Oral thrush is a fungal infection of the oral mucosa. In common parlance, this disease is also often called oral fungus. Especially people with weakened immune systems and infants have an increased risk of contracting oral thrush.
What is oral thrush?
Oral thrush affects the mucous membranes in the mouth. In the normal oral flora exists basically a variety of microorganisms, such as bacteria and also fungi. However, these do not cause any harm. However, there are also bacteria, viruses and fungi that cause diseases if they can penetrate the mucous membranes of the mouth. Among them is the causative agent of oral thrush, a yeast fungus. Based on the pathogen, the disease is therefore often called oral fungus. The triggering yeast fungus can spread very quickly in the body and migrate from the oral mucosa to the throat, from where it can also infect the esophagus to the stomach and intestines. Therefore, oral thrush should be treated as soon as possible.
Causes
Oral thrush is caused by an infection with a yeast fungus. In most cases, this is Candida albicans, a very widespread pathogen from the yeast family. However, Candida tropicalis and Candida stellatoidea also cause oral thrush. However, not every person who comes into contact with one of these pathogens will also contract oral thrush. For the disease to break out, the body’s immune system must be weakened. For this reason, there are various risk groups that are considered particularly at risk for oral thrush. These include, above all, infants, the elderly and patients with chronic diseases that cause a weak immune system. In people with an intact immune system, the pathogen has no chance to cause the disease. The pathogen is very quickly recognized and fought by the immune system.
Symptoms, complaints and signs
Depending on the form, oral thrush can cause various signs and symptoms. Pseudomembranous candidiasis is manifested by a white coating that is easily wiped off and an inflamed mucosa that is slightly red and hurts to the touch. Acute erythematous candidiasis is associated with burning mucous membranes that are very red in the area of the tongue. Coatings do not usually appear in this form. In hyperplastic candidiasis, a white coating with red demarcations appears on the mucosa and tongue and is difficult to detach. The forms in which coatings form have in common that bleeding can occur when they are touched. Any form of candidiasis can spread rapidly and spread to the pharynx. The result of such a spread is a sore throat and difficulty swallowing. In severe cases, oral thrush spreads to the esophagus and through it to the gastrointestinal tract. This can lead to stomach cramps, heartburn and nausea. This is accompanied by general symptoms such as fever, fatigue and a strong feeling of malaise. If candidiasis is confined to the oral cavity, no major complications occur. The mucosal changes usually subside once the infection has subsided.
Diagnosis and course
Typical of oral thrush is a whitish coating on the oral mucosa and in the throat. However, this does not necessarily have to occur; a reddened oral mucosa may also be present. In addition, there may be a burning sensation in the mouth. To make a diagnosis, therefore, a detailed discussion between the doctor and the patient is first necessary. This is followed by a physical examination, during which the oral mucosa is examined in detail. Very often, oral thrush also causes unpleasant bad breath, which is caused by the fungus. The lymph nodes may also be swollen. Oral thrush hardly causes any pain, but sensitive infants may experience this differently and, in the worst case, stop eating. Therefore, a quickly initiated treatment is very important. Also to prevent the spread of the disease.
Complications
In most cases, this disease can be treated relatively well and easily, so that there are no serious complications or other complaints. Those affected mainly suffer from severe discomfort in the mouth. There is a dry mouth and thus also increased thirst. Sometimes a coating appears on the tongue and patients usually suffer from foul breath.Likewise, burning of the tongue may occur and the patient’s sense of taste is significantly disturbed by the disease. The quality of life is significantly reduced by the disease. There may also be discomfort when taking liquids and food, as this is usually associated with pain. This leads not only to deficiency symptoms, but also not infrequently to psychological complaints or depression. During the treatment itself, there are no further complications. With the help of medication or antibiotics, the disease can be defeated relatively easily. In severe cases, other areas of the body must be treated if the disease has also penetrated the area of the stomach and intestines. This usually does not reduce or limit life expectancy.
When should you see a doctor?
In infants and young children, any occurrence of oral thrush is reason to see a doctor. At this age, the immune system is still in the midst of development and, most importantly, young patients need regular nourishment. Because of oral thrush, they may refuse the breast or bottle or not want their porridge, which can quickly weaken the immune system even further, allowing the already existing oral thrush to spread. In adults, oral thrush usually only occurs when the immune system is severely compromised or certain antibiotics are taken. In the case of a long-term existing disease that has weakened the immune system, adult patients should also visit the doctor at the first symptoms of oral thrush and be treated with medication against it. This can prevent oral thrush from spreading and causing unpleasant symptoms. In addition, the doctor can take this opportunity to investigate whether a nutrient deficiency may be responsible for the oral thrush developing in the first place. A recurrence can then be prevented with suitable nutritional supplements. Furthermore, it must be clarified whether the presumed diagnosis of oral thrush is not a precursor of a tumor that looks exactly the same and causes comparable symptoms. However, this differential diagnosis usually occurs only in adults; in young children, the first suspicion is usually correct.
