By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

WHITE “COTTAGE CHEESE” PATCHES IN MOUTH ARE SIGN OF THRUSH

Question: My mother, who is in her 80s, has thrush. She is generally in good health so this has her concerned. I thought only babies got thrush. Could you give me more information on this problem?

Answer: Thrush -- a fungal infection of the mouth or throat -- can occur in anyone at any age. It is, however, more common in babies, older adults and people with a compromised immune system. Thrush is caused by a fungus in the Candida family, Candida albicans. This type of fungus can also be referred to as yeast, so in the remainder of this column I’ll use the terms interchangeably.

The C. albicans fungus is also responsible for some skin conditions such as diaper rash, vaginal yeast infections and fungal infections in the fingernails and toenails. It can also affect the esophagus and the digestive tract. In the U.S., we tend to limit the term thrush to refer to Candidal or yeast infection in the mouth or throat.

The Candida fungus is normally present in and on our bodies, but only in small amounts. When something happens to upset the balance of yeast and bacteria in our bodies, the yeast can overgrow and cause an infection. This happens frequently when antibiotics disturb the bacteria/fungi balance by killing the bacteria. Illnesses like poorly controlled diabetes and stress can also upset this delicate body balance. Other things, like dry mouth and wearing dentures can make conditions ripe for the development of thrush. If your mother wears dentures, this could be a factor in her having thrush.

When a patient comes into the doctor’s office with thrush, his or her first complaint will often be of a sore mouth or painful swallowing. The diagnosis is fairly straight-forward. An experienced dentist or physician can usually make it by visual inspection alone.

When your health-care provider examines your mouth and throat, he or she will typically see patches of whitish “cottage cheese like” material. When these are removed, the tissue underneath is quite reddened and inflamed. Less commonly, the condition begins as a generalized sore mouth or throat without the classic “cottage cheese like” lesions.

In most healthy people who get thrush, the treatment is easy. In people with weakened immune systems or ongoing health problems, like poorly controlled diabetes, the infection may be more stubborn. In uncomplicated cases, oral medication will usually clear up an infection in a couple of weeks. Reinfection is not uncommon in children.

Prevention is always better than catching anything. Good oral hygiene with frequent brushing is a great place to start. If you suffer from a dry mouth condition, use special dry mouth toothpastes, mouthwashes and lubricants. Also, keep well hydrated and drink plenty of water. Don’t smoke.

If you wear dentures and get thrush, discuss denture cleaning with your dental office. Keep your hands and various non-food items like pencils out of your mouth. If you have a chronic medical problem, see your physician regularly and take your medicines as directed.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.