How the Mouth is Affected & Treatment Options

The mucous membranes and the skin (Mucocutaneous) are the most common places for a yeast infection to occur. Mucous membranes, a form of skin, are found in the mouth, along the GI tract, and in the genital and urinary tracts. A Candida, or yeast, infection of the mucous membranes of the mouth is also called Thrush, or Oral Candidiasis.

Up to 60% of healthy adults have Candida as their normal oral flora. Under certain conditions, the Candida species will overpopulate and dominate the flora.

Candida most commonly affects newborn infants, chronic steroid users (such as children who use steroid inhalers), people on a long course of broad-spectrum antibiotics, the debilitated, those who wear dentures at night, or the immunocompromised. Immunocompromised individuals are people whose immune system is not strong enough to fight off infection.

Who gets Oral Thursh?

Oral Candidiasis is an opportunistic infection. Simply put, it means that if the opportunity arises, it can cause an infection. The opportunity presents with conditions such as AIDS where the immune system is deficient or in steroid use, where normal flora population is disturbed. It results in an overgrowth of yeast that forms a false membrane from necrotic or dead tissue. In fact, Thrush is sometimes the first sign that an AIDS patient's immune cells are dangerously low.

Individuals who use full dentures that are not removed at night can develop an oral yeast infection. Chronic redness and swelling of the areas of the mouth that contacts the fitting surface of the denture are characteristic.

Newborns can get thrush as they pass through the birth canal if the mother has an active vaginal yeast infection. Breast-fed infants can also develop oral thrush if they are feeding from breasts or bottles that have been infected. The gastrointestinal tract is believed to be a reservoir for Candida Albicans. This is probably related to the diaper rash (Candidiasis) some children experience often simultaneously with thrush. It is believed that up to 37% of newborns will develop thrush within the first months of life.

Since immunocompromised populations are more susceptible to Thrush, it is understandable why its incidence is increasing in developing countries. Some of the populations of these countries are severely malnourished, leaving them in a weakened state. Thrush affects males and females equally, but most often affects infants and has it's highest incidence one month after birth. Though Thrush can affect anyone at any age if they are predisposed, it is not common after the first year of life.

How does Thrush present?

Thrush appears as white flecks, or a coating in the mouth. It was named after a Thrush, a bird with white and black flecks on its breast. When it is first seen, it looks like the coating can be scraped off and many people do actually attempt this to no avail. Parents or patients who try to scrape off the yeast infection find that after the scraping, the mouth is raw and painful, and since it is a systemic infection, the problem has not been resolved with the scraping. It is important to be able to distinguish between Oral Candidiasis and a white coating, for instance, from milk or formula.

Clues pointing to oral yeast infection come from the nature of the onset. It does not appear all of a sudden and coat the entire mouth. It will start off as small, whitish patches that eventually enlarge and become plaques extending throughout the oral mucosa. Other clues include irritation and poor feeding by the baby. The plaques cause a lot of discomfort for the infant, so the mother may notice a fuller bottle, or breast.

Treatment

Thrush is usually self-limited, however, antifungal medications will generally relieve the symptoms.

The most popular drug at this time is Nystatin. It is taken by mouth and is commonly referred to as oral swish and swallow. It is placed in the mouth and should be swished thoroughly around the mouth. The whole mouth should be covered and after that, the Nystatin swallowed so that any areas of thrush along the esophagus may also be cleared. For those who cannot swish and swallow (for example infants), the solution should be applied on the inside of the cheeks on both sides.

Another solution used is Gentian Violet. This should be swished around in the mouth, but not swallowed. Lozenges have also been used to treat oral yeast infection.

Recurrent bouts of Oral Candidiasis will require a complete history and physical by a physician to search for the underlying cause. It is especially important in adults because the disorder may be pointing to systemic illness. Lab studies can be used to show yeasts are present. In many cases, treatment or management of the underlying disease will resolve the Oral Candidiasis.