Disease Description (Causes and Symptoms)
- Definition: A fungal inflammation of the oral mucosa (tongue and inner lining of the mouth) caused by the overgrowth of Candida (mainly Candida albicans), commonly referred to as thrush or candidal stomatitis.
- Causes and pathophysiology: Candida, which normally coexists as part of the normal oral flora, can overgrow when immunity is reduced or the oral environment changes (such as with long-term antibiotic use, smoking, dry mouth, poor oral hygiene, or wearing dentures), forming white plaques (reversible pseudomembranes) on the mucosa. In people with severe immunosuppression (diabetes, HIV, cancer treatment, immunosuppressive therapy, etc.), the risk of invasive or systemic infection increases.
- Main symptoms: White spots (plaques) in the mouth — they can be easily scraped off and may bleed, with localized pain or a burning sensation, decreased appetite, painful swallowing, bad breath, and fever (in cases of systemic infection)
- Risk factors: Children and older adults, diabetes, smoking, long-term use of antibiotics or steroids (including inhaled steroids), immunocompromised states, and improper denture care
Treatment Methods and Precautions
- First-line treatment (topical treatment)
- Topical antifungal: Apply nystatin oral suspension in the mouth (swish and swallow or spit out) — follow the prescription instructions. Treatment is often continued for an additional 5–7 days after the lesions disappear.
- Topical azole preparations (such as clotrimazole troches) may also be used.
- Systemic treatment (if necessary)
- Systemic antifungals: fluconazole, itraconazole, etc. — considered when there is no response to topical treatment or in patients with systemic symptoms, severe disease, or immunosuppression. ketoconazole is used only in limited circumstances because of the risk of hepatotoxicity.
- Denture-related care
- Disinfecting dentures: Remove and disinfect dentures (for example, soak them overnight in a 1:10 dilution of sodium hypochlorite solution), rinse them thoroughly, and adjust wearing time.
- Addressing causes and lifestyle management
- Improve oral hygiene, stop smoking, rinse the mouth after using inhaled steroids, control blood glucose (for patients with diabetes), and shorten or reassess unnecessary courses of broad-spectrum antibiotics.
- Complications and precautions
- In immunocompromised patients, topical treatment alone may not result in healing, and esophageal or systemic involvement may occur → prompt evaluation and systemic antifungal treatment are necessary.
- Be aware of drug interactions with antifungals (especially azole agents) and the possibility of hepatotoxicity. Consult a doctor if pregnant or breastfeeding, or if you have liver disease or other relevant conditions.
- Prognosis
- Improvement is usually rapid when there is no underlying disease and appropriate treatment is provided. If the condition is recurrent, evaluation for underlying diseases (diabetes, immunosuppression, medications, etc.) is necessary.
Checklist Before an Outpatient Visit (Items to Prepare and Information to Share During the Appointment)
- Items / records to bring
- A list of currently used medications (including antibiotics, steroids, anticancer drugs, immunosuppressants, oral contraceptives, etc.)
- Underlying diseases (diabetes, HIV, cancer, etc.) and recent test results (blood glucose, immune-related tests, etc.)
- When the symptoms began and their course (when they occur, how often, aggravating factors), and whether fever or difficulty swallowing is present
- Whether you wear dentures and how you care for them, and whether you smoke
- Previous antifungal treatment history (medication name, duration, and effectiveness)
- If possible, photographs of the oral lesions (taken before the appointment)
- Items to show the doctor during the outpatient visit
- Symptom photographs, medication list, and recent test results (if available)
Examples of General Questions to Ask the Doctor
- What are the side effects and precautions for this medication (the prescribed antifungal)?
- How long will the treatment last, and until when should I take the medication? What is the next plan if it recurs?
- Are there any interactions with other medications (or supplements) I am taking?
- What aspects of my oral hygiene, diet, or lifestyle should I improve?
Examples of Disease-Specific Questions
- I have diabetes (or HIV, or I am undergoing cancer treatment). How does my underlying condition affect the choice of treatment? Are additional tests or monitoring necessary?
- I use dentures. What specific cleaning and care methods, and what recommendations for adjusting denture-wearing time, can help prevent recurrence?
(Recommendations related to treatment and medication are general information. Follow the diagnosis, prescription, dosage, and treatment plan provided by your doctor.)