Oral candidiasis is an opportunistic infection that develops when Candida yeasts overgrow inside the mouth. It is also called oral thrush. It most often affects the tongue, the inside of the cheeks, the palate and the tissues under a denture.
For oral thrush to clear up, the diagnosis must be correct and the contributing factors must be identified. Treatment may involve adjusting oral care and using an antifungal medicine with a prescription. In recurrent or persistent cases, underlying health problems should be investigated.
What Is Oral Thrush?
Candida yeasts can live in many people's mouths without causing symptoms. When the balance in the mouth is upset, these microorganisms can multiply more than usual. This can lead to white plaques, redness, burning and a change in taste.
Oral thrush is relatively uncommon in healthy adults. It is seen more often in babies, older people and patients whose immune system is suppressed. Wearing dentures, dry mouth and some medicines can also increase the risk.
In adults, oral thrush is generally not regarded as an easily transmitted infection. However, it can pass back and forth between a baby and a breastfeeding mother. In that case, mother and baby may need to be assessed together.
What Are the Symptoms of Oral Thrush?
The symptoms of oral thrush can vary with the type of infection and the area affected. The best-known appearance is creamy white plaques on the tongue or inside the cheeks. The tissue under these plaques can be red, tender and bleed easily.
- White plaques on the tongue, inside the cheeks, on the palate or on the gums
- Redness, tenderness or burning inside the mouth
- Pain in the tongue and a cottony feeling
- Reduced sense of taste or a bad taste in the mouth
- Discomfort while eating, drinking or swallowing
- Redness and cracking at the corners of the lips
- Widespread redness or tenderness under a denture
Forcefully scraping the white areas at home is not appropriate. Doing so can cause bleeding, irritation and pain in the tissue. It is safer to have the appearance assessed by a dentist.
| Appearance | Possible Features | Assessment Note |
|---|---|---|
| Creamy white plaques | May leave a red, tender surface when wiped | May be consistent with pseudomembranous candidiasis |
| Red, shiny areas | Burning, tenderness and a change in taste may occur | Erythematous candidiasis can be considered |
| A white patch that does not wipe away | May form a thick or irregular surface | It must be told apart from other oral diseases |
| Redness under a denture | Usually causes limited pain or burning | The fit and cleaning of the denture should be examined |
| Cracks at the corners of the lips | There may be redness, soreness and crusting | Causes other than fungus may also be involved |
What Is Tongue Thrush?
Tongue thrush is an everyday term for candidiasis that shows up on the surface of the tongue. White plaques, red and smooth areas or burning may be seen on the tongue. A change in the sense of taste can also be part of the picture.
Not every white area on the tongue is fungal. A coated tongue, dry mouth, smoking and inadequate oral care can create a similar look. Geographic tongue, lichen planus and some white lesions can also be confused with thrush.
White areas that do not wipe away, become firm or last a long time in particular should be examined. A diagnosis of oral thrush should not be made for these lesions on appearance alone.
What Causes Oral Thrush?
Oral thrush may not come from a single cause. Local conditions in the mouth and general health can both play a part. The main factors that make it easier for Candida to multiply are:
- Recent or long-term use of antibiotics
- Use of corticosteroid inhalers prescribed by a clinician
- Not rinsing the mouth after using an inhaler
- Not taking removable dentures out at night or not cleaning them well enough
- Ill-fitting dentures irritating the oral tissues
- Reduced saliva and dry mouth
- Diabetes that is not under control
- Diseases or treatments that suppress the immune system
- Cancer treatment and radiotherapy to the head and neck area
- Use of cigarettes and other tobacco products
- Inadequate oral care and nutritional problems
Do not stop your medicines on your own because you suspect oral thrush. Changes to antibiotic and corticosteroid treatment should be planned by the relevant clinician.
One situation we often come across in our clinic is tongue and palate complaints in patients who do not rinse their mouth after using an inhaler. Keeping a denture in the mouth all night can also be a contributing factor.
How Is Oral Thrush Diagnosed?
The diagnosis is usually made with an oral examination, the medical history and an assessment of risk factors. The dentist looks at the location and color of the lesions and whether they wipe away. The medicines used and current illnesses are also asked about.
In cases that do not respond to treatment or recur often, a sample may be taken from the mouth. A laboratory examination can help to identify the Candida species. If needed, antifungal susceptibility testing may also be requested.
For white lesions that do not wipe away, other diseases must be ruled out. If the dentist considers it necessary, a biopsy or a referral to the relevant specialty can be planned. Medical investigations of blood sugar and the immune system may also be needed.
How Does Oral Thrush Clear Up?
Treating oral thrush is not only about removing the white plaques. Correcting the factors that make the infection easier is important for reducing the risk of recurrence. Treatment is decided according to the person and the severity of the picture.
Antifungal Treatment
In mild cases, topical antifungal medicines applied inside the mouth may be preferred. In widespread or severe cases, or when topical treatment does not work, systemic treatment can be considered. These medicines should be used with a prescription.
Antifungal medicines may interact with other medicines. Conditions such as liver disease, pregnancy and immune suppression affect the choice of treatment. For this reason, the type of medicine and the length of use are decided individually.
