Oral thrush

Oral thrush is visible as a white coating that covers your mouth and throat. Scraping it off with a tongue depressor will reveal inflamed red areas that often bleed slightly as well. Even if they practice good oral hygiene, people who have oral thrush will notice a constant cottony feeling in their mouth. Their sense of taste will also be affected and they may have pain or a burning sensation on their tongue. That can make it difficult to eat and drink. Severe oral thrush can also affect your ability to swallow or speak.

Oral thrush is usually the result of certain medical conditions or a side effect of medical treatment. Infections are generally more likely to occur if the body and immune system are weakened. A very dry mouth makes it easier for the fungus to grow.

Oral thrush can result from cancer treatment. Chemotherapy can damage the mucous membranes and weaken the immune system, allowing the fungus to spread more easily. This mostly affects people having high-dose chemotherapy, to treat leukemia for instance. Stem cell transplants and radiotherapy in the head and neck area also increase the risk.

People who have had an organ transplant are also very vulnerable. People with HIV/AIDS are especially at risk if they don’t receive adequate antiviral treatment.

Diabetes can also increase the risk of oral thrush, as can dentures and certain medications like steroid sprays and broad-spectrum antibiotics used for several weeks at a time. Oral thrush is more common in older people who require nursing care and are generally very weak overall, eat and drink very little or are fed through a tube.

Oral thrush usually doesn’t cause any serious health problems, but it can be very unpleasant. If the fungus spreads to your food pipe, for example, it may cause problems swallowing. Together with the other symptoms, this may cause people who have oral thrush to eat less and lose weight. That's mostly a problem if they are already weakened by another medical condition or a treatment, or if they also have other problems like nausea or lack of appetite.

Left untreated, oral thrush can last for months or even years. If your immune system is very weak, the fungi may penetrate deeper layers of tissue, reaching the circulatory system and causing life-threatening sepsis. But this only rarely happens.

If you have a higher risk of developing oral thrush, it’s important to tell your doctor or caregiver about any unusual sensations or pain you may feel in your mouth. They could then check whether it’s a fungal infection. If they think it might be oral thrush, a sample of the coating can be taken using a sterilized cotton swab and then tested in a laboratory.

Oral thrush can be discovered earlier in people who have cancer or HIV/AIDS if they have their mouth checked regularly. You can also check your mouth yourself in the mirror by looking for changes like a white coating or inflamed areas. Or you can have family members or caregivers help you.

If you’re healthy, you don’t have to do anything to prevent oral thrush. But if you are at higher risk, it is especially important to care for your teeth, gums, and the lining of your mouth, and to keep that area moist and protected from injury. A soft-bristled toothbrush is gentle on the gums. Cleaning between your teeth removes plaque and food particles. Dentures should be cleaned regularly, for example with a toothbrush and a special cleaning solution. Anyone who uses steroid sprays should rinse their mouth with water afterward.

Hospital staff will take special care to ensure that people that people with weakened immune systems do not become infected with germs during treatment. Antifungal drugs called antimycotics are used in rare instances to prevent fungal infections. These drugs kill the fungus or reduce its growth. But taking them as a preventive measure is only a good option in certain situations – for example, during a stem cell transplant. It is still important to detect oral thrush early and then have it treated.

Oral thrush can be treated very effectively with antimycotics. Some of these medications can be applied directly (topically) to the affected mucous membranes in the mouth – that is often all that is needed for milder oral thrush. Other kinds are swallowed. They then spread through your body (systemic treatment). Small amounts of topically applied medication enter the gastrointestinal tract (stomach and bowel) through saliva. Some of the medication is absorbed there and then also spreads through the body.

But they can have side effects, including headaches, rashes, nausea, flatulence (wind) and diarrhea. Resistance can also develop – meaning that the fungus becomes less sensitive to certain antimycotics. This can make treatment more difficult.

Factors like your general health and how much the infection has spread will determine which antimycotic is suitable for you. The medications are typically used over a time period of about one to two weeks.

You can also change what you eat so that the mouth sores are less painful – for example, by switching to soft foods, avoiding hot or alcoholic drinks and leaving heavily seasoned or acidic foods out of your diet.

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.