Thrush

What Is Thrush? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Holly Pevzner
By
Natalia Johnsen, MD
by
Updated on May 16, 2023
Thrush is a fungal infection that grows in the mouth and throat. It’s also called oropharyngeal candidiasis or oral candidiasis. And it’s the most common human fungal infection, especially among the very young and the elderly.

Normally, small amounts of the fungus, or yeast, known as Candida albicans, reside in the mouth along with various other bacteria. But when Candida albicans grows out of proportion to the mix, thrush can occur. Thrush is usually not serious, but treatment is often important to relieve uncomfortable symptoms.

Signs and Symptoms of Thrush

Thrush isn’t a slow-and-steady type of infection. Instead, it could develop quickly. Here are common symptoms:

  • Cottage-Cheese-Like Lesions Creamy white patches or coatings that often appear on the tongue or inner cheeks, but they can also develop on the roof of the mouth, gums, tonsils, or the back of the throat.
  • Sore Mouth
  • Loss of Taste
  • Cottony Feeling in the Mouth
  • Painful Swallowing
  • Cracked and Red Corners of the Mouth
  • Bleeding Lesions This can occur when the sores are scraped during toothbrushing.
  • Trouble Breast- or Bottle-Feeding Infants with thrush may have a hard time feeding.
  • Fussiness and Irritability These are symptoms associated with thrush in infants.

Causes and Risk Factors of Thrush

Thrush, whether in the mouth, throat, or esophagus, is not common in healthy adults. Instead, it most often occurs in babies younger than 6 months old and in older adults.

 Individuals at an elevated risk of oral candidiasis include:
  • Infants Oral thrush is most common in babies under 1 month old and less common in infants older than 6 months.

  • Pregnant Women
  • Those Wearing Dentures It’s estimated that 50 to 65 percent of people who wear removable dentures get thrush.

  • Smokers This includes users of e-cigarettes (with or without nicotine).

  • Individuals With Uncontrolled Diabetes
  • Cancer Patients
  • Those With HIV/AIDS
  • People Experiencing Dry Mouth
  • Residents in Care Facilities Between 65 and 88 percent of individuals living in acute and long-term care facilities are diagnosed with oral thrush.

In addition, folks who are taking certain medications can raise their chances of developing thrush. These meds include:

  • Chemotherapy Drugs
  • Corticosteroids These include prednisone and inhaled corticosteroids for conditions like asthma.
  • TNF (Tumor Necrosis Factor) Inhibitors TNF inhibitors treat autoimmune diseases such as inflammatory bowel disease, psoriasis, and rheumatoid arthritis.
  • Antibiotics
  • Medications That Cause Dry Mouth These include antidepressants, certain medications for high blood pressure or heart failure, some antihistamines, pain medications, and more.

Most people who get thrush in the esophagus have weakened immune systems, such as individuals living with HIV/AIDS, or with blood cancers like leukemia.

It’s also important to note that oral thrush is transmittable by way of breastfeeding and kissing.

 Oral sexual contact with someone who has a yeast infection can cause oral thrush, too.

RELATED: Type 2 Diabetes Complications You Can Avoid

Thrush and Breastfeeding

Babies who have oral thrush can easily pass the infection to their mothers via breastfeeding. Breastfeeding moms who develop yeast infections around the breasts and nipples can just as easily transmit the infection to their babies. Mothers taking antibiotics are especially prone to the fungal infection. Symptoms include:

  • Red, cracked nipples
  • Sensitive, painful, itchy nipples
  • Shiny or flaky skin on the areola
  • Painful nursing
  • Deep, stabbing pain within the breast

“If you are nursing, it’s best to consult your doctor before beginning any antifungals,” says Nina L. Shapiro, MD, a pediatric otolaryngologist at Westside Head and Neck in Santa Monica, California. In all likelihood, you won’t need to stop breastfeeding with thrush. “If your breasts are cleaned in between feedings, and antifungals are being used, you can continue to breastfeed if it’s comfortable,” she says.

How Is Thrush Diagnosed?

Thrush generally is easy to diagnose. Healthcare providers, whether general practitioners or dentists, can usually make the call simply by looking inside the mouth for white lesions. Diagnosis may also involve the following:

  • Scraping the Lesions Your practitioner will scrape a small amount of tissue from the lesions and will look for bleeding or examine the specimen under a microscope.
  • Throat Culture A provider will swab the back of the throat and examine the microorganisms under a microscope.
  • Endoscopy A tube outfitted with a lighted camera will be passed through the esophagus, stomach, and small intestine. Again, this is reserved for those whose thrush has likely moved to the esophagus.

It’s sometimes important to also test for a possible underlying immunocompromising condition, such as HIV or diabetes.

