Brief overview
- Treatment: Depending on the severity, antifungal agents (antimycotics) for application or ingestion, oral hygiene measures
- Symptoms: White, strippable coatings on the cheek mucosa, tongue or palate, reddened, burning tongue, taste disturbances
- Causes and risk factors: Yeast infection (Candida albicans), increased risk of infection in babies, denture wearers, lack of oral hygiene, weakened immune system due to illness, taking certain medications (antibiotics, cortisone)
- Course of the disease and prognosis: With appropriate treatment, oral thrush heals after a short time. Complications can occur in people with a weak immune system.
- Diagnosis: Based on the typical appearance, swab from the affected area and pathogen detection using a fungal culture
- Prevention: Careful oral hygiene, hygiene in infant care, treatment of underlying diseases
What is oral thrush?
Oral thrush is a yeast infection in the mouth. Oral thrush is relatively common in newborns and babies. Oral thrush in adults more frequently affects older people and people with certain underlying diseases (e.g. diabetes mellitus or HIV).
Oral thrush can also occur after taking certain medications (e.g. antibiotics, cortisone).
There is no reliable information about the incubation period for oral thrush (the time from infection to the onset of symptoms). The fungi also occur on healthy skin. Whether an infection occurs or not depends on whether the immune system is able to fight off an excessive multiplication of the yeast fungi.
How is oral thrush treated?
To treat oral thrush, the doctor prescribes medication that acts against fungi, so-called antimycotics. In the case of mild oral thrush, topical agents are usually sufficient. They are available, for example, as lozenges, oral gel, solution or suspension (liquid with a pipette).
The oral thrush medication used often contains the active ingredients amphotericin B, nystatin or agents from the group of so-called azoles. If the oral thrush does not go away with topical treatment or if there is a suspicion that the oral fungus has spread to other organs (such as the oesophagus or intestines), the doctor will prescribe antifungal medication to take.
When treating oral thrush, it is important that you adhere to the treatment duration. It is also advisable to pay attention to careful oral hygiene in the case of oral thrush. If your baby has oral thrush, change all pacifiers, bottle teats and toys such as teething rings or sterilize them thoroughly (e.g. by boiling them).
Which doctor treats oral thrush?
If an adult is suspected of having candidiasis in the mouth, the family doctor, dentist or dermatologist is the right person to contact. A pediatrician treats oral thrush in infants or small children.
Oral thrush: What home remedies help?
Some guides claim that household remedies such as baking soda, apple cider vinegar or garlic can help with oral thrush. However, there is no scientific evidence for this. Home remedies are not advisable as the sole treatment for either adults or babies with oral thrush.
Home remedies have their limits. If the symptoms persist over a longer period of time, do not improve or even get worse, you should always consult a doctor.
There is also no scientific proof of the benefits of treating oral thrush with homeopathy.
What are the symptoms of oral thrush?
In principle, oral thrush symptoms can occur in various places in the mouth. Signs of oral thrush can be found on the tongue, lips, palate or in the corners of the mouth.
There are various forms of oral thrush:
Pseudomembranous candidiasis
The classic symptoms of this form of oral thrush are severely reddened oral mucous membranes with white specks on them. Initially, these specks look like small, milky-white speckles.
They are often found in the following places:
- Palate
- Under the tongue (tongue fungus)
The symptoms of oral thrush sometimes also affect the gums, especially if the fungi settle under dentures.
The small, white plaque can usually be easily wiped off. A red, shiny spot appears underneath them. As they progress, the spots multiply and enlarge, sometimes merging into larger white patches. When these are removed, the skin underneath begins to bleed slightly.
Sometimes the mouth fungus spreads into the throat and oesophagus.
In addition, this form of oral thrush sometimes triggers the following symptoms:
- Feeling of “furredness” and dryness in the mouth
- Increased thirst
- Taste disturbances (possibly metallic taste)
- Bad breath
- Burning sensation on the oral mucosa
However, in many cases these symptoms do not occur at all while the oral thrush is still in its early stages. A sign of oral thrush in babies is sometimes that they no longer want to drink. When the yeast fungus in the mouth spreads, fungal plaque may appear on the baby’s lips or in the corners of the mouth.
