Oral Thrush

Written By Sharon Boyd, RDH, BS.       |       Reviewed by Lara T. Coseo, DDS

Definition

oral-thrush

What is oral thrush? Thrush is a fairly common infection of the mouth due to a yeast infection. Typically the infection lasts for about two weeks and appears as a white velvety patch, or sometimes red, raw skin.

Also known as candidiasis, this is a fungal infection caused by the candida albicans fungus, or yeast. Candidiasis is the most common form of fungal infection, typically in those with a reduced immune function. Oral thrush usually presents white lesions on the tongue or cheeks, but can spread to the gums, tonsils, throat, and the roof of the mouth. Healthy individuals can experience thrush, but it's found more frequently in those with compromised immune systems. If you are healthy, it can be treated pretty easily, however, in those with weaker immune systems the symptoms can be much more severe and more difficult to manage.

Causes

What causes oral thrush and yeast infections? Thrush is due to an imbalance in the natural oral flora in the mouth. Certain people are more likely to develop thrush than others. Common risk groups include:
  • Infants
  • Elderly
  • Denture wearers
  • Immunocompromised (diabetes, HIV/AIDS)
  • Poor oral hygiene
  • Xerostomia (dry mouth)
  • Use of steroid, antibiotic or asthma medication
  • Chemotherapy

People with suppressed immune systems are more likely to develop infections like oral thrush. Diabetics may have a difficult time managing the infection due to elevated blood sugar levels. Because yeast feeds off of sugar, imbalances in diabetics may make the infection worsen. Typically most of the above-listed factors are the primary causes for oral thrush. (1)  

Signs And Symptoms

Because thrush can affect different parts of the body, the signs and symptoms can vary greatly from case to case. It usually develops suddenly, but can become chronic and persist over a long period of time. The most common sign of thrush is the presence of creamy white, slightly raised lesions in the mouth. These lesions, which may have a "cottage cheese" appearance, can be quite painful and may bleed if scraped or when brushing your teeth. 

Other symptoms associated with thrush are oral discomfort, pain when eating, loss of taste, dry mouth, fever, pain when swallowing, pain in and behind the breast bone area, painful eyes, gradual decrease in vision, joint pain, painful or increased urination, constipation, neck stiffness, diarrhea, nausea, loss of appetite, headache, or symptoms of heart failure such as ankle swelling and shortness of breath.

Most yeast infections are not painful, but they may be uncomfortable in some people depending on the severity.

Dangers And Health Risks (If Any)

It is very rare for oral thrush infections to cause severe adverse reactions although it is worth mentioning that severe infections that are uncontrolled may possibly place other parts of the body at risk due to spread of infection through the touch or cardiovascular system. Examples of increased secondary infection sites are the eyes, esophagus, heart and brain.

The real danger of thrush is that it can easily spread to and affect other parts of the body if your immune function is not performing properly. This can be a result for those who suffer from immune dysfunctions like HIV or AIDS, or those who are undergoing chemotherapy or radiation therapy for different forms of cancer. In these cases where it spreads there have been numerous cases of death from the infection.

How To Prevent Oral Thrush

clean-dentures
Prevention of thrush weighs heavily on how well you can control the contributing factors. The candida fungus will always be around, it's just a matter of maintaining the environment required to keep it in check. 
Practicing good oral hygiene and maintaining a healthy lifestyle are the best ways to prevent oral thrush or yeast infections. Some simple ways to prevent oral thrush include:
  • Practice good oral hygiene every day – brush, rinse, and floss
  • Use pure botanical ingredients to kill the bad bacteria that lead to oral health problems
  • Limit the use of antibiotic or steroid medication
  • Give up smoking
  • Replace your toothbrush frequently or after illnesses
  • Remove dentures and clean them thoroughly each day
  • Manage blood sugar levels

Treatment

The goal in any treatment of thrush is to prevent the spread of the fungus, but the best approach to this may vary on your age, health, and the cause of the infection. For nursing mothers and babies suffering from thrush, it is likely that both mother and child will be treated. Doctors may prescribe the antifungal medication for the baby and creams for the mother. This is important, because otherwise you could be continually passing the infection back and forth. For adults or children who are otherwise healthy, anti-fungal medications are a normal treatment. However, eating unsweetened yogurt can help restore the normal bacteria in the mouth and thus help regulate the candida fungus. In those with compromised immunity, candida can often build resistance to medications, so be sure to consult your doctor.

