Definition

Oral thrush, also known as mouth candidiasis, is a fungal infection caused by Candida albicans in the inner layer of the mouth or its surrounding areas. While Candida is a normal organism in the mouth, overgrowth can lead to symptoms. Oral candidiasis typically presents as white plaques in areas such as the tongue or inner cheeks and can extend to the roof of the mouth, gums, tonsils, or the back of the throat.

Certain groups of people are more susceptible to oral thrush, including infants and the elderly due to their relatively weaker immune systems, individuals with compromised immune systems or underlying diseases, and those taking specific medications. While oral thrush may be a mild issue in individuals with a healthy immune system, it can become more severe and challenging to control in immunocompromised individuals.

Causes

Normally, the immune system functions to eliminate harmful invaders such as bacteria, viruses, or fungi, maintaining a balance between beneficial and harmful microbes in the body. However, there are instances when the immune system fails, leading to an overgrowth of Candida in the mouth and causing oral candidiasis. Candida albicans is the most common type of fungus associated with this condition, and various factors, such as a weakened immune system, can increase the susceptibility to mouth candidiasis.

Risk factor

The risk factors for candidiasis include:

Immunocompromised or Weak Immune System

Oral thrush is more common in infants due to their weaker immune system. Certain medical conditions and treatments, such as cancer and its treatment, organ transplantation, and medications that weaken the immune system, can increase susceptibility to oral candidiasis.

Diabetes Mellitus

Untreated or uncontrolled diabetes can lead to saliva containing glucose, promoting the growth of Candida in the mouth.

Vaginal Candida Infection

Candidiasis in the vagina, caused by the same fungus as in the mouth, can result in a mother spreading the infection to her baby.

Other Factors

Medications like corticosteroids and antibiotics can disrupt the natural balance of microorganisms in the body, increasing the risk of mouth candidiasis. The use of false teeth, especially upper teeth, or conditions that cause dry mouth can also elevate susceptibility to candidiasis.

Symptoms

In the initial stage, oral thrush symptoms may not be noticeable, but the signs and symptoms can include:

For Adults and Children:

In the initial stage, the symptoms may not be felt. The signs and symptoms are:

• Cream-colored, slightly raised lesions resembling cheese on:
• Tongue
• Inner cheek
• Mouth ceiling
• Gum
• Tonsil
• Redness, burning sensation, and severe pain making eating or swallowing difficult
• Minor bleeding if brushed or grazed
• Red and cracked corners of the mouth
• Cotton-like feeling in the mouth
• Loss of taste
• Redness, irritation, and pain under false teeth or dentures (denture stomatitis)

in severe cases, especially in immunocompromised individuals like cancer or HIV/AIDS patients, candidiasis can spread to the esophagus (esophageal candidiasis). Esophageal candidiasis can cause difficulty swallowing, pain, and a sensation of food getting stuck in the esophagus.

For Infants and Breastfeeding Mothers:

Apart from the distinctive white plaque in the mouth, infants may experience difficulty eating or become irritable. The baby can transmit the infection to the mother through breastfeeding, leading to symptoms such as:

• Red, painful, cracked, and itchy nipples
• Shiny or scaly skin on the areola (the dark area around the nipple)
• Normal breastfeeding pain, especially in the nipple area
• Sharp pain in the breast

Diagnosis

The diagnosis of oral thrush depends on the infected area and the underlying cause of the disease.

Candidiasis Limited to the Mouth

To diagnose oral candidiasis, doctors and dentists typically:

• Examine the mouth to check for candidiasis spots.
• Take a small scrape of the white spots for examination under a microscope.
• If necessary, conduct a physical examination and specific blood tests to identify other health issues causing oral candidiasis.

Mouth and Esophageal Candidiasis

To establish the diagnosis, doctors may perform one or more of these tests:

• Conduct a biopsy examination where tissue samples are taken and cultured on special media to determine if other microorganisms are causing oral thrush.
• Perform an endoscopic examination. In this procedure, the doctor examines the esophagus, stomach, and upper part of the small intestine (duodenum) using an endoscope, a flexible, illuminated tube with a camera at its end.
• Conduct blood tests or physical examinations if necessary, to identify other health issues that may be contributing to oral candidiasis in the esophagus.

Management

The goal of treatment is to halt the spread of the fungal infection, with the choice of medication depending on the patient's age, overall medical condition, and the underlying cause of the infection. Addressing the root cause is crucial to prevent recurrence.

Antifungal medications, such as lozenges, swallowable tablets, or mouthwash solutions, are commonly recommended for adults and children. These medications help combat Candida overgrowth in the mouth. In cases where a breastfeeding mother and her baby are both affected, the doctor may prescribe mild antifungal medication for the baby and an antifungal cream for the mother's breasts. This approach aims to prevent the reciprocal spread of the infection between mother and child.

Patients with compromised immune systems, like those with cancer, autoimmune conditions, or HIV/AIDS, often receive antifungal medications as recommended by their doctors. It is important to treat oral thrush promptly in immunocompromised individuals. Oral thrush can recur if the underlying causes are not effectively addressed. Proper cleaning of false teeth and careful use of inhaled steroids are essential preventive measures.

Complications

Oral candidiasis is typically a manageable condition in healthy adults and children, but it can pose more serious challenges for individuals with compromised immune systems, such as those with cancer, autoimmune disorders, or HIV/AIDS. When left untreated, oral thrush has the potential to escalate and become more severe. In individuals with weakened immune systems, the infection may spread beyond the oral cavity, reaching areas such as the esophagus or other body parts.

Prevention

Reducing the risk of candidiasis involves adopting several preventive measures:

• After Using Inhaled Corticosteroids: To minimize the risk of candidiasis, wash your mouth with water or brush your teeth after inhaling corticosteroids.
• Oral Hygiene: Practice good oral hygiene by brushing or flossing your teeth at least twice a day or as your dentist recommends.
• Care for False Teeth: If you wear false teeth, remove them at night, ensure they are positioned correctly, and clean them daily. Consult your dentist for the best cleaning methods based on the type of false teeth.
• Regular Dental Check-ups: Schedule regular dental check-ups, especially if you use false teeth or have diabetes. Discuss with your dentist how often check-ups are advisable.
• Dietary Choices: Monitor your diet and limit the consumption of sugary foods, as excessive sugar intake can promote the growth of Candida.
• Diabetes Management: If you have diabetes, maintain your blood glucose levels. Controlled glucose levels help reduce the amount of sugar in saliva, limiting Candida growth.
• Prompt Treatment of Vaginal Candidiasis.
• Mouth Care: Take care of your mouth and consult with your doctor on how to prevent or treat dry mouth, which can contribute to developing candidiasis.

When to see a doctor?

If you or your child notices white spots in the mouth, it is advisable to consult with a doctor or dentist. While oral thrush is rare in healthy teenagers and adults, the presence of candidiasis symptoms in these groups should prompt a doctor's consultation. The healthcare professional can assess the symptoms and determine whether further examinations are necessary to identify any underlying medical issues that may be causing the symptoms.