Thrush (Oral Candidiasis)

Medical Author : John P. Cunha, DO, FACOEP

Medical Editor : Jerry R. Balentine, DO, FACEP

A woman touches her mouth.

 

Thrush facts

  • Thrush (oropharyngeal candidiasis) is a medical condition in which a fungus called Candida albicans overgrows in the mouth and throat.
  • Thrush may be caused by a variety of factors, including illness, pregnancy, medications, smoking, or dentures.
  • Thrush in infants is common and usually not harmful.
  • Risk factors for thrush include weakened immune systems, medications, smoking, or stress.
  • Symptoms of thrush include white patches in the mouth, inner cheeks, throat, palate, and tongue, as well as soreness and mouth pain.
  • Thrush is usually diagnosed by clinical examination by a physician or dentist.
  • Treatment for thrush depends on the severity and the cause and can include simple home remedies, oral medications, or systemic medications.
  • The prognosis for mild cases of thrush is good. The outlook for severe cases depends on the underlying cause and the status of the patient's immune system.
  • Thrush can be prevented in most cases by risk factor modification.
    A plate culture of the fungus Candida albicans, strain 7H10, grown at 37 C and Candida albicans at 200X magnification

    What is thrush?

    Thrush (oropharyngeal candidiasis) is a medical condition in which a fungus called Candida overgrows in the mouth and throat. Candida is normally present in the mouth, digestive tract, and skin of most healthy people. The immune system and the body's normal bacteria usually keep Candida in balance. When this balance is interrupted, it can result in an overgrowth of the Candida fungus, causing thrush, a yeast infection of the mouth or throat.

    Thrush is not the same as a vaginal yeast infection.
    Close-up of oral thrush, showing ulcers inside the mouth of a baby

    What causes thrush?

    An overgrowth of the Candida fungus in the mouth or throat is what causes thrush.

    Thrush in infants is relatively common and is only a concern if it causes poor feeding or is associated with weight loss or other symptoms of systemic illness. Consult a pediatrician if thrush in an infant lasts more than a couple of weeks. 
    A man stands in front of a medicine cabinet containing antibiotics, corticosteroids, and dentures; a sick woman lies in a hospital bed; and a pregnant woman feels ill.

    What are risk factors for thrush?

    Healthy adults generally do not get thrush without having some risk factors. Patients with weakened immune systems are most at risk for getting thrush. Risk factors associated with thrush include the following:

    • Illnesses, including poorly controlled diabetes, HIV/AIDS infection, cancer, and dry mouth
    • Pregnancy
    • Taking medications such as antibiotics, corticosteroids, chemotherapy or other cancer drugs, radiation, and birth control pills
    • Having an organ transplant
    • Smoking
    • Poorly fitting dentures
    • Stress
    In general, thrush is not contagious. However, a nursing infant with thrush may transmit it to the mother's breast by contact.
    Examples of thrush (oral candidiasis)

    What are thrush symptoms and signs?

    Thrush is characterized by a white coating or white patches on the tongue, mouth, inner cheeks, and the back of the throat. The tissue under the white patches is often red, raw, and sore. The lesions can be painful and even bleed when scraped. Some general symptoms of thrush are as follows:

    • Characteristic white patches
    • Cracking at the outer edges of the lips (cheilosis)
    • Dry mouth
    • Feeling of food stuck in the throat
    • Soreness in teeth
    • Strange or unpleasant taste in mouth
    • Bad breath
    In severe cases of thrush, the esophagus, leading down to the stomach, may also be involved. This will cause pain with swallowing. If someone has a weakened immune system (HIV/AIDS, cancer, chemotherapy, etc.), the Candida fungus can spread to other parts of the body and cause a systemic infection. If a person has signs or symptoms of thrush and develops a fever, shaking or chills, or difficulty swallowing, contact a doctor immediately. 
    A doctor examines a baby's throat and mouth.

    How do physicians diagnose thrush?

    Thrush is clinically diagnosed by a physician or dentist when the characteristic-looking white patches are found in the mouth or throat.

    To confirm the diagnosis, or if there is question about whether the white patches are caused by the Candida fungus, a scraping may be done. The doctor or dentist can scrape off a small amount of the white matter from the mouth or throat and look at it under a microscope.