Duration of Thrush

Once a person begins treatment for thrush, the infection is usually resolved within two weeks. If thrush becomes a recurrent issue, bring it to the attention of your healthcare provider. It may be because of an underlying condition.

Treatment and Medication Options for Thrush

Some babies don’t need to be treated for oral thrush, and the infection can be allowed to go away on its own.

 But for most others, thrush can — and should — be easily and effectively treated.

Medication Options

Oral candidiasis, whether in the mouth, throat, or esophagus, is most often treated with an antifungal medication that’s applied to the inside of the mouth for up to 14 days.

 These antifungals can come in the form of a lozenge or liquid that you swish in your mouth and then swallow. For babies, medication is often applied several times throughout the day with a sponge applicator.

These medications include:

  • clotrimazole (Mycelex)
  • miconazole (Oravig)
  • nystatin (Mycostatin)
But if the thrush infection is deemed severe — or if it impacts the esophagus — the antifungal medication fluconazole (Diflucan) is usually given by mouth or intravenously.

When mothers and breastfeeding infants both develop thrush, both should be treated simultaneously to prevent an ongoing back-and-forth exchange of the infection.

Healthcare providers will also likely recommend an antifungal cream for the infected woman’s breasts.

Alternative and Complementary Therapies

Beyond antifungal medications, healthcare providers may also suggest you take the following steps to help treat the infection.

Use probiotics. Sometimes healthcare providers suggest adding a probiotic as an oral supplement, for example with Lactobacilli or other strains (aka “good” bacteria) or by adding probiotic yogurt to your diet. There’s some evidence to support its use to help rid the mouth of yeast overgrowth and for prevention of thrush.

Brush and floss regularly. Replace your toothbrush regularly, and be sure to start using a new toothbrush once your thrush infection is gone.

Keep dentures clean and fitting. Remove and clean dentures daily first by soaking, then by brushing with a soft-bristled brush and nonabrasive cleanser. If you use an adhesive, be sure to clean the grooves that fit against the gums. For overnight, soak in water or a mild cleaning solution as recommended by the dentist. See the dentist if dentures become loose.

Rinse with saltwater. To help speed healing, dissolve ½ teaspoon of table salt into 1 cup of warm water. Swish and spit without swallowing.

Try oil pulling. This involves swishing 1 tablespoon of sesame or coconut oil for 15 to 20 minutes, then spitting it out, rinsing, and brushing your teeth. It’s thought that the antifungal properties of the oil may kill yeast. While one review found that this technique, in addition to traditional plaque control, can significantly improve oral health, the overall evidence on oil pulling is sparse. It isn’t advisable for children under 5 years old and shouldn’t be the only treatment you take for the infection. If you are thinking about trying oil pulling, make sure to discuss it with a healthcare provider first.

Prevention of Thrush

Not all cases of oral thrush can be prevented, but here are some things that you can do to help reduce the chances.

  • Quit smoking.
  • Practice good oral hygiene. Brush teeth at least twice a day; floss at least once a day; see the dentist every six months for cleaning.
  • Treat dry mouth.
  • Control diabetes. When your blood sugar is well-controlled, it can reduce the amount of sugar in your saliva, which discourages the growth of yeast.
  • Rinse your mouth. It’s important either to rinse your mouth or to brush your teeth after using a corticosteroid inhaler. “This can clear the residual steroid that may sit on the lips, tongue, or inside the cheeks,” explains Dr. Shapiro.
  • Use a spacer. Patients with asthma who use a corticosteroid inhaler should use a spacer. A spacer is a tube with a mouthpiece that sends medicine to the lungs and not to the mouth, tongue, and back of the throat, where it can cause thrush.

  • Clean pacifiers and nipples. If your baby uses a pacifier or bottle, thoroughly clean both in hot water after each use. This helps to avoid reinfection if there is yeast on the pacifier or nipple.

  • Use probiotics. “We’ve found that taking probiotics can help modulate the overgrowth of existing candida, thereby reducing the likelihood of thrush,” says Shapiro. In fact, a study found that twice daily use of probiotics (specifically two strains of Lactobacillus) reduced the prevalence of high candida amounts in elderly nursing-home residents.

Again, oral thrush can be passed through kissing and oral sex with an individual with a yeast infection, so it’s best to avoid these activities if one of you has an active infection of candida.

Complications of Thrush

Thrush usually doesn’t lead to any further health issues or complications. But if you or your baby keeps getting oral thrush, talk with your doctor. This might be a sign of another health issue, or it may signify that your baby’s pacifiers or bottles aren’t being properly cleaned to remove the yeast.

In people who have untreated thrush and another underlying condition that weakens the immune system, thrush can spread into the upper gastrointestinal tract or even into the bloodstream, leading to severe infection.

Research and Statistics: How Many People Have Thrush?

