Oral Thrush

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Oral thrush is a localized, mucocutaneous Candida infection characterized by white plaques in the oral cavity that can be scraped off, resulting in red, inflamed, or bleeding areas.

Cause

  • Candida albicans

Signs and symptoms

  • Creamy white, cottage cheese-like lesions on the tongue, cheeks palates, gum and tonsils
  • Redness, irritation and pain under dentures (denture stomatitis)
  • Slight bleeding if lesions are rubbed or scraped
  • Cracking and redness at the corners of your mouth
  • Redness, burning or soreness associated with difficulty in eating or swallowing

Differential diagnosis

  • Aphthous ulcers

Complications

  • Systemic candida infections

Investigations

  • Physical examination of the mouth
  • Microscopic evaluation and cultural sensitivity of swab sample
  • Blood test to identify any possible underlying medical conditions
  • Biopsy and histopathological examination

Treatment objectives

  • Restore oral health

Non-pharmacological treatment

  • Clean baby’s mouth and mother’s nipple with clean soft wet towel before feeding

Pharmacological treatment

Adult:

Nystatin oral tablets

500,000-1,000,000 IU every 6 hours for 10 days (chewed then swallowed)

Child:

Nystatin oral suspension

< 5 years: 100,000 IU every 6 hours for 10 days

5-12 years: 200,000 IU per dose every 6 hours for 10 days

Note: Avoid feeding the baby for 5-10 minutes after administration of nystatin

Prevention

  • Sterilize feeding bottles after each use
  • Rinse mouth after eating or taking medicine
  • Brush teeth at least twice a day and floss daily 
  • Removal of dentures at bedtime.
  • Treat dry mouth