DefinitionThrush is a fungal infection of the mouth. It usually begins on the tongue and inside of the cheeks. It may also spread to the palate, gums, tonsils, and throat. Severe, untreated thrush can spread to the:
- Urinary tract
- Whole body—systemic infection causes multiple organ failure and death
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CausesThrush is caused by a fungus. There are many microorganisms that normally live in the mouth. When these organisms become imbalanced, the fungus can grow and cause thrush. The imbalance of organisms may be caused by a medical condition or medication.
Risk FactorsFactors that may increase your baby's chance of getting thrush include:
- Contamination from caregivers
- Contamination during breastfeeding
- Birth complications, such as preterm birth, premature rupture of membranes, or perinatal asphyxia
- Very low birth weight babies admitted to neonatal intensive care
- Vaginal yeast infection in the mother at the time of birth
- Health conditions that suppress the immune system, such as:
- Prolonged illness
- Use of antibiotics
- Conditions that cause a dry mouth
- Use of medications that treat psychiatric conditions
SymptomsThrush may cause the following in infants:
- Decreased interest in feeding
- White, lacy patches on the inside of the cheeks or tongue that don't come off when rubbed
- Sore mouth and throat
- Difficulty swallowing
- Differences in taste
- White or red patches on the inside of the cheeks or tongue that may or may not come off when rubbed
- Fissures or cracks in the mouth
DiagnosisYou will be asked about your child's symptoms and medical history. A physical exam will be done, including an inspection of the mouth. Diagnosis can usually be done after physical exam. The doctor may take a sample of cells from the affected area. The sample will be examined under a microscope to confirm thrush or look for other infections.
TreatmentThe goal of treatment is to restore the normal balance of bacteria and yeast in the mouth. If any underlying conditions contribute to thrush, they will also be treated.Treatments include:
MedicationsIn infants, antifungal medications may be a gel or a rinse that is swished around your baby's mouth. Systemic medications may be used if:
- Your baby is at risk for developing a systemic infection
- Your baby can't tolerate other treatments
- Your baby doesn't respond to other treatments
Proper Oral HygieneOral hygiene practices that may aid in healing include:
- Clean your baby's mouth with a clean, moist gauze pad as soon as baby teeth appear.
- Have your child rinse his or her mouth with warm salt water
- Gently scrape patches off your child's mouth with a toothbrush
- Gently brush any newly appearing teeth with a child-size toothbrush and water.
- Start to clean your baby’s teeth regularly as soon as they come in. Use an amount of fluoride toothpaste that is about the size of a grain of rice. Progress to an amount that is about the size of a pea by the time your child is 3 years of age. This will reduce the risk of your child swallowing it.
- If your child has 2 teeth that touch, you can start to use dental floss.
PreventionTo help reduce your child's chance of getting thrush, take these steps:
- Maintain proper oral hygiene after treatment.
- If your child is at risk, ask your child's doctor about antifungal medication.
- Thoroughly clean your baby's pacifier and toothbrush.
- If your baby is prone to thrush and drinks from a bottle, use disposable nipples.
- Avoid mouthwashes and mouth sprays. These can upset the normal balance of yeast and bacteria in the mouth.
- If your child uses a corticosteroid inhaler, make sure they rinse their mouth thoroughly after each use.
Centers for Disease Control and Prevention
National Foundation for Infectious Diseases
Canadian Dental Association
Public Health Agency of Canada
Babies and kids healthy habits. American Dental Association Mouth Healthy website. Available at: http://www.mouthhealthy.org/en/babies-and-kids/healthy-habits. Accessed January 13, 2015.
Greenspan D, Greenspan JS. HIV-related oral disease. Lancet. 1996;358:9029).729-733.
Oral candidiasis. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/fungal/diseases/candidiasis/thrush/. Updated February 13, 2014. Accessed January 13, 2015.
Oral candidiasis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 6, 2014. Accessed January 13, 2015.
Oral candidiasis in infants. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 26, 2013. Accessed January 13, 2015.
A prospective, randomized, double-blind, placebo-controlled trial evaluating the effects of nystatin on the development of oral irritation in patients receiving high-dose intravenous interleukin-2. J Immunother. 2001;24(2):188-192.
2/17/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: American Dental Association Council on Scientific Affairs. Fluoride toothpaste use for young children. J Am Dent Assoc. 2014 Feb;145(2):190-191.
- Reviewer: Michael Woods, MD
- Review Date: 01/2015
- Update Date: 02/17/2014
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