Oral Yeast Infection:
the TRUTH Behind Oral Yeast Infection

Oral yeast infection (also called thrush, or oral candidiasis) is a subtype of a fungal infection that develops in the mucous membranes of the mouth. Oral yeast infection tends to be a temporal condition when it manifests in babies, while in adults it may be an evidence of various autoimmune disorders. Moreover, left untreated, oral thrush may spread to the throat and esophagus causing more severe complications.

Candida species, the most dominant of which are Candida Albicans, are a normal oral commensal that is present among 30% - 60% of healthy individuals. Colonization of oral surfaces can serve as a reservoir for yeasts` multiplication and disseminated infections. However, the presence of yeasts in the oral cavity does not necessarily lead to oral yeast infection. Oral candidiasis develops under some predisposing conditions, such as:

1. Systemic diseases affecting host defenses.

2. Drug therapies that affect the host’s defenses and cause changes in the oral cavity.

3. Antibiotic therapies that disrupt the normal inner balance of organisms in the intestines by the elimination of the beneficial gastrointestinal bacterial flora that normally help to prevent Candida multiplication.

4. Physiologic conditions such as aging, pregnancy, infancy, dietary factors, iron deficiencies, diseases like diabetes, hypothyroidism, hypoadrenalism etc.

5. Oral exposure to yeast infection contributors, such as medications, vitamin or mineral deficiencies, allergies to foods or food additives, oral irritation etc.

6. Psychological factors such as stress, depression or anxiety.

7. Local factors, such as wearing dentures as dentures can trigger oral Candida cultivation (old dentures with porosity can result in poor mouth hygiene, promoting yeast colonization). Secondly, since saliva hardly flows underneath dentures, its mechanical washing effect is absent. Thus, the median prevalence of yeast organisms was found to be 37% in the saliva of subjects with natural teeth and 85% in denture wearers with clinically normal palatal mucosa.

Other conditions that affect salivary flow, such as Sjogren’s syndrome and some types of antidepressants, can contribute to Candidiasis predisposition as well.

The most common symptoms of oral yeast infection are:

1. White, creamy or yellow spots with red background that appear in the inner surface of the mouth. Aggressive scrubbing will result in bleeding rather then their elimination.

2. Extra tissue that cannot be wiped off (hyperplastic).

3. Redness in the tongue with no bright spots, sometimes followed by peeling patches on the surface of the tongue.

4. Red cracks at the corners if the mouth (angular cheilitis).

Alongside with its visible symptoms, oral candidiasis can be accompanied by an unpleasant burning sensation in the infected area.

Oral thrush is extremely common in newborn babies. In newborns, restlessness and anger during feedings, as well as sudden refuse to take a pacifier, serve as the first evidence for oral yeast infection, which demands further tests.

Oral yeast infection can be effectively treated with some anti – fungal drugs, such as :

1. Nystatin (brand names: mycostatin, mycolog and nilstat): An antibiotic used for different subtypes of fungal infections. It is non-toxic and doesn’t damage bacteria or viruses. In case of oral yeast infection, it can be taken by mouth as a tablet or a liquid three to five times a day. Oral yeast infection usually disappears after 48 hours of using this medication. Note that this drug requires multiple doses, which can lower the patient compliance.

2. Ketoconazole (brand names: mycelex, monistat and nizoral): an antifungal that alters the fungus cell wall while eliminating fungi organisms.

3. Triazole antifungal agents, such as itraconazole and fluconazole. Itraconazole may be taken orally or intravenously as part of a continuous treatment (at least three months, until a laboratory test results find no fungal infections). Itraconazole’s main disadvantages are poor absorption and various side effects, such as nausea, vomiting, abdominal pain, fatigue etc. Fluconazole comes as a tablet or a liquid and to be taken orally once a day for several weeks or longer.

4. Amphotericin B (brand names: fungizone, adria and apothecon): polyene antimycotic drug, a powerful antibiotic for treatment of fungal infections. This drug is usually prescribed for the treatment of severe candidiasis and given during hospitalization. This drug exhibits toxicity and may cause a variety of side effects.