Oral thrush treatment can be through conventional or home remedies. Natural, over-the-counter treatments to get rid of oral thrush are typically successful but professional intervention may be needed if the infection is too severe.

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Conventional Treatment

Your dentist will most likely recommend that you use preventive home remedies to help clear up your fungal thrush infection. For severe cases of oral thrush, your dentist or doctor may recommend:

  • Prescription antifungal medication
  • Topical medication in the form of a mouth rinse

Home Remedies

Home remedies for oral thrush include:

  • The use of essential oils (2)
  • Decreased sugar intake (yeast thrives on sugar)
  • Increased intake of yogurt or acidophilus
  • Giving up smoking

  Here are some more things to know about oral health nutrition. Here’s more essential oils benefits.   

Oral Thrush In Babies

baby-sore-throat    

Causes

It is very common for young infants or babies to develop yeast infections or thrush in the mouth. This may be due to breastfeeding by a mother who is taking antibiotics, poor hygiene of bottle nipples or pacifiers, or in some cases from unknown reasons.    

Trace amounts of candida fungi are always present on the skin and in the mouth and digestive system of most healthy people. These fungi are usually kept in check by other bacteria and other micro-organisms. Certain illnesses, stress and medications can alter the environment in the body to make it more susceptible to infections. When these situations present themselves, candida fungi can grow out of control and cause thrush.

Uncontrolled diabetes, cancer, dry mouth, pregnancy, and HIV are health conditions that can create environments that are more likely to be susceptible to thrush. Ill fitting dentures can be another risk factor, as well as smoking. Infants are often more likely to be affected by thrush as sometimes their immune systems, are still developing, and in this case they can pass it to their mothers while breast feeding. Medications like birth control pills and antibiotics can upset the balance as well as they can eliminate some of the helpful bacteria that normally regulate candida.

Prevention

Always keep your child’s mouth clean, as well as any nipples or pacifiers that they use. Infants can have their mouth cleaned with warm water on a soft washcloth, gently wiping the tongue, roof of mouth, gums and inside of the cheeks. Mothers who breastfeed will want to use good hygiene habits to prevent spread of infection to their child, and treat any yeast infections in themselves appropriately.  

Treatment And Remedies

Infants that develop oral thrush should have all of their pacifiers or bottle nipples sterilized or thrown away. Using a soft washcloth to wipe the child’s mouth and remove some of the bacteria by improving hygiene can help the infection go away.

Conventional Treatment

In severe cases, prescription medication such as pilocarpine or cevimeline may be used to manage xerostomia and get rid of dry mouth.  

Your Questions Answered About Oral Thrush

Is oral thrush contagious?

The fungus can be spread. You should change out your toothbrush. Infants with thrush should have pacifiers and bottle nipples sterilized or replaced.

How long does oral thrush take to heal?

Most oral thrush infections don't last too long and should go away within two weeks.

What causes oral thrush?

Oral thrush is a yeast infection due to an imbalance of natural flora or bacteria in the mouth. Typically the infection is due to lack of adequate hygiene or a compromised immune system, allowing the yeast or fungus to infect the area.

Who can get oral thrush?

Most people who get oral yeast infections are the very young of elderly. Other people who get thrush of the mouth may have recently taken antibiotics, be diabetic, have a compromised immune system or smoke.

What does thrush look like?

Usually thrush infections look like white film or velvet on the surface of the tongue or roof of the mouth. In some cases a red, raw patch of skin may also be visible.  

Is oral thrush painful?

Thrush can cause red, raw tissues inside of your mouth. Because of this characteristic, it’s often painful or causes “burning mouth syndrome.” 

Is it painful for babies?

Babies with oral thrush may seem especially fussy or unable to eat due to discomfort.

Why is it painful?

When the bacterial layer of thrush is wiped away, it reveals completely raw, exposed tissues.

What does oral thrush feel like?

Usually, oral thrush causes soreness or sensitivity on your gums and various areas inside your mouth. You may also experience symptoms of burning mouth syndrome (a separate oral condition that may be confused with oral thrush.)

