Accessed July 7, 2009.

    National Institute of Allergy and Infectious Diseases website. Available at: http://www3.niaid.nih.gov/ . Accessed July 7, 2009.

    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. Journal of Immunotherapy ; 2001.

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