Dealing with Candidasis: fungal infection in mouth
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By George Malkemus  January 12, 2012 12:04 pm

Candidasis, commonly called “thrush,” is an infection of the mouth caused by the Candida fungus, which grows out of control and causes painful lesions usually on the inner checks and tongue, but can also spread to the roof of the mouth, gums, tonsils and throat. Symptoms of Candidasis include pain or difficulty swallowing, a feeling that food gets stuck in the throat, and fever.

People of all ages can contract thrush, though it occurs most often in infants, the elderly, and anyone who has a suppressed immune system. Candida infection is not limited to the mouth; it can occur in other parts of the body as well, causing diaper rash in infants or vaginal yeast infections in women.

What causes thrush?
Small amounts of the Candida fungus are present in the mouth, digestive tract, and skin of most healthy people and are normally kept in check by other bacteria and microorganisms in the body. However, certain illnesses, stress, or medications can disturb the delicate balance, causing the Candida fungus to grow out of control, causing thrush.

Sometimes illnesses like cancer, HIV, diabetes, or antibiotics, chemotherapy medications, immunosuppressant drugs, a corticosteroid inhaler for asthma, or stress can change the body's chemistry and create an environment in which the fungus can flourish.

Many medications that caused reduced saliva production (called dry mouth), can allow the fungus to grow without the normal healthy cleaning functions of saliva. Medications that upset the balance of microorganisms in the mouth and may cause thrush include corticosteroids, antibiotics, and birth control pills.


Illnesses or medical situations that make Candida infection more likely to develop include uncontrolled diabetes, HIV infection, cancer, or pregnancy (caused by the hormonal changes that occur with pregnancy). People who wear dentures that don't fit properly also are at increased risk for thrush. Even using too much antimicrobial mouthwash can bring on a case of thrush. Smoking also ups the risk.

What are the signs of thrush?
It is easy to spot Candidasis because it produces slightly raised, creamy white clumps that look like cottage cheese on the tongue, gums, cheeks, throat, tonsils and/or roof of the mouth. The cottage cheese looking clumps can be painful and may bleed slightly when scraped or brushed. Thrush usually develops suddenly, but it may become chronic, persisting over a long period of time.

Thrush is common in infancy, during which time the normal microorganism balance in the mouth is developing. In addition, babies can pass the infection to their mothers during breast-feeding, since the disease is contagious. With an infant, thrush usually goes away without treatment in a few weeks.

For an adult, if Candidasis is left untreated, the fungus can spread to other parts of the body. The infection may spread into the throat, causing painful, difficult swallowing and possibly fever. In severe cases, it has been known to invade the lungs, eyes, joints, liver, heart and even the brain. This happens more often in people with cancer, HIV, or other conditions that weaken the immune system.

How is thrush treated?
While healthy children and adults can be effectively treated for thrush, the symptoms may be more severe and difficult to manage in those with weakened immune systems. Antifungal medications, which are generally taken for 10 to 14 days, are usually prescribed to treat thrush. These medicines are available in tablets, lozenges, or liquids.

Last year, I treated an 81-year old woman with a loose fitting upper denture with severe soreness on the roof of her mouth. The sore on her palate was a cottage cheese white with redness and bleeding, indicating Candida infection. I prescribed Nystatin, antifungal tablets. Her denture was old, worn and ill-fitting. Underneath the denture, the denture material was rough and impregnated with Candida fungus. A new denture was made that fit great and now she is happily infection-free.
Sometimes the presence of Candida infection can be a symptom of other medical problems. Depending on the patient’s age, medical history, cause and severity of the infection, a patient should be sent to their physician for diagnosis and treatment of any underlying health problems.

About 10 years ago, I saw emergency patient, a 23-year-old young man, with extreme mouth pain. His entire mouth was covered in cottage cheese white puffy clumps. No pink tissue could be seen. His tongue looked like a swollen white “Hostess Snow Ball.” He had severe Candida infection. He had no known medical problems and was on no medications. But I definitely knew he had some underlying medical problem to allow such an advanced fungal infection. I prescribed pain and antifungal medications and arranged for him to immediately go to the emergency room. He was found to have a complete kidney shut-down at medical emergency room and was quickly admitted into the hospital and put on dialysis. I was later told by his internist that if he had delayed a few more hours, he would not have survived.

Candidiasis is just one more reason to make and keep those regular dental check-up appointments. If you ever have a sore, lump, or change in your mouth that lasts more than a week, you should have the area checked right away.
Enjoy Life and Keep Smiling!

George Malkemus has had a Family and Cosmetic Dental Practice in Rohnert Park for over 26 years at 2 Padre Parkway, Suite 200. Call 585-8595, or e-mail info@ malkemusdds.com. Visit www.malkemusdds.com for more information.

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