Can it cause headaches?

Unless the thrush is severe and has spread to other parts of your body, you likely won’t experience any systemic symptoms like a headache or fatigue. However, if you have a compromised immune system (which can predispose you to thrush) you are more likely to experience secondary symptoms.

Does it make you tired?

People with oral thrush as well as an accompanying viral infection or immune deficiency are likely to experience symptoms of fatigue.

Does it get worse at night?

It may seem worse when you wake up in the morning, because of your mouth being dried out overnight. Xerostomia (dry mouth) may make it worse, as a lack of saliva allows bacterial levels to rise more easily.

What’s oral thrush look like?

A classic oral thrush case will look like a layer of white that can be wiped off of your cheek, leaving red and exposed tissues behind.

Will it look yellow?

Thrush on your tongue may take on other colors, such as yellow, based on what you eat.

Is it always white?

Usually, oral thrush is always white.

Can it be scraped off?

A classic symptom of yeast infections like oral thrush is being able to wipe it off of your skin.

Can you wipe it off?

Yes, such as with a washcloth. Bacteria on your tongue can be cleaned off with a tongue scraper. However, you should decontaminate it between uses.

Where and how did oral thrush start?

Like any type of infection, thrush starts by having an imbalance of bacteria inside of your mouth, usually caused by poor oral hygiene habits, antibiotic use, or an immune disorder.

How did I get it?

Oral bacteria can cause infections like thrush at any point, if bacterial levels (good or bad) become imbalanced. Viruses can also cause oral thrush, which can be spread through kissing, drinking/eating after someone, taking antibiotics, or putting unwashed hands in your mouth.

When do you get it?

If you’ve recently been ill, wear a removable dental prosthesis (such as a denture,) have an immunological disorder, or are an infant or senior, you are more prone to getting thrush.

Can anyone get it?

Oral thrush usually affects infants and seniors, but anyone with a weak immune system can develop it.

Does it go away on its own?

Usually not. Special steps must be taken including modified home care and the use of supplements.

Where does it come from?

Oral thrush is an overgrowth of normal bacteria inside of your mouth.

How did it start?

It is a type of yeast infection. When your typical body flora become imbalanced at any point, infections like oral thrush are allowed to develop.

Why does it keep coming back?

Your body may be having a hard time getting normal bacterial levels back in check, such as following a chronic infection, antibiotic use, cancer diagnosis, or other immune deficiencies.

Could I have had it for years?

The bacteria that cause oral thrush are a part of your normal oral flora. However, imbalances may occur for extended lengths of time. Usually the only time it lasts longer than a month or two is if a more serious medical condition is to blame.

Did antibiotics cause it?

Antibiotics can cause oral thrush, as other types of GI issues or yeast infections.

Is there a good probiotic for it?

As with other types of yeast infections, some people see improvement in symptoms or reduced risk of thrush by taking probiotics. However, they should be the type of probiotic that’s designed for oral biofilm, not other parts of the body (since different types of bacteria are found in different locations.)

Are there any foods I should avoid?

Avoid eating anything that could cause your mouth to burn, such as acidic foods. High carb foods should be limited, such as white breads, which may “feed” the thrush-causing bacteria.

Any foods I should eat?

A properly balanced diet can help to boost your immune system to help your body fight off the fungal infection. A multivitamin may also help.

Can my diet affect it?

Yes. Carbohydrates may add to the level of thrush-causing bacteria.

Did yogurt affect it?

Some people find it beneficial to eat yogurt regularly while they’re taking antibiotics, to reduce their risk of yeast infections and oral thrush.

Should I be scared?

Unless you have a chronic immune deficiency or are medically compromised, there’s usually nothing to be afraid about when it comes to oral thrush.

Is oral thrush normal?

Technically, no. Oral thrush is caused by unnormal levels of bacteria. That being said, it is a fairly common type of yeast infection.

Is it caused by stress?

Stress can reduce your body’s resistance to infection, thereby making you more prone to getting oral thrush.

When is it serious?

Thrush should always be taken seriously, as it is an opportunistic type of infection.

How come oral thrush won’t go away?

