Toadstool in the mouth – How to treat oral thrush?

What is oral thrush?

Oral candidiasis, also called oral moniliasis or thrush, is an infection of the oropharynx caused by the fungus Candida albicans.

Toadstool in the mouth is a mild form of candidiasis, which mainly affects the mucous membrane of the tongue and the inner part of the cheek.

To have oral candidiasis it is not necessary to have a significant immunosuppression. Contrary to what many people think, oral candidiasis is not exclusively a problem for patients with HIV or other serious illnesses. Moniliasis can indeed be one of the signs of AIDS, but it also often appears in children, the elderly, or people with an altered immune system.

Just as there are billions of bacteria living harmoniously in our bodies, the candida fungus is also considered a natural microorganism of our microbial flora.

Having small colonies of the candida fungus living in our skin, mouth, and digestive tract is perfectly normal. When our immune system is intact, it is fully capable of keeping the population of this fungus under control, preventing it from causing any kind of illness.

However, whenever there is a weakness in our immune system, the Candida albicans population can grow rapidly and become capable of invading the deeper layers of the skin and causing inflammation. The more severe the degree of immunosuppression of the patient, the more aggressive and dangerous the candida fungus infection will be, and it may even invade the bloodstream, heart, or central nervous system.

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The vast majority of cases of thrush are caused by Candida albicans, but other Candida species may also be responsible, such as Candida glabrata, Candida krusei, or Candida lusitaniae.

Risk factors for oral candidiasis

Oral candidiasis can appear in anyone, but it is much more common in those who have the following characteristics:

  • Older age.
  • Children in their first year of life.
  • Pregnant women.
  • Use of dentures.
  • Recent use of antibiotics
  • Prolonged use of corticosteroids
  • Use of immunosuppressive drugs.
  • HIV positive.
  • Poorly controlled diabetes mellitus
  • Being under treatment with chemotherapy or radiotherapy
  • Smokers
  • People with xerostomia (dry mouth).
  • Hospitalization.
  • Malnutrition.
  • Heavy drug users.


Oral lesions caused by Candida albicans are white plaques, with a creamy or ricotta cheese like appearance, affecting the tongue, the inner wall of the cheeks, and sometimes the palate (roof of the mouth), gums or tonsils.

Oral candidiasis lesions may appear small and asymptomatic, going unnoticed for some time. However, they tend to evolve and become easily visible and have symptoms such as pain and decreased sense of taste. A cottony feeling in the mouth is also a common symptom of thrush.

Toadstool in the mouth - How to treat oral thrush?

In the elderly who wear dentures, the white lesions that are typical of candidiasis may not be present, but there may be intense redness of the gums below the dentures. Angular cheilitis is also very common .

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In babies, the candidiasis lesion can be mistaken by mothers for leftover milk in the mouth. It is important to know that milk disappears spontaneously after some time, and if you swab the tongue, it comes off easily. As for candidiasis, the white plaques are well adhered to the mouth. When an attempt is made to scrape them off, there may be bleeding, and the mucous membrane underneath is bruised and very red.

In more severe cases, candidiasis can spread to the larynx and/or esophagus, causing symptoms such as hoarseness and pain/difficulty swallowing food. Candidiasis of the esophagus is usually a sign of more severe immunosuppression, and is very common in AIDS patients.

The diagnosis of oral candidiasis is simple. In many cases, the lesion is typical and the patient’s history pointing to the presence of an immunosuppressive factor facilitates the diagnosis. If the doctor wants confirmation, he or she can scrape off a piece of the lesion and take it under a microscope to identify the presence of yeast.

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Toadstool in the mouth - How to treat oral thrush?
Toadstool in the mouth - How to treat oral thrush?
Toadstool in the mouth - How to treat oral thrush?
Toadstool in the mouth - How to treat oral thrush?


Treatment of oral candidiasis can be done with rinsing and swallowing nystatin 4 times a day for at least 1 week.

If there is no improvement, the use of fluconazole tablet is indicated. The recommended dose is 200 mg the first day, followed by 100 to 200 mg once a day for 7 to 14 days; this treatment has a success rate of over 90%.

To help with treatment, it is recommended that you stop smoking, brush your teeth properly and regularly (but avoid using antiseptics), and avoid alcoholic beverages and foods rich in sugars. Sugar-free yogurts help restore the natural flora of bacteria in the mouth, increasing competition for food, which inhibits the proliferation of Candida.

In babies, it is important to clean pacifiers, cutlery, or baby bottles thoroughly after use to prevent fungal colonization. Following the same reasoning, an antifungal cream should be applied to the mother’s nipple after proper cleaning.