Oral Thrush
What are the symptoms of this condition?
Oral thrush refers to the infection of the oral cavity with
the Candida fungus. This is a very common condition in babies,
especially in the first few months of life, when it is often
passed on by the mother during childbirth; it may also occur
in adults.
The condition presents with slightly raised white or yellow
patches on the tongue, cheeks, and roof of the mouth, which
looks similar to milk curd but does not wipe off as easily.
If removed, the area underneath will be sore and red and may
bleed slightly. It is often painful and uncomfortable; in
babies, this will be evident at feed time.
What is the cause of this condition?
The Candida fungus is responsible for the infection; whilst
this is present in the mouths of around 50% of the population,
it will only multiply enough to cause a noticeable thrush
infection when the conditions are right - there are a number
of factors which can influence this. In babies and small children,
the immune system is still developing and the first time that
the fungus is presented to the mouth will more than likely
cause oral thrush. Recurrent oral thrush in children is uncommon,
but may be caused either by the presence of Candida on the
mother's nipples whilst breast feeding, or inadequately sterilised
bottle teats in bottle fed babies.
In adults, the immune system should prevent the onset of oral
thrush by controlling the population of Candida in the mouth,
if present, however there are situations in which the balance
may be disturbed. The most common causes of oral thrush in
adults are the use of steroid inhalers ("preventer" inhalers)
and the use of dentures; other possible causes are a previous
course of antibiotics, diabetes, malnutrition, or a compromise
of the immune system by some other factor, in which case the
doctor should be consulted.
Also, the over-use of strong mouthwashes and mouth sprays
may upset the balance of micro-organisms in the mouth, making
oral thrush more likely.
What complications might occur?
Complications arising from oral thrush in children or adults
are rare, however if an infection fails to respond to treatment,
or if the child or adult falls into any of the categories
listed above, you should talk to your pharmacist or doctor
for further advice.
What can I do to treat myself?
For babies and children, ensure that feeding equipment and
dummies are properly sterilised to avoid reinfection, or if
breast-feeding, a small amount of an antifungal gel may be
applied to the nipple. Further advice about treatment using
an antifungal gel is given below.
In adults, where the cause is thought to be related to the
use of an asthma inhaler, you should rinse the mouth with
water after use, to remove particles of powdered medication
remaining in the oral cavity. Ask your pharmacist if you are
unsure about the correct way to use your inhaler, as correct
use can minimise the amount of powder deposited in the mouth;
there are also devices which can be used alongside common
inhalers to prevent this effect if necessary.
If oral hygiene is difficult because of soreness in the mouth,
consider using a soft toothbrush until the condition is under
control.
What treatments are available for
me to purchase?
The most effective treatment available without a prescription
is miconazole gel (Daktarin Oral Gel). This is an orange flavoured
antifungal gel, which can be used for all ages, and may be
applied to the mouth of a young child using a cotton bud or
the handle of a teaspoon. It's important that the gel is retained
in the mouth for as long as possible after application, and
treatment should be continued for two days after the symptoms
have cleared, to ensure complete eradication of the infection.
Treatment should work within one week. However, this gel is
not suitable for people taking anticoagulants, such as warfarin
tablets.
For more information about Oral treatments,
contact
our pharmacist.
Other products which are suitable for the treatment of oral
thrush include Corsodyl mouthwash, Corsodyl dental gel, and
Oraldene mouthwash, all of which are based on a strong oral
antiseptic.
To see the range of mouthwashes and oral hygiene products
available from Pharmacy2U,
click
here.
What treatments are available from
my doctor?
Other antifungal preparations based on an ingredient called
nystatin can be prescribed by a doctor for oral thrush which
is resistant to non-prescription treatments. This is available
in a dropper form for adults and children, or as a pastille
for adults. This is usually used four times a day and treatment
is continued for two days after all symptoms have cleared,
as for the miconazole gel, above. Nystatin preparations should
also be held in the mouth for as long as possible - they are
broken down as soon as they reach the stomach.
The doctor may recommend other courses of action if necessary,
depending on the underlying cause of the condition, such as
recommending better fitting dentures, a modification of medicines
for diabetes, or referral for further investigation.
What additional investigations might
be needed?
The doctor should be consulted in the following circumstances:
· The patient is an adult, and there is no obvious underlying
cause
· Non-prescription treatments have been tried, and have failed
· Oral thrush is a recurring problem
· The patient has a compromised immune system
· Your pharmacist has referred you
If the doctor is unsure of the nature of the infection, a
scraping from the mouth can be sent for analysis, to confirm
the diagnosis if necessary.
Any other information I should have?
Oral thrush is a common condition in babies and young children,
and can usually be treated quickly and successfully using
a non-prescription oral antifungal gel. It commonly occurs
at the same time as nappy rash; this can be treated using
an antifungal cream such as Canesten or Daktarin Cream. Ask
your pharmacist if you need more advice.
However, it's not as common in adults, and may be painful
but it is rarely serious. If oral thrush appears for no apparent
reason, then talk to your pharmacist or doctor for the best
advice.