Acute erythematous candidiasis
This candidiasis in the mouth mainly develops during antibiotic therapy or HIV infection. It often occurs as a result of pseudomembranous candidiasis.
Hyperplastic candidiasis
In chronic hyperplastic candidiasis (also known as Candida leukopathy), adherent white coatings with red edges are found on the mucous membrane and tongue, which cannot be easily removed. This form of oral thrush is more common in people with immune system disorders and sometimes persists for months or years.
What is the cause of oral thrush?
The cause of oral thrush is usually an infection with Candida albicans, a widespread fungus from the yeast family. It can be detected in the oral cavity of around 50 percent of healthy people. It is also frequently found in the intestines and on various mucous membranes.
This normal colonization sometimes develops into a so-called opportunistic infection in people with a weakened immune system: the fungi exploit a gap in the immune system and begin to multiply rapidly. This is why oral thrush is typical in newborns and babies who do not yet have a strong immune system.
Older people with missing teeth and dentures are also at risk.
In addition to Candida albicans, other yeasts such as Candida tropicalis (found in soil, feces, on fish, in kefir and yogurt) and Candida stellatoidea cause oral thrush in rare cases.
Oral thrush is contagious
Newborns with oral thrush have usually already been infected at birth – through a possibly unnoticed vaginal fungus in the mother. The fungus in the baby’s mouth then generally appears in the first few days of life. Older babies become infected, for example, via pacifiers that have been in contact with the saliva of a caregiver.
When breastfeeding, a child sometimes becomes infected with oral thrush on the mother’s nipples. In babies with diaper dermatitis, the yeast fungi sometimes reach the child’s mouth from the diaper area during diapering. Hygiene in baby care (hand washing, fresh changing mats) is therefore particularly important.
Risk factors
Almost everyone comes into contact with Candida albicans at some point in their lives, but an infection only breaks out under certain circumstances. In addition to very young and very old age, other risk factors for oral fungus include
- HIV infection and AIDS disease
- Diabetes mellitus
- Cancer (e.g. leukemia, Hodgkin’s disease)
- Acute infectious diseases (e.g. pneumonia)
- Nutrient deficiencies (e.g. iron deficiency, vitamin B deficiency)
- Reduced saliva production
- Nicotine consumption
- Dentures and other forms of dental prostheses
- Poor oral hygiene
How long does it take to heal?
Normally, the healing and treatment of oral thrush takes no longer than eight to ten days. The prerequisite is consistent treatment of oral candidiasis with a suitable medication. The symptoms often subside within the first few days of treatment.
In rare cases, however, the fungus in the mouth persists and returns again and again. In this case, the doctor sometimes prescribes a stronger antifungal agent that is also effective in the rest of the digestive tract – especially the intestines. Even stubborn oral thrush can usually be controlled with this.
Without treatment, oral thrush will not go away and may continue to spread. This can lead to complications, particularly in people with a weakened immune system.
How does the doctor diagnose oral thrush?
Oral thrush is diagnosed by a dentist, a pediatrician, a dermatologist or a general practitioner. The doctor will first take a medical history from the affected person or the baby’s caregiver. The doctor will ask about the symptoms, previous illnesses or whether the patient is taking any medication.
If the fungus in the mouth looks atypical, further examination is necessary for diagnosis. It then makes sense to take a swab from the affected mucous membrane. This allows the pathogens to be detected under the microscope.
In the case of oral thrush, antibodies against the Candida fungus are found in a blood analysis. However, a blood test is only necessary for diagnosis in exceptional cases.
How can oral thrush be prevented?
There are a number of measures that can be taken to prevent oral thrush – both to protect adults and children from oral thrush:
- Hygiene is particularly important to prevent oral thrush in babies and young children. Clean pacifiers, teats and teething toys regularly and refrain from “cleaning” dropped pacifiers with your own saliva, for example.
- If you wear dentures, make sure that they fit properly. Clean them thoroughly after every meal and generally practise careful oral hygiene to prevent oral thrush.
- If you have an immune deficiency and repeatedly develop thrush in your mouth, it is sometimes advisable to use an antifungal medication daily as a preventative measure. Be sure to discuss this with your doctor.
- Very ill and elderly patients who are artificially fed usually have a low saliva flow, which means that bacteria and fungi multiply quickly in the mouth. Carers therefore regularly moisten the mouths of those affected.