Unless the bacterial levels are changed inside of your mouth, it is impossible for thrush to go away.

Will it go away on its own?

Not usually. Special home care and supplements are usually needed.

When will it go away?

Thrush can start to improve within a few days of treatment, but symptom may not be completely resolved until 1-2 weeks later.

Will it come and go?

It can. Since thrush is caused by bacteria that’s already inside of your mouth, it may start to clear up and then reoccur if not treated properly.

Will oral thrush go away without treatment?

Possibly, but it is not recommended. There is a higher risk of it advancing into a more severe infection than there is of it resolving itself.

Will it heal on its own?

Some types of bacterial infections heal on their “own” with the help of your immune system. But bacterial overgrowth or an immune deficiency may prevent your body from healing itself.

How long until it clears up?

With treatment, oral thrush symptoms should start to improve within a few days and completely within two weeks.

What if I’ve had it for months?

Individuals with chronic oral thrush symptoms should see medical attention if symptoms do not improve with home care.

What kills it?

Nothing will “kill” oral thrush, as some of these “good” bacteria are still essential for a healthy mouth. Killing all of the bacteria would simply result in another type of imbalance.

Can oral thrush cause fever?

Any type of chronic infection can cause a fever, especially when bacteria start to spread to other parts of the body or are found in high quantities.

Can it cause sore throat?

Yes. The throat is usually one of the first places for oral thrush to spread to.

Can it cause swollen lymph nodes?

Yes. Swollen lymph nodes are your body’s response to any type of acute or chronic infection.

Can it cause bad breath?

Yes. Halitosis (bad breath) can come in many forms, based on the presence of oral biofilm throughout the mouth, throat, respiratory and GI tract.

Can it cause dry mouth?

Oral thrush usually doesn’t cause dry mouth, but dry mouth may lead to thrush.

Does it cause coughing?

If thrush expands into your throat and/or respiratory system, it can lead to coughing.

Will it cause a tickling cough?

Depending on the amount of yeast bacteria at the back of your mouth, you may start to experience “tickling” symptoms.

Will it make it had to breathe?

If you are having trouble breathing, seek immediate medical attention. It is most likely due to something beyond typical oral thrush.

Is oral thrush common?

Yes, thrush is a common type of oral infection. It’s usually seen in babies/infants and the elderly.

Is it a sign of pregnancy?

No. Being pregnant should have no impact on the development of oral thrush.

Is it common in pregnancy?

No, it isn’t.

Is it dangerous if pregnant?

Any type of infection during pregnancy could potentially cause harm to your baby. Modern research now shows oral bacteria can spread directly to your developing child via the placenta.

Does oral thrush smell?

Yes. Oral infections such as thrush may contribute to bad breath, but not always.

What’s it smell like?

Since thrush is a type of yeast infection, it often causes a foul, pungent, or musty odor.

Does it cause nausea?

Not unless it is very severe.

Does it burn?

Thrush causes irritation to oral mucosa, which in turn can lead to symptoms of burning mouth.

Can it cause ear pain or infect your ears?

Oral infections (such as strep throat or dental abscesses) often radiate into other areas, causing sinus or ear pain and headaches. Thrush may not, unless it is aggressive.

Will it spread to ears?

Any chronic overgrowth of bacteria has the potential to spread elsewhere in your body. However, if it does, you will require medical attention.

Does it itch? 

In general, most yeast infections (including thrush) have the potential to cause itchiness.

Does it cause swelling?

Mild erythema (swelling) usually accompanies severe redness and raw tissues.

Where all will it spread to?

A typical oral thrush case will cover areas such as inside your cheeks, the surface of your tongue, floor of the mouth, inside of the lips, roof of the mouth, tonsils, and back of the throat.

Is oral thrush a sign of cancer?

It can be. Thrush usually occurs in people who are immunocompromised, which can include people with cancer or HIV.

Is it an STD?

No. Oral thrush is not a sexually transmitted disease. 

Did an STD cause it?

It is possible for other types of infections, including STDs, to increase your risk of getting thrush (especially if you’re treated with an antibiotic.)

Does it mean I have HIV?

Oral thrush does not mean you have HIV/AIDS, but having HIV/AIDS will make you more likely to develop oral thrush.

Is it infectious?