    Thrush located farther down the throat or in the esophagus is usually found by doing a procedure called an endoscopy. In this procedure, the doctor passes a small camera through the back of the throat into the esophagus and into the stomach to observe the tissue and take samples. If the white lesions are found, they may be biopsied or scraped to confirm the diagnosis of thrush. This procedure is usually performed by a gastroenterologist.
    A baby is given antifungal drops to treat thrush.

    What is the treatment for thrush?

    Treatment of thrush depends on the cause and severity of the infection.

    If thrush is caused by something reversible, such as taking antibiotics, smoking, ill-fitting dentures, or poorly controlled diabetes, these factors must be corrected as part of the treatment.

    Infants, toddlers, and children with thrush often do not require treatment. In cases that last more than a few weeks, a child's pediatrician may prescribe antifungal nystatin (Mycostatin, Nilstat, Nystex) drops.

    If an adult patient is diagnosed with a mild case of thrush, the doctor may prescribe an antifungal mouthwash (nystatin) or lozenges (clotrimazole [Mycelex]) for short-term use.

    For more severe cases of thrush or if someone has other reasons for a weakened immune system, he or she may need stronger systemic medications, such as fluconazole (Diflucan) or itraconazole (Sporanox). For severe or resistant thrush, amphotericin B may be prescribed.
    A mother and daughter brush their teeth; a woman eats yogurt; a boy rinses his mouth; and a boy eats a popsicle.

    Are there home remedies for thrush?

    Home remedies for thrush are aimed at decreasing risk factors for thrush as well as preventing overgrowth of Candida yeast.

    • Brush the teeth with a soft toothbrush.
    • Rinse the mouth with a diluted 3% hydrogen peroxide solution.
    • Rinse the mouth with warm saltwater.
    • Avoid mouthwash as it can alter the normal flora of the mouth.
    • Keep dentures clean and see a dentist if they do not fit correctly.
    • Eat unsweetened yogurt while taking antibiotics.
    • Lactobacillus acidophilus supplements may help maintain a healthy balance of Candida.

    Home remedies that may reduce the discomfort of thrush include

    • drinking cold liquids, or eating frozen or ice treats;
    • eating soft, easy-to-swallow foods;
    • drinking from a straw if the patches are painful.
    Gentian violet (1%) is a natural treatment that sometimes works as treatment for thrush. It is a dye that kills bacteria and fungi, and it is available without a prescription. Talk to a doctor before using gentian violet. Grapefruit seed extract is sometimes used by nursing mothers who have developed thrush of the nipples. It can be applied topically (on the skin) or taken orally. Consult a doctor before using this or any supplement.
    A doctor talks with a patient.

    What is the prognosis of thrush?

    The prognosis of thrush depends on the severity of the infection and the status of the immune system of the patient.

    Mild cases of thrush caused by some of the reversible risk factors are generally easily treated, and the prognosis is good.

    Thrush in infants and children is rarely serious or life-threatening and often goes away on its own without any need for medical treatment. If a child's thrush does not improve within two weeks, consult the child's pediatrician.

    Patients with weakened immune systems are at risk for severe and life-threatening complications. These patients can become critically ill or die from severe Candida infections. Candida can spread throughout the body to other organs and can cause severe dysfunction. Systemic treatment in addition to long-term hospitalization may be necessary.
    A mother and daughter floss their teeth; a dentist examines a patient; a man breaks a cigarette; and a woman eats a salad.

    Is it possible to prevent thrush?

    Thrush can be easily prevented in healthy adults by modifying risk factors that contribute to Candida fungus overgrowth.

    Risk factor modifications for prevention of thrush include the following:

    • Brush and floss teeth and gums regularly, and maintain proper oral hygiene.
    • See a dentist regularly.
    • Make sure dentures are clean, properly maintained, and fit well.
    • Keep diabetes under control.
    • Quit smoking.
    • Eat a balanced, healthy diet low in sugar and yeast.
    • Limit use of antibiotics. Only use as prescribed by a physician.
    To prevent thrush in babies or nursing infants, keep pacifiers and bottle nipples clean and sterilized. Nursing mothers should discuss the use of any over-the-counter or prescribed medications with their doctor before breastfeeding as some medications may increase the risk of causing thrush.

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