If you notice a white rash in your mouth, don’t be alarmed. You may have a fungal infection known as oral thrush.
Although it’s more common in babies, people who have an immune deficiency, and those who use steroid sprays to treat asthma, oral thrush also occasionally occurs in healthy individuals.
The good news is, oral thrush is typically easy to treat.
To help you determine if you have oral thrush and how to remedy this condition, in this article, I will explain the symptoms of oral thrush, how it is diagnosed, and the treatment options for adults and infants.
I’ll also share how, by practicing good oral hygiene, you can prevent your chances of contracting the infection or having it recur.
What Is Oral Thrush?
Oral thrush, which is also called oral candidiasis, is a yeast infection.
It starts when the fungus candida albicans overgrows in the mouth. If left untreated, the infection can spread to other parts of the body such as the lungs, liver, and skin.
Oral thrush happens more frequently in people with compromised immune systems (such as those battling cancer or HIV) and infants.
Oral thrush may show no symptoms in the early stages, but as it develops, it can cause:
- White or yellow slightly raised areas on the tongue, inner cheeks, back of the throat, roof of the mouth, gums, or tonsils
- Cottage cheese-like raised spots
- Bleeding if the bumps are scraped or irritated
- Dry, red skin at the corners of the mouth
- Soreness or burning in the mouth
- Cotton-like feeling in the mouth
- Bad taste in the mouth
- Loss of taste
In extreme cases, oral thrush symptoms can include:
- Difficulty swallowing and/or a feeling that food is stuck in the throat
- Tightness in the middle of the chest
Infants can pass oral thrush onto their mothers during breastfeeding.
This can result in the following symptoms for the mother:
- Red, itchy nipples
- Sensitive, shiny, or cracked skin on the nipple and areola
- Painful nursing or nipple pain between feedings
- Sharp, stabbing pains deeper in the breast
How Is Oral Thrush Diagnosed?
Oral thrush is often grouped into three types:
- Pseudomembranous: the mouth lesions appear white and creamy
- Erythematous: the mouth lesions are red, raw, and painful
- Hyperplastic: white plaque-like lesions or speckled red spots are visible
A healthcare professional will typically diagnose oral thrush by looking for these distinctive characteristics in and on the mouth.
However, in some cases, they may do one of the following procedures:
- Biopsy: Using a cotton swab, the doctor scrapes off a small portion of a bump and sends it to a laboratory for analysis to determine what type of bacteria or fungi is causing your symptoms.
- Endoscopic exam: If a provider suspects thrush infection of the esophagus, you may need an endoscopy. A specialist inserts an endoscope—a thin tube with a light and camera attached—through the mouth and into the esophagus to examine it. They may also take a biopsy during this procedure.
- Physical examination: In certain circumstances, a physical exam and blood tests may be necessary to identify any underlying medical condition that could be causing thrush in the esophagus.
What Are Your Treatment Options?
The best treatment for oral thrush depends on your age, overall health, and the cause of the infection.
Your provider will consider these factors to select the right treatment and measures to prevent recurrence.
Doctors commonly prescribe one of the following medications to treat oral thrush:
- Fluconazole (Diflucan): an oral antifungal medication
- Clotrimazole (Mycelex Troche): an antifungal medication that’s available as a lozenge
- Itraconazole (Sporanox): an oral antifungal medication suitable for people with HIV and those who do not respond to other treatments
- Nystatin (Nystop, Nyata): an oral antifungal medication used for infants and those with weakened immune systems
- Amphotericin B (AmBisome, Fungizone): an injection that’s used for more severe cases of oral thrush
Prescription medications are safer and more effective than over-the-counter options.
Always speak with a healthcare professional before trying these OTC treatments, especially when treating a baby:
- Probiotics: Some research suggests probiotics may help treat oral thrush in adults who have normal immune systems by restoring a healthy balance of bacteria in the mouth. However, more research is needed to confirm how effective probiotics are.
- Gentian violet: Sometimes used to treat mild cases of oral thrush in healthy adults, infants, and breastfeeding mothers, gentian violet is an antifungal. However, it can be irritating or toxic at some doses, stains skin and clothing, and is not regulated for use as a treatment by the FDA.
Home remedies may help you treat oral thrush and prevent it from coming back.
Practicing good oral hygiene is extremely important:
- Choose a soft-bristled toothbrush to avoid aggravating the bumps caused by thrush.
- Invest in a new toothbrush after you finish your treatment for oral thrush.
- Thoroughly clean your dentures or any mouth devices that you wear such as retainers, tooth-alignment devices, or mouthguards.
- Unless prescribed by your doctor, avoid mouthwashes or mouth sprays.
- Talk to your doctor about taking a probiotic supplement or eating yogurt that contains live cultures.
- For oral thrush in infants, consult your pediatrician. Some cases of infant thrush will go away on their own, but others may require prescription treatment.
Once you begin treatment, you can expect oral thrush to go away in a few weeks. If symptoms persist, consult your healthcare provider.
The easiest way to help prevent oral thrush is to practice good oral hygiene:
- Use an alcohol-free antiseptic mouthwash twice a day or as directed by your dentist or healthcare provider.
- Brush your teeth twice a day and floss daily.
- Remove your dentures at night and clean them daily. You may want to check with your dentist that your dentures fit properly and aren’t causing irritation.
- If you experience dry mouth, discuss treatment options with your healthcare provider.
- Limit the amount of sugary foods that you eat. These foods may promote the growth of candida.
- Keep your blood sugar levels in check. This will help control the amount of sugar in your saliva, which is known to encourage the growth of candida.
When to See a Doctor
Normally your immune system works well to fight off fungi that can be harmful to your health and, with the right treatments, oral thrush will resolve within two weeks.
However, this is not always the case, especially if you have a compromised immune system.
Visit your healthcare provider if:
- You have a medical condition (such as HIV or cancer) that causes a weak immune system.
- Your child shows symptoms of oral thrush.
- You are generally healthy but the sores won’t go away with at-home treatments.
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