Candidiasis in the mouth, throat, and esophagus is uncommon in healthy adults in the United States, but it’s one of the most frequent infections among individuals with HIV/AIDS. In fact, about one-third of people with advanced HIV infections have candidiasis in the mouth and throat.

Between 4 and 15 percent of babies under 1 year old get oral thrush.

Instances of oral thrush in cancer patients range from 7 to 52 percent.

Thrush and Black Americans

No population is more prone to contracting oral thrush than any other, but Shapiro says, “socioeconomic disparities in oral health [correspond] with disparities in oral thrush.” The authors of a review of 23 studies cite challenges to accessing treatment, insurance, and the cost of treatment as some of the barriers to oral care within the African American community.

And while no population is more prone to contracting oral thrush, rates of candidemia — a bloodstream infection that is the most common form of invasive candidiasis — are twice as high in Black Americans as in all other groups. (See below for more on invasive candidiasis.)

 It’s not clear exactly what accounts for the difference in rates, but underlying conditions and socioeconomics may play a role.

Related Conditions and Causes of Thrush

Oral thrush is caused by fungi of the genus Candida, which resides in the mouth, throat, vagina, and gut. But it can sometimes overgrow and bring about an infection.

A fungal infection caused by candida in the vagina is commonly referred to as a yeast infection.

Invasive candidiasis occurs when candida enters the bloodstream and can spread to the brain, eyes, kidneys, heart, bones, or other parts of the body. Unlike the vast majority of thrush and yeast infections, invasive candidiasis is very serious. Candida is one of the main causes of bloodstream infections contracted in American hospitals.

Resources We Trust

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

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  2. Candida Infections of the Mouth, Throat, and Esophagus. Centers for Disease Control and Prevention.
  3. Thrush. Cleveland Clinic.
  4. Oral Thrush. KidsHealth.
  5. Oral Candidiasis. StatPearls.
  6. E-Cigarettes Increase Candida Albicans Growth and Modulate Its Interaction With Gingival Epithelial Cells. International Journal of Environmental Research and Public Health.
  7. Dry Mouth (Xerostomia). Cleveland Clinic.
  8. Yeast Infection (Thrush) From Oral Sex? Go Ask Alice!
  9. Oral Thrush: Symptoms and Causes. Mayo Clinic.
  10. Thrush In Newborns. MedlinePlus.
  11. Effect of Probiotics on Oral Candidiasis: A Systematic Review and Meta-Analysis. Nutrients.
  12. Denture Care: How Do I Clean Dentures? Mayo Clinic.
  13. Oil Pulling and Importance of Traditional Medicine in Oral Health Maintenance. International Journal of Health Sciences.
  14. Comparison of Adverse Events Associated With Different Spacers Used With Non-Extrafine Beclometasone Dipropionate for Asthma. NPJ Primary Care Respiratory Medicine.
  15. Effect of Probiotic Bacteria on Oral Candida in Frail Elderly. Journal of Dental Research.
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  17. Neonatal Thrush of Newborns: Oral Candidiasis? Clinical and Experimental Dental Research.
  18. Oral Candida Colonization and Infection in Cancer Patients and Their Antifungal Susceptibility in a Tertiary Care Hospital. International Journal of Advanced Research.
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  20. Invasive Candidiasis Statistics. Centers for Disease Control and Prevention.

Resources

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Natalia Johnsen, MD

Medical Reviewer

Natalia Johnsen, MD, practices internal medicine and lifestyle medicine. She works as an internist for the Vancouver Clinic in Vancouver, Washington.

Johnsen trained and worked as ob-gyn in Russia before coming to the United States in 2000. Subsequently, she interned in internal medicine at the University of Nevada and completed her residency at a Stanford-affiliated program in Santa Clara, California. After that she worked as a general internist for two years before to switching to full-time hospital work.

Johnsen has always been fascinated by the effects that lifestyle can have on physical and mental health, and she fell in love with the concept of lifestyle medicine as a specialty after seeing patients struggle with issues that could have been prevented had they known more about a healthy lifestyle. To make an impact on her patients through lifestyle interventions, she launched her own lifestyle medicine clinic, Vivalso Health and Longevity.

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Holly Pevzner

Author

Holly Pevzner is a writer who specializes in health, nutrition, parenting, and pregnancy. She is currently a staff writer at Happiest Baby. Her work, including essays, columns, features, and more, spans a variety of publications, websites, and brands, such as EatingWell, Family Circle, Fisher-Price, Parents, Real Simple, and The Bump. Pevzner has written several monthly health columns, including for First for Women and Prevention magazines. She previously held senior staff positions at Prevention, Fitness, and Self magazines, covering medical health and psychology. She was also a contributing editor at Scholastic's Parent & Child magazine.

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