Correcting the Contributing Factors
Dentures should be cleaned properly every day and taken out of the mouth for the periods your dentist recommends. Ill-fitting dentures may need to be adjusted or replaced. Microorganisms left on the denture surface can contribute to the infection coming back.
If there is dry mouth, the cause should be investigated. The medicines used, salivary gland diseases and head and neck radiotherapy can affect the amount of saliva. After a clinical assessment, ways of keeping the mouth moist can be planned.
Blood sugar control is important in people with diabetes. If there is a known disease affecting the immune system, follow-up together with the relevant clinician may be needed.
Does Home Care Help With Oral Thrush?
Home care can support the prescribed treatment. However, clear oral thrush should not be expected to clear up with home methods alone. A product should not be used without a diagnosis, especially for white lesions appearing for the first time.
- Brush your teeth gently twice a day with a soft brush.
- Clean your dentures every day using the method your dentist recommends.
- Follow your clinician's advice about not keeping dentures in your mouth while you sleep.
- After using an inhaler, rinse your mouth with water and spit it out.
- Drink enough water to reduce dry mouth.
- Stay away from cigarettes and other tobacco products.
- Limit very hot, spicy or irritating foods until the complaints settle.
Rinsing gently with warm salt water can reduce the feeling of irritation. However, this does not replace antifungal treatment. Evidence for the effectiveness of vinegar, garlic or strong baking soda applications is limited, and they can irritate the tissue.
What Does Persistent Oral Thrush Mean?
Oral thrush that does not clear up means the diagnosis needs to be reconsidered. A white or red lesion may be due to another oral disease. A risk factor that makes treatment harder may also still be present.
- Medicines not being used as recommended
- The denture surface not being cleaned well enough
- Ongoing dry mouth
- Diabetes that is not under control
- A health problem affecting the immune system
- A different Candida species or antifungal resistance
- Another oral lesion that mimics a fungal infection
For lesions that do not heal despite an examination, a culture, a laboratory test or a biopsy may be needed. Repeating an antifungal medicine on your own can delay the diagnosis. Unnecessary use is also unwise in terms of drug interactions and resistance.
When Should You See a Dentist?
A dental examination is recommended when a white plaque, unexplained redness or constant burning appears in the mouth for the first time. When oral thrush develops in a healthy adult, investigating the contributing causes is especially important.
Do not put off an assessment if any of the following signs are present:
- Pain or difficulty when swallowing
- A feeling that food is sticking in the throat
- Lesions that spread quickly or cause severe pain
- Complaints that prevent eating and drinking
- White or red areas lasting longer than two weeks
- A lesion that does not wipe away, becomes firm or bleeds
- Fever or a marked decline in general condition
- A history of a disease or treatment that suppresses the immune system
Difficulty swallowing may suggest that the infection has spread to the throat or the food pipe. If there is difficulty breathing, emergency medical help should be sought. In babies, refusal to suck and signs of fluid loss should also be assessed without delay.
How Can Recurrent Oral Thrush Be Prevented?
Regular oral care and control of risk factors can reduce the chance of recurrence. In recurrent cases, simply using another medicine may not be enough. The underlying cause needs to be found.
- Have your dental and denture check-ups regularly.
- Follow the care instructions for removable dentures.
- Do not neglect oral hygiene after using an inhaler.
- Use antibiotics only with a prescription.
- Tell your dentist about any complaint of dry mouth.
- Continue your diabetes follow-up as advised by the relevant clinician.
- Do not try to scrape persistent tongue or mouth lesions at home.
The appearance of oral thrush can be confused with other diseases. For this reason, a correct diagnosis is the first step to safe treatment. Recurrent candidiasis in particular should be handled by assessing oral and general health together.
Frequently Asked Questions
Is oral thrush contagious?
In adults, oral thrush is generally not an easily transmitted infection. Because it can pass back and forth between a baby and a breastfeeding mother, they may need to be assessed together.
Does oral thrush clear up on its own?
Mild symptoms may ease once the contributing factor is removed. However, if there are white plaques, pain or burning, a correct diagnosis and a clinical assessment are needed.
How long does oral thrush take to clear up?
The healing time varies with the severity of the infection, the risk factors and the treatment given. If the symptoms do not improve, you should be examined again rather than repeating the medicine on your own.
Is every white area on the tongue fungal?
No. A coated tongue, dry mouth, geographic tongue and some oral lesions can look white. Areas that do not wipe away or that last longer than two weeks should be examined.
Which specialty should you see for oral thrush?
You can see a dentist for symptoms inside the mouth. If an underlying systemic problem is suspected, a referral can be made to the relevant medical specialty.
Do dentures cause oral thrush?
Wearing dentures on its own does not mean an infection. Dentures that are not taken out at night, not cleaned well enough or ill-fitting can make it easier for Candida to multiply.
Why does oral thrush come back?
If dry mouth, denture care, uncontrolled diabetes, some medicines or immune problems continue, the infection can recur. In recurrent cases, the underlying cause should be investigated.