Oral thrush, medically referred to as primary gingivostomatitis herpetica, is an inflammatory infection of the mouth. Predominantly, the disease occurs in children, but transmission to adults is in principle equally possible.
What is oral thrush?
Oral thrush is caused by viruses. The symptoms already form at the first infection with herpes viruses. The main age of onset is between six months and five years. Only rarely are the diseased persons over 20 years of age. Infants are particularly severely affected when the disease occurs in the first weeks of life. Oral thrush is contagious, so affected individuals should avoid contact with other people, especially children. Transmission occurs by droplet infection. Sharing cutlery, for example, is a common cause of infection.
Causes
Oral thrush always develops when the initial infection with herpes manifests in the oral cavity. The HSV-1 herpes virus is responsible. However, in rare cases, the HSV-2 virus can also cause the disease. Oral thrush is highly contagious, so transmission by an infected person is one of the most common causes of the disease. The most common areas of infection are kindergartens and schools. Here, oral thrush spreads rapidly, and the incubation period is very short – one to three days. It should be noted that not every infection with oral thrush also leads to the development of the typical symptoms. A large proportion of all infected persons do not show any symptoms, but still pose a risk of infection to other people.
Symptoms, complaints and signs
Already a few days after the initial infection, the first symptoms appear with oral thrush. Typical for an infestation of stomatitis aphthosa are high fever episodes. At the same time, patients feel very fatigued, similar to the flu, and have a reduced ability to concentrate. As a direct consequence of the first signs of the disease, small vesicles appear in the area of the oral cavity or lips. Likewise, a prominent reddening of the oral mucosa appears, which is accompanied by intense, burning pain for sufferers. Unfavorable courses also affect the gums, and the entire oral cavity is then affected. After a maturing period, the blisters burst and release a secretion. Painful scars with reddish borders and a light-colored coating in the center remain. These vary in appearance from punctate to lentil-sized areas. Physicians refer to these lesions as aphthae. Other consequences of the infection are increased salivation and a distinctive bad breath. Due to the high level of suffering, young children often avoid eating. External signs of the disease also include swollen lymph nodes in the neck. When light pressure is applied, patients complain of pain in corresponding areas. In some cases, there is also an increased tendency to nausea with possible nausea. Smear infection may result in secondary spread of the herpes viruses from the oral mucosa to the nasal cavities.
Diagnosis and course
The diagnosis of oral thrush can usually be made only after laboratory analysis, because other diseases in the oral cavity cause similar symptoms. The disease progresses to different degrees, especially infants often suffer from more severe symptoms than older children. At the beginning of oral thrush, body temperature is usually elevated, children refuse food and are tearful. The refusal of food and often also of liquids results from the burning pain in the mouth, which can occur even before the first blisters are visible. Only in the course of the disease the herpes infection shows directly on the mucosa. Small, painful blisters form on the gums, lip and tongue, which are the main reason for food refusal. On average, an infection with oral thrush lasts for at least a week, only after which the blisters slowly dry up and the pain decreases. In adults, the disease usually progresses with significantly fewer symptoms than in younger children.
Complications
Oral thrush is a medical condition in which, of course, various complications are possible. As a rule, oral thrush is noticeable by small blisters that burst open after a short time.At the same time, these small blisters cause severe pain, so that the affected person must expect considerable complications when eating. In particularly bad cases, the burst blisters even develop into open wounds, so that there is an increased risk of inflammation. An open wound is very susceptible to viruses and bacteria. If these have taken up residence in the open wound, pus may even form. The formation of pus is always an indication of a significant worsening of the existing inflammation. If you want to avoid further complications at this point, you should see a doctor as soon as possible. Only by taking appropriate medication can a quick and effective recovery take place. In rare cases, viruses and bacteria enter the bloodstream of the affected person through the open wound. This can cause an infection to develop, resulting in headaches, an elevated temperature, nausea and vomiting. For this reason, oral thrush should be treated very quickly by an appropriate physician. Only if treatment is given promptly, the above complications can be avoided.
When should you go to the doctor?
