Thrush (Oral Candidiasis)

What thrush looks like

• creamy white or yellowish patches, like cottage cheese, on the tongue, inner cheeks, gums, palate or throat
• patches that can be wiped or scraped off, leaving red, sometimes bleeding areas
• redness and soreness, especially under dentures
• cracks and redness at the corners of the mouth (angular cheilitis)
• a cottony feeling, loss of taste or an unpleasant taste
• pain when eating or swallowing

Milk residue on a baby's tongue wipes off easily and is not raised; thrush patches stick more firmly and also appear on the cheeks and gums.

Thrush in babies

• white patches in the mouth
• fussiness during feeding
• often a diaper rash from Candida at the same time: bright red with small spots at the edges
• breastfeeding parents may get nipple thrush: cracked, shiny, sore nipples and burning or shooting pain during or after feeds

Thrush in adults

More common in people who:

• wear dentures, especially overnight
• use inhaled corticosteroids for asthma or COPD
• have recently taken antibiotics
• have diabetes, especially if poorly controlled
• have a dry mouth from medicines, radiotherapy or Sjögren's syndrome
• smoke
• have a weakened immune system: HIV infection, chemotherapy, organ transplants, or long-term steroid tablets

Types of oral candidiasis

Diagnosis

Doctors and dentists usually diagnose thrush by its appearance. A scraping can be examined under a microscope. Endoscopy is used if esophageal involvement is suspected. Adults with unexplained or recurrent thrush may be tested for diabetes and HIV.

Treatment

Babies

• nystatin suspension or miconazole oral gel (miconazole gel is not recommended for babies under 4 months in some countries due to choking risk; follow your doctor's advice)
• continue treatment for a few days after the patches go
• treat the breastfeeding parent's nipples with an antifungal cream at the same time if affected
• sterilize bottles, nipples and pacifiers

Adults

• mild to moderate: clotrimazole lozenges, miconazole buccal tablets or nystatin suspension for 7 to 14 days
• moderate to severe or esophageal: oral fluconazole tablets
• resistant infections: other antifungals as advised by a specialist

Self-care and prevention

• rinse your mouth with water and spit after using a steroid inhaler; use a spacer
• remove dentures at night, clean them daily, and soak them in a denture cleanser
• brush teeth twice daily and see a dentist regularly
• control blood sugar if you have diabetes
• stop smoking
• treat dry mouth with sips of water or saliva substitutes

Is thrush contagious?

Candida lives normally in most people's mouths. Thrush can pass between a baby and a breastfeeding parent, which is why both are treated. It is not generally considered contagious between healthy adults. "Thrush" is also a common name for a vaginal yeast infection, caused by the same fungus.

Frequently asked questions

What causes oral thrush?

Oral thrush is caused by an overgrowth of Candida yeast, which normally lives in the mouth. Triggers include antibiotics, steroid inhalers, dentures, dry mouth, diabetes, smoking and a weakened immune system. In babies, an immature immune system makes it common.

How do I know if it is thrush or milk on my baby's tongue?

Milk residue wipes off easily and is usually only on the tongue. Thrush patches also appear on the cheeks and gums, are harder to wipe off, and may leave red, sore spots underneath.

How long does oral thrush last?

With treatment, thrush usually clears within 7 to 14 days. In babies, mild cases may go away on their own, but treatment helps prevent spreading to the breastfeeding parent.

Can adults get oral thrush?

Yes. It is common in adults who wear dentures, use steroid inhalers, have recently taken antibiotics, have diabetes, or have weakened immunity. Unexplained thrush in an adult should be checked by a doctor.