Is it just a sore or is it an Oral Thrush?

Many people worry sometimes about the white stuff that grows in their mouths. They grab a tongue scrubber and try to remove these whitish patches but it doesn’t help.

They are insecure because their mouths look funny and feel weird like sandpaper.

Well, my friend, these people might have thrush.

The mouth, this oval-shaped cavity that contains many structures inside of it, is just like any other organ. It can get different infections and diseases.

So, let’s talk about the mouth and its anatomy first before heading off to infections and diseases.

The mouth is an important structure. It is also called the oral cavity or the buccal cavity. Parts of the mouth include lips, mouth cavity, gums, teeth, vestibule, hard palate, soft palate, tongue and salivary glands. The two main functions of the mouth are eating and speaking.

As we studied in biology class, the digestive tract begins at the mouth. In fact, digestion of food starts when the food is taken up in the mouth, mixed up with the saliva and ground up by the teeth.

We also studied that the digestion of carbohydrates starts in the mouth. The saliva has an enzyme called amylase that breaks down carbohydrates into sugars.

The food is then moved inside the mouth cavity by the tongue. The movement of the tongue pushes the wet soft mass of food into the back of the mouth cavity where it can be swallowed.

When the food is being swallowed, the epiglottis covers the windpipe (trachea) to ensure the entering of food inside the esophagus and then to the stomach where digestion continues.

This is the mouth role in eating and digestion, but what about the talking process?

Talking is a complex process. It requires a complex sequence of events to occur in the right order to produce meaningful words and sentences.

The process starts when expelled air runs through the vocal cords in the larynx. This induces vibration in the vocal cords which in turn produce different sounds.

However, the type of sound depends on the tightness of the vocal cords and the force of the expelled air.

To shape the different sounds, movements of the tongue and lips help.

Of course, not only the tongue, lips and vocal cords are involved in the talking process. Other structures play a great role such as the nose, hard palate and soft palate.

That takes us to a very important point. What are the structures inside of the mouth? Or in other words, what is the anatomy of the mouth?

To grasp a better understanding of the eating and talking processes, we need to know more about every structure in the mouth and its function.

The main structure in the mouth include:

Lips. They represent the entrance of the mouth. They are two mobile muscular structures. Lips mark the transition of skin to moist mucus membrane. They help in the form of different sounds in the talking process.
The vestibule. It is the space between the soft tissue of the mouth, the lips and cheeks, and teeth and gums. The vestibule is always moist thanks to the secretions of the parotid salivary gland. The two parotid glands are located in front of the ears behind the angle of the jaw.
The mouth cavity. It is the large space inside of the mouth. It is bounded by several structures. The alveolar arches, the bony parts of the jaw that contain the teeth, surround the mouth cavity at the front and on the sides. Overhead are the hard and soft palates and below lies the tongue. The mouth cavity is always kept moist due to the secretions of the submaxillary and sublingual salivary glands located in the floor of the mouth below the tongue.
Gums. They line the alveolar arches and anchor the teeth to them. They are made of dense fibrous tissue.
Teeth. The important part of your smile. One has two sets of teeth throughout a lifetime. When we are children, the average child has their full set of 20 primary teeth by the age of three years. At the period between the age of six and seven years, the primary teeth start to fall out. Then they are gradually replaced by permanent teeth, also known as adult or secondary teeth. By the age of 21, the average person has 32 permanent teeth: 16 in the upper jaw and 16 in the lower jaw.
The Palate. There is the soft and the hard palate. The hard palate is the bony part or roof of the mouth. The soft palate, on the other hand, is a flap of the membrane that hangs between the mouth cavity and the back of the throat. As for the part that appears when you stick your tongue out and say “Ah”, it is called the uvula.
The tongue. The tongue is a muscle. Many people don’t think of it as a muscle, but in fact, it is made up entirely of muscle fibers. It is divided into an oral part and a pharyngeal part. The oral part includes the tip, blade, front, center and back. The pharyngeal part, on the other hand, is the part that is extended to the throat. The tongue’s main functions are to taste, speak and swallow. So, the next time you say, “this food is delicious”, you may think of the tongue for that.
The minor salivary glands. These are the glands that keep the mouth moist all the time by secreting a clear fluid, the saliva, that keeps the mouth moist. The saliva also contains some enzymes that break the food down, just like we mentioned before, saliva contains the amylase enzyme that breaks down the carbohydrates into sugars. These glands can be found in different locations in the mouth including the inner cheeks.

As for the nerve supply for the mouth. The trigeminal nerve, or also called the fifth cranial nerve, is considered the major nerve of the face. It has three main branches:

The upper branch. It supplies the scalp and forehead.
The middle branch. It supplies the cheeks, the top lip, upper jaw, top teeth, and gums. It also supplies some areas of the nose.
The lower branch. It supplies the lower lip, the lower jaw, the lower teeth and gums.

