It is a superficial infection of the yeast of the mouth that can affect the tongue, the inner cheek (buccal mucosa), the region of the inner lip and occasionally the gums.
Although seen more frequently in small babies, candidiasis can affect young children and, to a lesser extent, older children and occasionally adults.
Oral candidiasis diagnosed in older children, adolescents and any adult should always lead to a search for an underlying medical condition ( diabetes , use of immunosuppressive therapy, etc.).
What are the causes and risk factors of oral candidiasis?
Thrush is caused by an overgrowth of the yeast Candida albicans, which is commonly found on the surface of the skin, the oral cavity and throughout the intestinal tract of healthy individuals.
Newborn babies are often exposed to the fungus during vaginal delivery and may present oral evidence of candidiasis within 10 days after delivery. Breastfeeding babies can infect their mother’s nipple area during breastfeeding.
In addition, an overgrowth of Candida in the stool may be associated with a characteristic rash of the diaper. Contamination of formula bottles and pacifiers with the Candida fungus can also introduce yeast into a child’s oral cavity.
In older children and adults, oropharyngeal candidiasis is associated with several risky behaviors, including prolonged or repeated use of oral antibiotics, prednisone (or other steroid medications), smoking, dentures.
Also the use of contraceptive pills and medical conditions, especially diabetes (either I or type II) or any disease that can suppress your immune system (HIV / AIDS ).
Perhaps the most common association for the development of thrush is an inadequate technique during the use of inhalers containing corticosteroids for the control of asthma or COPD (chronic obstructive pulmonary disease).
Such medications require rinsing the mouth with water and then spitting out the water to remove any non-inhaled medication.
Patients using a metered dose inhaler (MDI) for the administration of steroids are advised to use a “spacer” to decrease the remaining amount of residual steroids in the mouth.
What are the symptoms and signs of oral candidiasis?
Oral candidiasis is characterized by a thick white layer of the tongue, internal cheeks, the region of the inner lip or gums. This coating can be differentiated from the very common white discoloration of the tongue associated with breast milk or the remains of infant formula by several means:
- An oral Candida infection is a very bright white color.
- Candida oral infections can also affect the buccal surface, the inner lip area and the gum, while the milk remains limited to the tongue.
- Oral Candida is quite adherent to the surface of the affected skin, while the milk remains can be cleaned more easily with a damp cloth. Neither candidiasis nor remnants of milk cause discomfort or other symptoms when limited to the mouth.
- Candidiasis of the nipple / maternal areola usually causes signs and symptoms such as redness and tenderness of the affected area.
- The rash associated with Candida diaper dermatitis is usually not as bothersome as the most common diaper rash associated with irritation from excess faeces and the contact of urine with the baby’s skin.
When should someone seek medical care for oral candidiasis?
Medical attention should be sought when it is suspected in a child outside the age range of the baby, when over-the-counter remedies are not useful or if the infection is painful (involvement of the mother’s breast, for example, cracking) or bleeding from the nipple.
How do health professionals diagnose oral candidiasis?
The diagnosis of oral aphthae usually does not require laboratory tests, the visual inspection of the mouth is all that is needed to confirm the diagnosis.
Is oral candidiasis contagious?
Oral candidiasis is transmitted to a person through several mechanisms. Newborn babies may be exposed during vaginal delivery if their mother has a vaginal yeast infection. The use of bottle nipples contaminated with Candida can also cause exposure.
Another mechanism to develop oral aphthae is the excessive growth of the normally small amount of Candida in the mouths of older children, adolescents and adults.
Inadequate technique while using an inhaled corticosteroid (without using a spacer) and not rinsing and spitting with water after the use of an inhaled corticosteroid are also common mechanisms that lead to the development of oral aphthae.
Oral candidiasis is not transmitted from animals. It is important to keep in mind that in a short period of time after birth all people have C. albicans in the skin, mouth, intestinal tract and vaginal tract (adolescents and elderly).
The development of Candida disease is not usually transferred from a host to an uncolonized recipient (with the exception of the newborn), but the development of symptoms and signs represents an overgrowth of the yeast for several potential reasons that are reviewed previously .
What is the incubation period of oral candidiasis?
The time between birth and vaginal canal infected by Candida and the development of the oral thrush is approximately seven to 10 days.
This is the only case of transmission from an infected host to an uncolonized individual. Beyond the neonatal period, the development of Candida disease and an overgrowth of the Candida yeast colonies already present.
What health care specialists treat oral candidiasis?
Primary care providers (pediatricians, family doctors and internal medicine doctors) are trained in the diagnosis and treatment of oral aphthae.
Older children, adolescents and adolescents without an obvious cause to develop oral aphthae (for example, an inadequate technique using inhaled corticosteroids).
There are two types of treatments to treat oral candidiasis, a traditional medical approach and a homeopathic approach. Traditional medicines can be applied topically (for example, nystatin, 1% purple gentian) or ingested in liquid form (eg, Fluconazole, Diflucan).
Nystatin is usually applied for a period of five to seven days. One study (treatment of patients with HIV / AIDS) showed a cure rate of 52% (compared to 87% when fluconazole is used, the immunosuppressed state of the study population may have affected results).
When treating infants and young children, using a small gauze or Q-tip is more effective than just drinking the preparation.
Most pediatricians will choose topical nystatin instead of oral medications to facilitate administration, reserving the use of fluconazole for treatment failures; 1% purple gentian is rarely used in the long-lasting bright purple stain that occurs in the mouth or on clothing / bedding.
Fluconazole is a once-a-day preparation that is used for 14 days. The primary side effects are few (5% or less) and generally of intestinal nature (upset stomach, vomiting and / or diarrhea).
It is rare that such side effects require the suspension of the medication. Relapse rates are lower than fluconazole compared to nystatin.
Regardless of the approach used, the application of medication for bottle nipples, pacifiers, or nipples of breastfeeding mothers is felt to augment the success rate of therapy by reducing the probability of reintroduction of Candida to the infant .