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Thrush Mouth in Adults

David De Lossy/Photodisc/Thinkstock
David De Lossy/Photodisc/Thinkstock
Because the appearance of some types of oral thrush is so distinctive, it can often be diagnosed simply on sight.

Without yeast, there is no warm bread, cold beer or creamy cheese, no wine or whiskey. A world without yeast is hardly a world worth living in, culinarily speaking.

Yeast is a fungus, and as strange as it may seem, that beautiful glass of Malbec you're drinking is a fungal concoction. There are many different kinds of yeasts, and while some create gustatory pleasure, others work toward a goal like diaper rash. (These yeasts are, perhaps, the evil stepsiblings of the cheese kind.)

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Yeasts are everywhere. You can find them in soil and water, and on plants and people, too. And while most of the time these organisms contribute happily to the little colonies of beings that live in harmony on your skin, in your mouth and in your innards, disruptions in their ecosystems do not go unnoticed. That's when people get conditions like oral thrush.

The yeast behind oral thrush is Candida albicans (although sometimes Candida glabrata or Candida tropicalis make a guest appearance). It's the same great yeast that brings us vaginal yeast infections and the skin infection candidiasis. (Yes, oral thrush is a nicer way of saying "yeast infection of the mouth.")

But for most people, it's not so bad. Find out what oral thrush looks like on the next page.

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There are four kinds of oral thrush: pseudomembranous, hyperplastic, erythematous and angular cheilitis.

The calling card of the pseudomembranous type is raised white lesions in the mouth that are described as having a cottage-cheese appearance. (If you were planning on having cottage cheese at lunch, we're sorry.) If you scrape them, they tend to bleed. Sometimes, they join together to make larger spots called plaques that can discolor into a yellowish hue. They like to grow on the insides of your cheeks, your tongue and the roof of your mouth.

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The hyperplastic type prefers to stay in your cheeks, but unlike the pseudomembranous kind, the plaques can't be scraped off.

Angular cheilitis also involves white plaques, but its hallmark is cracks around the mouth. In a young person, it often signals HIV infection, as does erythematous oral candidiasis, characterized by red lesions on the palate and under the tongue or spots on the mucous membranes of the cheeks.

An infection of your mucous membranes isn't too bad, but if it spreads to your esophagus from, for example, the insertion of a nasogastric tube, things get more serious. Once the infection has spread way back there, your mouth may feel cottony and your sense of taste deadened. Esophageal infections might make you feel like food is stuck in your throat and inhibit your ability to swallow. For people with compromised immune systems, thrush can run rampant, taking over the lungs, liver and intestines.

Because the appearance of some types of oral thrush is so distinctive, it can often be diagnosed simply on sight, although sometimes a sample from one of the white spots is taken and treated with a potassium hydroxide solution, periodic acid-Schiff or Gram stain to spotlight the yeast cells under a microscope.

Thrush in the esophagus, however, is diagnosed by a throat culture (the same cotton throat swab that gets you a strep diagnosis) or an endoscopic exam. An endoscopic exam is reserved for serious cases because it requires anesthesia, but it enables a doctor to get a close look at your esophagus, stomach and duodenum with a camera.

Once you have a diagnosis or oral thrush, the next question on your mind is probably: Where did I get it from?

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There are plenty of factors that can disturb the natural ecosystem of microorganisms that live in your mouth, unfortunately. Oral thrush is most common in people who:

  • Wear dentures (especially ill-fitting dentures)
  • Have compromised immune systems (from cancer treatment or HIV/AIDS, for example)
  • Have diabetes
  • Smoke
  • Use inhaled corticosteroids (especially with improper technique)
  • Are taking antibiotics or birth control
  • Are under stress
  • Have dry mouth (xerostomia)
  • Have poor oral hygiene

Diabetes, for example, creates more sugars in the person's saliva than is normal, which Candida considers a welcome mat. Improper usage of an inhaler can result in residual steroids in the mouth, which your balance-loving fungi and bacteria will protest. Antibiotics slay germs, but they can do so somewhat indiscriminately, killing off the good kind you need to keep yeasts in check.

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The common factor in most of the above, of course, is that they're conditions or behaviors, such as smoking, that directly affect your mouth's microorganism population.

The group in whom infections are most worrisome is those with compromised immune systems. As we mentioned earlier, these infections can spread to vital organs and lead to serious health issues. Oral or intravenous antifungal medications such as fluconazole, itraconazole or miconazole may be used to wipe out Candida. With late-stage HIV, amphotericin B may be necessary. Antifungals can cause intestinal distress, but the most serious side effect to watch out for is liver damage.

For the rest, modern medicine comes to the rescue in the form of a mouthwash (that doesn't taste great), drops, gels or lozenges. Nystatin is the drug most commonly used, and it requires about a week of application to do the dirty job.

Antifungals aren't your only option, however. Take a look at some home remedies on the next page.

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If you're the type who goes to the doctor only as a last resort (you know who you are), there are some things you can try at home.

Unsweetened yogurt with Lactobacillus acidophilus in it or over-the-counter acidophilus capsules won't kill Candida for you, but they can bring back balance to your bacterial community. Rinsing your mouth with warm saltwater can also help -- the Mayo Clinic recommends you use a mixture of ½ teaspoon salt to 1 cup water. A diluted 3 percent hydrogen peroxide solution can also serve as a rinse.

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Common home remedies for thrush include a swab of coconut oil, distilled white vinegar or a baking soda solution to affected areas, but there's no scientific evidence to back any of these as a cure, so use at your own risk.

As with so many conditions, prevention is key, and taking good care of your mouth goes a long way toward not having to explain that you can't kiss someone because you have a yeast overgrowth in your mouth. So, remember:

  • Brush your teeth. Brush at least twice a day with a soft toothbrush. If you're an inhaler user, brush after each use. If you're not a great brusher (we all have our strengths), invest in an electric toothbrush.
  • Replace toothbrushes frequently.
  • Floss daily.
  • Make regular appointments with your dentist.
  • Avoid mouthwashes and breath sprays.

And for dentures-wearers, clean your faithful prosthetic device each and every night. Want to learn more about thrush? We have lots more information on the next page.

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Related Articles

Sources

  • Mayo Clinic. "Oral Thrush." Aug. 20, 2011. (Nov. 12, 2011) http://www.mayoclinic.com/health/oral-thrush/DS00408
  • MedicineNet.com. "Dental Health and Thrush." (Nov. 12, 2011) http://www.medicinenet.com/thrush/article.htm
  • Mersch, John. "Oral Thrush." eMedicineHealth. April 16, 2010. (Nov. 12, 2011) http://www.emedicinehealth.com/oral_thrush/article_em.htm
  • Nordqvist, Christian. "What is Oral Thrush in Adults (Candidosis or Moniliasis)?" Medical News Today. Feb. 11, 2010. (Nov. 12, 2011) http://www.medicalnewstoday.com/articles/178864.php
  • SoftDental. "Oral Candidiasis (Moniliasis, Thrush)." (Nov. 12, 2011) http://www.softdental.com/diseases/Oral_Candidiasis_Moniliasis_Thrush.html
  • WebMD. "Dental Health and Thrush." (Nov. 12, 2011) http://www.webmd.com/oral-health/guide/dental-health-thrush

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