We also need to mention the temporomandibular joint because it is the joint that allows your mouth to open and close, move the lower jaw forward as well as side to side. The joint also helps in chewing, swallowing and talking.

Now as we know all about the mouth anatomy, it is time to go back to our main point.

What is Thrush?

Thrush is a fungal (yeast) infection.

It can grow anywhere in the body. It can grow in the mouth, throat or other parts of the body.

It is also called oral candidiasis. In this condition, the fungal candida Albicans accumulate and grow in the lining of the mouth cavity and inner cheeks.

The fungus candida Albicans is a normal organism in the mouth but sometimes it overgrows and causes symptoms. When this happens in the mouth and throat it is called oropharyngeal candidiasis.

Thrush infection is very annoying but generally, it is considered a minor mouth problem especially for healthy people. With antifungal treatment for a few weeks, it can be treated effectively. But for those who suffer from severe diseases or weakened immune systems, it can be so severe and difficult to control.

What does the thrush look like?

When oral thrush or oral candidiasis occurs, it appears like a growth that looks like cottage cheese. It appears as creamy white and raised lesions on the surface of the tongue and cheeks.

Sometimes it may spread to the roof of the mouth, gums, tonsils, and the back of the throat.

So, who is more likely to get oral thrush?

Let's agree that oral thrush can occur to anyone. However, babies under one month old, toddlers, older adults, people who take certain medications and people with diseases that weaken their immune system where symptoms can be harder to control.

For example, thrush in the esophagus is one of the common infections in people with HIV or AIDS.

So, what does oral thrush do? What are the symptoms of oral thrush?

Usually, thrush develops all of a sudden. The most common sign is the presence of creamy white raised lesions on the tongue, inner cheeks, tonsils or throat.

Initially, symptoms may not be noticed.

Symptoms include:

Raised lesions with cottage-cheese like appearance.
Redness, burning or soreness. It can be so severe that it causes difficulty eating or swallowing.
Minimal bleeding if the lesions were scraped, rubbed or when the patient is brushing their teeth.
Redness and cracking at the corners of the mouth.
A cottony feeling in the mouth.
Loss of taste.
Redness, irritation and sometimes pain under dentures.
Pain or difficulty swallowing.
A feeling of food gets stuck in the throat or mid-chest area. This specifically happens in severe cases related to weakened immune systems from HIV/AIDS, when the lesion spreads down to the esophagus.
Fever. It happens when the infection spreads beyond the esophagus.

These symptoms occur in adults and children.

And what about infants? What are the symptoms of oral thrush in infants?

Infants may show different symptoms besides the distinctive white lesion in their mouths. They may have trouble feeding or they might show irritable behaviour. They might get so fussy and irritable at the times of their feeds.

Surprisingly, infected infants can pass the infection to their mothers during breastfeeding. Then the infection will keep passing back and forth between the mother's breast and the infant's mouth.

So, can we say that oral thrush infections are contagious?

Thrush is highly contagious to those at risk such as people with weakened immune systems.

In healthy people, it is rare to be passed through kissing or other forms of close contact.

So, bottom line, thrush isn't particularly infectious but it can be transmitted.

And as we mentioned, it can be transmitted from an infant to his mother and surely it will induce some symptoms.

What are the symptoms of candida infection in breastfeeding mothers?

Women whose breasts are infected with candida during breastfeeding might experience the following signs and symptoms:

Unusual cracked, red, sensitive and itchy nipples.
The skin of the areola may look shiny or flaky. The areola is the darker circular area that surrounds the nipples.
Pain in the nipples between feedings.
Unusual pain during breastfeeding.
Severe stabbing pain deep within the breast.

From this, we can deduce that candida thrush infection is a concern during breastfeeding.

Why is it a concern during breastfeeding?

Because infants are more at risk of getting and giving thrush during breastfeeding.

Mothers, especially those who are taking antibiotics, may develop thrush around their breasts and nipples and then pass it to their babies.

In fact, thrush infection is a common breastfeeding problem and its treatment can be a bit tricky because when a mother and her baby develop thrush, they should be treated at the same time to prevent the transfer of the infection back and forth between both of them.

Candida infections and oral thrush, like any other disease, has causes.

To better understand the disease, we must get down to its roots.

What causes oral thrush?

Normally our immune system works to prevent the invasion of harmful organisms such as bacteria, viruses, and fungi. Meanwhile, the immune system also keeps the balance between good and bad organisms that live in our bodies.

As we mentioned before, some people have a small amount of candida in their mouths, digestive tract and on their skin.

This amount of candida is kept under control by other microorganisms and bacteria in the body.

But, sometimes, illness, stress or some types of medications disturb this balance and the immune system protective mechanisms fail. Consequently, candida overgrowth occurs and gets out of control allowing an oral thrush infection to occur.

The most common type of candida fungus is Candida Albicans.

