Oral thrush: Symptoms

The classic symptom of oral thrush is a strongly reddened mucous membrane of the mouth, on which white spots lie. In the beginning, these spots look like small, milky white speckles, often on the inside of the cheeks and lips, but also on the palate or under the tongue (tongue fungus). These small deposits are usually easy to wipe off, and a red, shiny spot appears underneath them. Especially often the fungi nest in the mouth even under a dental prosthesis. In the further course of time, the spots multiply and enlarge and sometimes merge into larger white spots. When these are removed, the skin underneath begins to bleed slightly. Sometimes the mouth fungus spreads to the throat and the esophagus.

Doctors also refer to this appearance as acute pseudomembranous candidiasis – the most common form of oral thrush. Symptoms of a yeast fungus in the mouth are also

• Feeling of “furiness” and dryness in the mouth
• increased thirst
• Flavor disturbances (possibly metallic taste)
• Bad breath
• stinging sensation in the mouth

However, in many cases these symptoms do not occur at all as long as the mouth fungus is still in its early stages. For babies, however, oral thrush is often very unpleasant, so that they do not want to drink any more. When the fungus spreads, infants sometimes develop fungal plaques on their lips or in the corners of their mouths.

Mouth sores can look different

Basically, there are different forms of appearance. The mouth and throat do not always have to be covered with white film. Somewhat less common is acute erythematosis candidosis – it develops mainly under antibiotic therapy or in HIV infection, often as a result of pseudomembranous candidosis. Instead of plaques, a strong reddening of the mucous membranes and a burning sensation in the mouth are the main symptoms, especially the back of the tongue is often affected.

There is also the form of chronic hyperplastic candidiasis (also: candida leukopathy). Here, white coatings with red edges are found on the mucous membrane and tongue, which cannot be easily removed. This form of oral thrush is more common in people with immune system disorders and can persist for months or years.

Oral thrush: causes and risk factors

Oral thrush is usually caused by an infection with Candida albicans, a widespread fungus of the yeast family. It can also be detected in the oral cavity in about 50 percent of healthy people, and it is also frequently found in the intestines and on various mucous membranes.

Only in people with a weakened immune system does colonisation turn into a so-called opportunistic infection: the fungi use a gap in the immune system and start to multiply strongly. Therefore, oral thrush is typical for newborns and babies who do not yet have a pronounced immune system.

But older children and adults can also develop a fungal infection in the mouth – especially when the immune system is suppressed by medication or weakened by an illness. Older people with missing teeth and dentures are also at risk.

Besides Candida albicans, oral thrush can also be caused by other yeast fungi such as Candida tropicalis and Candida stellatoidea. However, these fungi rarely colonize the oral cavity of humans.

Oral thrush: Infection Mother-Baby

Newborns with oral thrush are usually already infected at birth, by a possibly unnoticed vaginal fungus in the mother. The fungus in the mouth then usually shows up in the first days of life – this happens in up to five percent of babies. Older babies, for example, get infected via pacifiers that have been in contact with the saliva of a caregiver. In the course of their lives, almost all people come into contact with Candida albicans once, but the infection only breaks out under certain circumstances. In addition to very low and very high age are other risk factors for mouth fungus:

• HIV infection and AIDS disease
• Diabetes mellitus
• Cancer (e.g. leukemia, Hodgkin’s disease)
• acute infectious diseases (e.g. pneumonia)
• Medication: Antibiotics, chemotherapeutic agents, cortisone containing asthma sprays
• Nutrient deficiencies (e.g. iron deficiency, vitamin B deficiency)
• decreased saliva production
• Nicotine consumption
• Dentures and other forms of dentures

Oral thrush: examinations and diagnosis

The diagnosis of oral thrush can be made by a dentist, a pediatrician, a dermatologist or a general practitioner. First of all, he asks the person concerned (or in the case of babies, the respective caregiver) which symptoms he has noticed and how long they have existed. He also asks about existing previous illnesses and wants to know whether the patient is taking medication.

The clinical picture determines the diagnosis oral thrush

The most important factor in the diagnosis of mouth fungus is the clinical picture. Usually the doctor can tell at first glance if there is thrush in the mouth – the white spots are characteristic. However, there may be a risk of confusion with leukoplakia, a precursor tumour. The doctor therefore uses a wooden spatula to carefully scrape off the coating in one place to check how the mucosa under the oral thrushes behaves. This enables him to quickly diagnose pseudomembranous candidosis.

If the fungus shows an atypical picture in the mouth, the diagnosis is not so easy. In any case, it is advisable to confirm the diagnosis of oral thrush by a smear of the affected mucous membrane. In this way the pathogens can be detected under the microscope. During a blood test, antibodies against the candida fungus are found in oral thrush, but usually no blood sample is required for diagnosis.

Oral thrush: treatment

For oral thrush treatment, the doctor prescribes special antifungal agents (antimycotics) suitable for the mouth and throat area. These include, for example, the active ingredients Amphotericin B and Nystatin. They can be used in the form of lozenges, mouth gel, solution or suspension (liquid with a pipette).

It is important that you adhere to the planned duration of treatment and do not interrupt the therapy prematurely when no more fungal plaque is visible. If you have a fungal infection in your mouth, you should also pay attention to careful oral hygiene. If your baby suffers from a mouth fungus, you should also replace all soothers and bottle teats or at least sterilise them thoroughly.

Oral thrush: Prevention

There are a number of measures that you can take to prevent oral thrush in your child and yourself:

• Hygiene is particularly important for babies and small children to prevent oral thrush. Clean soothers, teats and biting toys regularly and refrain from “cleaning” e.g. dropped soothers with your own saliva.
• If you wear a denture, make sure that it fits properly. Clean them thoroughly after each meal and maintain careful oral hygiene to prevent oral thrush.
• If you have an immune deficiency and develop thrush in your mouth again and again, it can be useful to use an antimycotic daily as a preventive measure. In any case, discuss this with your doctor.
• A vaginal fungus can be transmitted from mother to baby at birth and can manifest itself as oral thrush in the newborn. If you are pregnant, treatment of a possible candida infection before birth is definitely advisable.
• In very sick and elderly patients who are artificially fed, the saliva flow is usually reduced to such an extent that bacteria and fungi multiply quickly in the mouth. Nurses and nurses therefore practice so-called thrush and parotitis prophylaxis, for example by regularly moistening the mucous membranes of the person being cared for.

Oral thrush: course of disease and prognosis

If the therapy is carried out consistently, oral thrush can usually be treated well. In rare cases, however, oral thrush can be persistent and return again and again. Then the doctor sometimes prescribes a stronger antifungal agent, which is also effective in the rest of the digestive tract – especially in the intestines – reducing the number of fungi and thus controlling the oral thrush.