Understanding Oral Thrush
Viral Patel
Galt Pharmaceuticals Medical Affairs Fellow, 2024-2025
Overview
Oral thrush is a type of fungal infection caused by an overgrowth of yeast. This opportunistic infection is also referred to as oropharyngeal candidiasis. This condition is primarily caused by the overgrowth of Candida species, most commonly Candida albicans. This condition disrupts oral mucosa and impairs innate and adaptive immune responses, particularly in immunocompromised individuals (1-2).
Risk factors
• Immunosuppression: Conditions such as HIV/AIDS, diabetes mellitus, cancer, and the use of immunosuppressive therapies significantly increase the risk (3-5).
• Medications: Broad-spectrum antibiotics can disrupt normal oral microbiota and can facilitate Candida overgrowth (4).
• Age: Both extremes of age, such as neonates and the elderly are susceptible due to immature or declining immune function (1)(6).
• Local factors: denture use, poor oral hygiene, and xerostomia are notable local predisposing factors (1)(6).
• Lifestyle factors: smoking has been associated with an increased risk of developing oral thrush (1).
Symptoms
Oral thrush can have many different symptoms including:
• White patches on inner cheeks, tongue, roof of the mouth, and throat
• Redness or soreness
• Cotton-like feeling in the mouth
• Loss of taste
• Pain while eating or swallowing
• Cracking and redness at the corners of the mouth (7)
Prevention
Populations that are at risk can prevent oral thrush using a combination of antifungal prophylaxis, maintaining good oral hygiene, and using antibiotics as appropriate to remediate risk of infection (3).
Conclusion
Oral thrush is a fungal infection with multiple risk factors, predominantly related to immunosuppression and local oral conditions. Effective management involves addressing these risk factors and utilizing appropriate antifungal therapies.
References
1. Akpan A, Morgan R. Oral candidiasis. Postgrad Med J. 2002;78(922):455-459. doi:10.1136/pmj.78.922.455.
2. Yang L, Cheng T, Shao J. Perspective on receptor-associated immune response to Candida albicans single and mixed infections: implications for therapeutics in oropharyngeal candidiasis. Med Mycol. 2023;61(8). doi:10.1093/mmy/myad077.
3. Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4). doi:10.1093/cid/civ933.
4. Stoopler ET, Villa A, Bindakhil M, Díaz DLO, Sollecito TP. Common oral conditions: a review. JAMA. 2024;331(12):1045-1054. doi:10.1001/jama.2024.0953.
5. Erfaninejad M, Zarei Mahmoudabadi A, Maraghi E, Hashemzadeh M, Fatahinia M. Epidemiology, prevalence, and associated factors of oral candidiasis in HIV patients from southwest Iran in post-highly active antiretroviral therapy era. Front Microbiol. 2022;13:983348. doi:10.3389/fmicb.2022.983348.
6. Campisi G, Panzarella V, Matranga D, et al. Risk factors of oral candidiasis: a twofold approach of study by fuzzy logic and traditional statistics. Arch Oral Biol. 2008;53(4):388-397. doi:10.1016/j.archoralbio.2007.11.009.
7. Centers for Disease Control and Prevention. Candidiasis. Available at: CDC.
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