White, slightly elevated lesions on the tongue and lips are typical of oral candidiasis. Oral candidiasis (thrush).  The white, slightly elevated lesions appear to be "sitting" on the tongue surface. Oral candidiasis (thrush) frequently has a white patch at the middle of the tongue, as displayed in this image. This image displays severe oral candidiasis (thrush) with thick, white lesions covering the tongue. Candida (yeast) infection of the mouth, also known as thrush, can cause a smooth patch at the middle of the tongue, as displayed in this image. This image displays oral candidiasis (yeast infection) at the corners of the mouth.
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Thrush (Oral Candidiasis)  Information for adults

Picture of Thrush (Oral Candidiasis): White, slightly elevated lesions on the tongue and lips are typical of oral candidiasis. Divider line
White, slightly elevated lesions on the tongue and lips are typical of oral candidiasis.
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Overview
Thrush (oral candidiasis), also known as oral moniliasis, is a yeast infection of the mouth or throat (the oral cavity). The yeast that most commonly causes oral candidiasis is Candida albicans.
Who's At Risk
Thrush is very common in infants. Adults who develop thrush include:
  • People with diabetes or other glandular (endocrine) disorders
  • Denture wearers
  • People taking antibiotics
  • Persons undergoing chemotherapy
  • Drug users
  • People with poor nutrition
  • Persons who have an immune deficiency, such as HIV
  • People who use inhaled steroids for certain lung conditions
  • Pregnant women or women on birth control pills

Signs and Symptoms
Thrush may appear as white or pale yellow spots on the inner surfaces of the mouth and throat, the tongue, and the lips. It may resemble cottage cheese or milk curds. However, scraping off these membranes may be difficult and may leave slightly bleeding sores.

Thrush may be associated with a burning sensation in the mouth or throat.
Self-Care Guidelines
Thrush may make eating and drinking uncomfortable, and people with thrush may become dehydrated. It is important to maintain good nutrition and hydration while infected with thrush.

Thrush needs medications prescribed by a health care practitioner.
When to Seek Medical Care
Thrush requires prescription medication after a quick visit to the physician. People with an immune system deficiency need even prompter and more aggressive treatment to make certain that the yeast does not enter the bloodstream or infect other organs. If the white or yellow membranes of thrush are accompanied by fever, chills, vomiting, or generalized illness, more immediate medical attention is warranted.
Treatments Your Physician May Prescribe
Although meticulous oral hygiene practices must be followed, treatments center on killing the overgrown yeast with anti-fungal medications.
  • Nystatin – This medicine must come into contact with the yeast in order to kill it. Nystatin comes in a suspension, or liquid, and in a lozenge, also called a troche. The suspension is swished around the mouth and then swallowed. The lozenge dissolves in the mouth. Both the suspension and the lozenges are used several times a day until the lesions are completely gone.
  • Amphotericin B suspension – The suspension is swished and swallowed several times a day until complete resolution of the lesions.
  • Clotrimazole lozenge – The lozenge is dissolved in the mouth several times a day until the lesions have disappeared entirely.
  • Fluconazole pill – This medication is swallowed once daily for 5–10 days.

References

Bolognia, Jean L., ed. Dermatology, pp.837, 1095, 1096, 1185. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp. 2013. New York: McGraw-Hill, 2003.
Last Updated: 22 Dec 2008