A visit to the doctor is advisable as soon as there is persistent discomfort in the mouth. Pain, changes in the mucous membranes, bad breath or a general feeling of discomfort should be examined and treated. If the discomfort in the mouth increases or spreads further, a doctor is needed. Increased salivation, redness of the gums and loss of appetite indicate a health disorder that needs to be treated. If there is inflammation or infection in the mouth and throat, discomfort when cleaning the teeth, and nausea and vomiting, a visit to the doctor should be made. Aphtae, lesions in the mouth, and hypersensitivity to food intake are signs of a condition that needs treatment. If the nasal cavities or throat are also affected by impairment, a doctor should be consulted immediately. Scarring of the mouth, development of vesicles, and interference with an existing denture are worrisome. A doctor should be consulted if there is a persistent refusal to eat or clean the teeth. Pus formation in the mouth or a repeated taste of blood should be presented to a doctor. In severe cases, the individual is at risk of sepsis or dehydration. Both represent life-threatening conditions of the organism that must be treated early by a physician to prevent premature death.
Treatment and therapy
Treatment of oral thrush is primarily for symptom and pain relief. Especially in children, adequate hydration is of high importance, otherwise dehydration of the body may occur. Children must be encouraged to drink, otherwise they will develop an avoidance pattern due to the pain. For the pain, doctors prescribe painkillers such as ibuprofen or paracetamol for oral thrush on the one hand, and local anesthetics are applied to the blisters on the other. In severe cases of oral thrush in adults, stronger painkillers such as Novalgin are sometimes used. Rinses with chlorhexidine are indicated for local disinfection of the mouth. Even if food intake causes pain, this must not be neglected under any circumstances. If there is severe blistering of the mouth, the administration of liquid food can meet the daily caloric requirements. Malnutrition must be avoided at all costs during the course of the disease, as the immune system would be weakened even further and there is a risk of a severe course of oral thrush.
Outlook and prognosis
Oral thrush has a very good prognosis and heals within a few weeks if left untreated. In this regard, it often occurs in children as a manifestation of a herpes infection. Although oral thrush is very unpleasant and makes life very difficult for those affected because of the pain, it is rightly considered harmless. After a few days of fever and the formation of blisters, it takes about a week to ten days for the disease to heal. Very rarely, the prognosis is worse in affected babies. However, this is only the case with newborns in the first weeks of life, where the infection can also affect the eyes or brain. In this case, medical treatment is urgently needed. In adults, oral thrush – just like cold sores, for example – can occur from time to time.Some people experience this frequently, others not at all. Even in these cases, the condition heals on its own within weeks. Possible treatment is always purely symptomatic in nature and only alleviates the suffering. The prognosis regarding healing then depends on various factors, such as stress and fluid intake.
Prevention
Oral thrush does not occur through the fault of the affected person, so it is also almost impossible to prevent infection. If cases of oral thrush are known in the immediate vicinity, contact with the affected persons should be avoided if possible. Sharing cutlery or drinking bottles should be avoided, as the viruses spread very quickly and infection can occur. Basically, the earlier oral thrush is treated, the faster the disease disappears. For this reason, disinfectant therapy should be started even if there is moderate pain in the mouth.
Aftercare
As soon as the blisters in the mouth have dried up and the aphthae have healed, the affected child can return to the childcare facility. Infection of other children is then no longer possible. This is usually the case after one week to ten days. In adult patients, healing can take up to 20 days. Separate follow-up care is not necessary, as there are no more symptoms after healing. The causative herpes virus cannot be cured, but no new outbreak of oral thrush is possible after the initial infection has been overcome. The virus retracts into the nerve nodes and does not cause any further symptoms for the time being. Only in the case of a weakened immune system or strong psychological stress such as stress or grief can the virus break out again and then become visible as cold sores, for the alleviation and healing of which the measures already mentioned are again necessary. Therefore, it is advisable to regularly strengthen the immune system and avoid stress. Although the herpes virus can survive outside the body only for a short time, the toothbrush used during the disease should be disposed of to prevent accidental transmission of the virus.
Here’s what you can do yourself
Normally, oral thrush clears up on its own after two to three weeks, without the need for medical treatment. However, the patient must take it easy and should get enough bed rest. Affected children often refuse to eat because of the pain in the mouth. Parents should watch for any deficiency symptoms and, if in doubt, take the child to the pediatrician. Appetite-stimulating teas and antipyretics can reduce discomfort. The diet should consist of liquid or mushy foods and mild and cool foods. The child also needs to drink enough water, and a straw can help with fluid intake. In consultation with the doctor, mouth rinses with active ingredients such as chlorhexidine can also be used. Medicines containing the active ingredient lidocaine can be applied locally and promise rapid relief of symptoms. Furthermore, the aphthae should be treated with a disinfecting solution. In severe cases, oral thrush must be treated by a doctor. If the symptoms are very intense or a child is no longer taking in fluids due to the pain, a clinic should be visited. In newborns, close monitoring by a specialist is indicated because of the high risk of spread.