Treatment and therapy
To treat oral thrush, special medications are used, called antifungals, antifungal agents. These drugs come in different forms: Lozenges, solutions, suspensions or as a gel. The active ingredients amphotericin B and nystatin are frequently used. If the oral thrush is in an early stage, treatment with such medications is sufficient and the symptoms will usually subside quite quickly. However, if oral thrush is more advanced and has penetrated deeper into the body, this form of treatment with an antifungal agent is no longer sufficient. In addition to local application, the active ingredients must then also be taken orally so that they can reach the other affected parts of the body and fight the yeast infection there. In any case, it is important to strictly adhere to the prescribed treatment duration. Even if the symptoms have already subsided or even disappeared completely, the medication should be taken until the end. Otherwise, there is a risk that the disease will flare up again. In particularly stubborn cases, when oral thrush cannot be contained or keeps recurring despite sufficiently long therapy, stronger antifungals can be used. These penetrate into the gastrointestinal tract and effectively combat the yeast fungi there. If the patient suffers from pain caused by oral thrush, additional painkillers can be prescribed. In the case of oral thrush, paracetamol is very often used. During the disease, strong attention should be paid to hygiene. This is especially important for infants. Thus, it is recommended to boil the teats of bottles and also pacifiers daily and to exchange them after healing of the complaints.
Outlook and prognosis
Infections with Candida albicans are usually harmless and usually heal on their own within a few days. Almost everyone has oral thrush at least once in the course of his or her life, but it disappears on its own. The cause is usually a temporary weakening of the immune system or a disturbance of the natural oral flora, such as can be triggered by taking antibiotics.Longer-lasting oral thrush mainly occurs in newborns, older people or generally people with a weakened immune system. Here, more severe courses with extensive and long-lasting inflammation in the oral cavity may occur, in which case drug treatment may be necessary. This consists of the administration of antimycotics (e.g. Nistatin or Amphotericin B) and is usually successful within a few days. In the case of recurring oral thrush, the cause of the disease must be identified and, if possible, eliminated. Candida fungi can be detected on the mucous membrane of most people, but only cause problems if other factors favor this. In immunocompromised patients, prophylactic use of antifungals can help stop recurrent infections. Consequential damage from oral thrush is not expected.
Prevention
Oral thrush can be prevented primarily with hygiene. People with dentures should pay attention to careful oral hygiene and clean the dentures after every meal. Corresponding hygiene measures also apply to infants. Pacifiers, bottle teats and toys that are regularly put in the mouth should be cleaned regularly. For teats and pacifiers, killing all germs is done by sterilization using boiling or a special device.
Aftercare
Aftercare for oral thrush disease involves several starting points. First of all, it is important that patients do not discontinue the medication prematurely as soon as they notice an improvement. This is because in numerous cases, many pathogens are still present even when oral thrush is no longer visible. Therefore, the prescribed antimycotics must be taken for as long as the doctor has prescribed. Afterwards, it is advisable to have the attending physician perform a follow-up examination. Follow-up care also includes measures to prevent future outbreaks of oral thrush. In adults, for example, these include refraining from tobacco consumption and compensating for existing nutrient deficiencies. Care must be taken to ensure thorough hygiene when using dentures or braces. For infected babies, there are further rules that must be observed above all by parents. Pacifiers and other toys that are put in the baby’s mouth must be meticulously cleaned regularly. In addition, parents should ensure that their own saliva does not come into contact with the child’s mouth or toys, as this can also lead to reinfection. If oral thrush occurs frequently, regular check-ups with a doctor are advisable in order to be able to intervene in good time by administering medication. A preventive administration of antimycotics is then also possible.
What you can do yourself
Simple measures that can be easily integrated into the daily routine contribute significantly to the prevention or control of bacterial inflammation in the mouth. Optimal oral hygiene and a healthy diet deprive fungi of the food and life basis. Careful tooth brushing, twice a day, and changing toothbrushes and dental care products are important cornerstones of good oral hygiene. Regular check-ups of the dental condition by a dentist can be an important addition in the context of prevention. Wearers of dentures can counteract fungal infections by checking the surface and good fit of their dentures daily. Dentures can be cleaned with agents that are effective against fungus. For asthmatics, careful rinsing of the mouth after using sprays containing cortisone is important. After consulting with their pulmonary specialist, they may reduce the dose of the medication. Another component of self-help is a healthy probiotic diet. If the diet is very high in sugar, fungi find optimal living conditions. For diabetics, it is therefore important to regularly check the optimal setting of their blood sugar level. In general, a change to a low-sugar diet is recommended for oral thrush. In addition to observing simple hygiene and dietary rules, taking medication against oral thrush as prescribed by the doctor is crucial – premature termination of therapy can lead to a relapse.