Everyone has the bacteria that cause oral thrush, so technically it is not infectious.

How is it passed on?

Thrush is an “opportunistic” infection that happens when your body has an overgrowth of a specific bacteria. It isn’t generally spread, but you may transfer bacteria if you kiss or share food with someone.

Can you get oral thrush from kissing?

If you have a healthy immune system, you shouldn’t get thrush by kissing someone who has it.

Does it cause swollen lymph nodes? Swollen glands? Sores?

Depending on how your immune system responds to the infection, you may experience swollen lymph nodes and glands inside and around your mouth (including your neck.) Sores are not normal, other than red and raw tissues under the layer of thrush.

Will oral thrush spread?

Usually thrush starts in one part of your mouth and spreads to the entire mouth if left untreated.

Is it an infection?

Yes. Thrush is a bacterial yeast infection. Oral thrush is caused by an overgrowth of “good” bacteria inside of your mouth, like similar yeast infections.

Is it a fungal infection?

Yes. Oral thrush is a type of fungal (yeast) infection that occurs due to bacterial imbalances.

Is it a yeast infection?

Yes. Oral thrush is technically considered to be a type of yeast infection.

How is oral thrush diagnosed?

A clinical exam that shows red tissues and white layers of bacteria are usually all that’s needed to diagnose thrush. Risk factors, age, medical history (including antibiotic use, cancer, viruses, etc.) and home care habits help determine whether or not a specific type of infection is oral thrush. However, chronic infections may require a swab (sample) for clinical diagnosis.

Who can diagnose it? 

Usually, thrush is self-diagnosed, or diagnosed by a dentist or medical practitioner.

Is it curable? Who treats it?

Yes. Typically, the best treatment is self-care (including improved hygiene and dietary supplements.) In severe situations, a prescription anti-fungal medication may need to be prescribed by your doctor or dentist.

Is it serious?

Any infection — including oral thrush — that goes untreated has the potential to become a serious health condition.

Can it make you sick?

Thrush makes most people sick, in that they do not feel well or are unable to eat comfortably.

Is it deadly?

Usually oral thrush itself is not deadly. However, it may accompany deadly health conditions such as cancer, HIV/AIDS, immunodeficiencies, etc.

When should I see a doctor?

If you are not able to heal thrush at home with improved self-care and dietary supplements within a week, you should seek medical or dental care.

Can oral thrush affect your voice?

If oral thrush spreads into your throat, it could cause you to lose your voice.

Can it affect your lips?

Oral thrush can affect any area inside of your mouth, including inside of your lips.

What makes oral thrush worse?

Untreated thrush will worsen on its own, especially if the mouth and removable prostheses are not cleaned regularly.

Can you treat oral thrush at home?

Yes. Most oral thrush cases are treated using improved home care and dietary changes, including supplements.

Do oral thrush tablets work?

A specially formulated thrush tablet can help to balance your natural oral bacteria levels.

Click here to learn how to kill the cause behind your teeth and gum problems.

References:

  1. Krishnan PA.; Fungal Infections Of The Oral Mucosa.; Indian J Dent Res. 2012 Sep;23(5):650-9. doi: 10.4103/0970-9290.107384.
  2. Ninomiva K, Maruyama N, Inoune S, Ishibashi H, Takizawa T, Oshima H, Abe S,; The Essential Oil Of Melaleuca Alternifolia (Tea Tree Oil) And Its Main Component, terpinin-4-ol protect mice from experimental oral candidiasis.; Biol Pharm Bull. 2012:35(6):861-5.

Sharon has been a Registered Dental Hygienist since 2001. She also holds a Bachelor of Science degree in Human Relations and Business. In 2011, she began implementing her dental knowledge into freelance writing services that aided dentists, product designers, continuing education providers and web marketing firms for their online and distribution purposes. She has since bridged her services into the medical and cosmetic surgery fields.

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Article Reviewed By Dr. Lara Coseo

Lara T. Coseo, DDS, is a 2004 graduate of Baylor College of Dentistry.  She has 13 years of experience practicing general dentistry.  She currently serves as a part-time faculty instructor at Texas A&M College of Dentistry and writes dental website content and blog material. Website / Linked In / Instagram

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