Treat Oral Thrush – Oral Medicine Specialist Advice

Oral thrush, also known as “oral candidosis” or “oral candidiasis” is a fungal infection. A fungal species called Candida is the cause of oral thrush. In most cases, when Candida is present, it’s harmless. They are what we call “commensal” organisms, which means they can live amongst us in harmony and not cause any harm. However, when our immune system is weakened, Candida species can change from being harmless to harmful rather quickly. This is when “oral thrush” occurs and treatment becomes crucial to minimize pain & discomfort. In this article, you will learn how oral medicine specialists diagnose and treat oral thrush.

How to Diagnose Oral Thrush

Diagnosing thrush can be confusing, as there are many forms and different methods to diagnose the infection. Candida fungi are often found in a healthy oral microflora and can live amongst good bacteria in the mouth, without causing any harm. Thus, simply taking a swab of the patient’s mouth to detect the presence of Candida isn’t always useful. Because even if there are some Candida fungi found in the swab, we cannot tell if they are part of the normal bacterial flora in your mouth, or if they are actively causing an infection. Therefore, we usually diagnose oral candidosis with a clinical examination and with consideration of your medical history. 

There are many different forms of oral thrush. In general, primary oral candidosis classification includes pseudomembranous, erythematous and chronic hyperplastic candidosis.  

Pseudomembranous Candidosis

Pseudomembranous candidosis is one of the most common forms of candidosis, and it may present with pain or a burning sensation. It is can be seen anywhere in your mouth, including the inside of your cheeks, tongue, or the roof of your mouth (aka the palate). The white patches of pseudomembranous candidosis can be wiped away and a red base may be seen.

Pseudomembranous candidosis found on the inside surface of the upper lip

Chronic Hyperplastic Candidosis

Chronic hyperplastic candidosis also look like white patches, however, these white patches cannot be wiped away. Hyperplastic candidosis is usually painless. However, hyperplastic candidosis has a higher chance of being precancerous and being linked to oral cancer. If these are seen, you should see an oral medicine specialist.

Erythematous Candidosis

Red patches in the mouth may be a form of erythematous candidosis. Generally, it’s a rarer form of oral candidosis. It’s usually found in people who have been taking antibiotics or corticosteroids for a very long time. Unfortunately, acute erythematous candidosis can be painful. 

Above are clinical presentations of pseudomembranous candidosis, erythematous candidosis and chronic hyperplastic candidosis

Candida-Associated Lesions

Candida-associated lesions” are conditions linked to the Candida species and many other microorganisms. These include:

  • Angular cheilitis, which are ulcerations and/or redness around the corners of your mouth.
  • Median rhomboid glossitis is a red diamond-shaped patch found in the middle of your tongue.
  • Denture-associated erythematous stomatitis, which causes redness under your denture.
  • Linear gingival erythema, which causes redness along the margins of your gums.

It’s recommended that you see an experienced dental professional and get an accurate diagnosis of oral thrush since it can easily be misdiagnosed.

Are You at Risk of Getting Oral Thrush?

Below are a few examples of risk factors, which increase your likelihood of developing oral thrush.

  • Wearing a denture, which can house a lot of bacteria if you don’t clean it daily.
  • Using a steroid asthma puffer, which can leave a residue of medicine.
  • A dry mouth. The lack of saliva allows for an overgrowth of organisms in your mouth.
  • Taking antibiotics (or other medications such as steroid medications). Medications can change the balance of your oral flora and your body becomes more vulnerable to infections, like thrush.
  • Immunodeficiencies or immunosupression. It is harder to fight off infections with a weakened immune system.
  • A nutritional deficiency. Lack of nutrients can once again cause your immune system to weaken, or affect the rate with which your oral tissues can renew (“turnover”).
  • Systemic Conditions or Malignancies. Sometimes, oral thrush infections are an indicator of bigger underlying problems, such as diabetes, tumours, or chronic infections. Thus, it’s crucial to see a healthcare professional when you develop oral thrush symptoms.

Treatment of Oral Thrush

Oral thrush can be treated using antifungals. Some common antifungal agents are polyene or azoles. You should seek advice before using these medications as there can be many drug interactions or adverse side effects.

There are quite a few treatment options for oral thrush. Three of the most commonly used polyene antifungal medications are Amphotericin B lozenges, Miconozole gel and Nystatin oral drops, but they should be used with caution. If you have a dry mouth, you may find Amphotericin B lozenges difficult to dissolve in your mouth and the sucking action may further irritate your mouth.

Nystatin oral drops are often used incorrectly, thus making it ineffective for oral thrush. Moreover, Nystatin oral drops contains a large amount of sugar, which increases your risk of dental decay. Thus, most patients should avoid Nystatin oral drops where possible. Other forms of Nystatin can be used, however they are not easily found in Australia. Please discuss with your doctor or dentist the antifungal treatment, which would best suit your needs.

On a side note, please don’t forget that when using antifungal medicines, you must remove your denture or prosthesis for treatment to be effective. Moreover, denture hygiene, such as removing your denture at night and cleaning it after every meal is also important.

What’s the Next Step When Oral Thrush Won’t Go Away?

If you feel that your oral thrush comes back frequently or never really goes away, then it’s time for you to ask your doctor or dentist for an oral medicine specialist referral. A specialist in the field can evaluate your infection, reach a diagnosis, and check for any underlying medical conditions which may be causing the fungal Candida infection.

If you want to read more about red and white patches on the tongue, click here, and read about Geographic Tongue.

Written by: Dr. Amanda Phoon Nguyen (Oral Medicine Specialist), BDSc (UniMelb), MRACDS (GDP), DClinDent (OralMed) (UWA), MRACDS (OralMed), Cert ADL, FOMAA, FPFA, FICD

Amanda Phoon Nguyen

Hi, I’m Amanda, an Oral Medicine specialist in Australia (Western Australia and the Northern Territory). My clinical and research interests include oral mucosal disease, orofacial pain, temporomandibular disorders, dental sleep medicine and pediatric oral medicine. Moreover, I run several oral medicine interest pages, including Spoonful of Oral Medicine on Facebook and @oralmedicineoralpathology on Instagram.

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    My Dr gave me Nystatin mouthwash. What are the other options?? I’m nervous and in USA.

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Treat Oral Thrush – Oral Medicine Specialist Advice
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