You may have an increased risk of oral thrush infection when any of the following risk factors take place:

Taking specific types of medications. Drugs such as some types of antibiotics, birth control pills, prednisone or inhaled corticosteroids can disturb the maintained balance of microorganisms in the body and cause the candida fungus to flourish and grow and, therefore, increase the risk of oral thrush infection.
Weakened immunity. If you thought about it, why does thrush occur more in infants and older adults? Because they have weak immunity. Besides, some medical conditions and drugs can decrease immunity and affect the overall strength of the immune system such as cancer and its treatments, organ transplantation and its drugs that suppress the immune system and HIV/AIDS.
Diabetes. People who have diabetes and live without treatment or poorly control it will have large amounts of sugar in their saliva, which induces the growth of candida.
HIV infections.
Dry mouth.
Cancer.
Pregnancy. The hormonal changes that occur with pregnancy can encourage the overgrowth of bacteria.
Smoking. Smokers generally have bad oral hygiene and reduced immunity, which also encourages the overgrowth of candida.
Having ill-fitted dentures, especially upper dentures.
Vaginal yeast infection. Vaginal yeast infection is caused by the same type of fungus that causes oral thrush, so a mother can pass it to her baby.
Other oral conditions. Any condition that causes dry mouth can increase the risk of oral thrush.

We need to emphasize that oral thrush is seldom a health problem for healthy children and adults.

However, it can get very serious for people with lowered immunity.

It can even deteriorate to be a systemic candida infection.

That's why if you have a weak immune system due to certain diseases or certain medications, you need to be careful.

Some measures can reduce the risk of developing candida infection, including:

Rinse your mouth carefully. If you have to use a corticosteroid inhaler, make sure to rinse your mouth or brush your teeth after using the inhaler.
Brush your teeth at least twice per day and floss daily. You can also take your dentist advice about the best oral hygiene option for you.
Check-up on your dentures. It is better to remove dentures at night. Always make sure that dentures fit well and don't cause irritations. It is also better to ask your dentist about the best way to clean your dentures and it is better to clean them daily.
Visit your dentist regularly. Visiting your dentist regularly is recommended especially if you have diabetes or you wear dentures. Based on your oral health, your dentist will tell you how often you should visit him or her.
Pay attention to what you eat. Limiting sugar-containing foods is better for your oral health because sugar-containing foods encourage the growth of candida.
If you have diabetes, control it and maintain good blood sugar levels. Well-controlled blood sugar will reduce the amount of sugar in saliva and discourage the overgrowth of candida.
Treat vaginal yeast infection. It is better to treat any candida vaginal infection as soon as possible.
If you have a dry mouth, treat it. Ask your family doctor to treat any condition that causes you a dry mouth.

How is Thrush diagnosed?

Some doctors think that oral thrush doesn't need to be diagnosed because it often goes away on its own once the cause is stopped.

But generally speaking, oral thrush can be diagnosed just by looking in your mouth. When your healthcare provider looks in your mouth and finds the distinctive white creamy lesions, he or she can tell instantly it is oral thrush.

On scraping the white lesions, a red tender area appears. It may slightly bleed.

But generally, the diagnosis of oral thrush depends on the location of the lesion and the underlying causes.

If the thrush is limited to the mouth, your doctor or dentist:

Will examine and look at the lesion.
Will take a small sample of the lesions to examine them under the microscope.
Will do a physical examination or ask for some blood tests to detect the underlying cause.

If the oral thrush extends to the esophagus, your doctor might recommend one of the following:

Biopsy. The doctor will take a tissue sample and culture it on a special medium to determine which bacterium or fungus is causing the symptoms.
Endoscopic examination. In this examination, the doctor views the esophagus, stomach and the upper part of the intestine using a long flexible tube that has a tiny camera and a source of light at the end of the tube.

What is the treatment of oral thrush?

The main goal of oral thrush treatment is to stop the rapid spread of fungi.

Choosing the right treatment plan for oral thrush depends on the age of the patient, the overall health and the cause of infection.

For healthy adults and healthy children, antifungal medications are recommended. Antifungal medications come in many forms such as lozenges, tablets and liquids that are swished in the mouth and then swallowed. If these topical medications are not enough, systemic antifungals can be used.

Infants and breastfeeding mothers, on the other hand, are usually prescribed mild antifungal medications, antifungal cream for the mother and antifungal medication for the baby.

But what about people who are at a higher risk? What about adults with weak immune systems?

They are most often prescribed a strong antifungal treatment.

Treating the underlying cause or the cause of the infection is the key to the success of treatment.

Thrush might return back even after it has been treated if the underlying cause is not addressed effectively, for example, poorly disinfected dentures or inhaled corticosteroids are not addressed.

What happens when the oral thrush won't go away?

If the white material doesn't go away even though you are taking your medications, don't hesitate to contact your doctor so he or she can look at your mouth and rule out other conditions.