YOUR MOUTH

PATHOPHYSIOLOGY Thrush is an overgrowth of yeast when normal host immunity or normal host flora has been disrupted (The University of Chicago, 2013). The epithelial cells desquamate due to the overgrowth of yeast in the oral mucosa (The University of Chicago, 2013). A pseudomembrane is formed when there is a build up of bacteria, keratin, and necrotic tissues (The University of Chicago, 2013). Infants are more prone to become infected with oral candidiasis which appears as white leesions in the mouth of the infants. This is due to the infants becoming colonized when passing through the birth canal. It could also be transmitted a mother breast during feeding, hands, and even the nipples of a bottle (The University of Chicago, 2013). People with asthma can develop thrush as an adverse effect from inhaled corticosteroids.

PREVALENCE IN THE U.S.A.

37 percent of infants in the United States will develop thrush in the first month of life (Mudra, K. 2017). One –third of patients with advanced HIV infection had candidiasis in the mouth and throat (CDC, 2017). 60 percent of people who wear loose or ill fitting dentures develop oral thrush (myVMC, 2011).

ETIOLOGY The immune system works to stop harmful invading organisms like viurses, bacteria, and fungi by maintaining a balance between good and bad microbes that inhibit the body (Mayo Clinic, 2018). When the protective mechanisms fail causing a increasing number of candida fungi and allowing an oral thrush infection to happen (Mayo Clinic, 2018). When the immune system is weakened by disease or drugs such as prednisone, and when antibiotics disturb the normal microorganisms in the body would make it more susceptible to get oral thrush. HIV damages or destroy cells in the immune system, this makes people more prone to opportunistic infections, repeated signs of oral thrush is early indication of immune deficiency. Cancer weakens the immune system and treat- ment from radiation or chemotherapy increases the risk of getting oral thrush. In uncontrolled diabetes mellitus large amounts of sugar is in the saliva which support the growth of candida (Mayo Clinic, 2018). Conditions that cause dry mouth also increase the chances of getting oral thrush.

Larcard.me, (2018)

Cunha, J.P., (2018)

Green, S. (2016)

CLINICAL MANIFESTATIONS The characteristics of oral thrush include: • Creamy white lesions on your tongue, inner cheeks, and sometimes on the roof of

your mouth, gums and tonsils • Slightly raised lesions with a cottage cheese-like appearance • Redness, burning or soreness that may be severe enough to cause difficulty eating

or swallowing • Slight bleeding if the lesions are rubbed or scraped • Cracking and redness at the corners of your mouth • A cottony feeling in your mouth, bad breath, soreness in teeth • Loss of taste • Redness, irritation and pain under dentures (denture stomatitis) • In severe cases, like cancer or a weakened immune system from HIV/AIDS, the

lesions may spread downward into your esophagus (Candida esophagitis); difficulty swallowing and pain or feeling as if food is getting stuck in your throat.

Mayo Clinic, (2018)

Cunha, J. P., (2018)

COMPLICATIONS Thrush is a problem for healthy children and adults. Very rarely, extensive tracheal and esophageal involvement in thrush may lead to dysphagia and respiratory distress in the healthy host (Mudra, K., 2017). Candida esophagitis is a common complication of thrush in immunocompromised patients (Mudra, K., 2017). Thrush could return even after it has been treated. People with HIV or cancer could develop a more serious problem if left untreated thrush can lead to systemic candida infections. Thrush could spread to the digestive tract, lungs, liver, and heart valves (Mayo Clinic, 2018). Thrush could also spread to the intestines making it hard to receive adequate nutrition that the body needs.

TREATMENTS Treatment for thrush depends on the cause and the severity of the infection (Cundra, J.P., 2018). The treatment options are: • Antifungal medication: Nystatin which comes in the form of a tablet,

capsule, liquid, or lozenges. It is active against most pathogenic Candida species like oral thrush. It binds to fungal cell membranes allowing leakage of cellular contents (Hopfer-Deglin, J., Hazard- Vallerand, A., 2009).

• Mycelex (clotrimazole): is also a antifungal medication for oral thrush. It inhibits growth and and death of susceptible candida, it also decreases the symptoms associated wit thrush (Hopfer-Deglin, J., Hazard-Vallerand, A., 2009).

• Miconazole (buccal): antifungal medication • Fluconazole, Itraconazole, Ketoconazole: these are stronger systemic

antifungal medications for the severe cases of thrush and the weak immune systems.

• Amphotericin B: antifungal for the resistant thrush (Cunha, J.P., 2018) • Home remedies/prevention: rinse the mouth with a diluted 3%

hydrogen peroxide solution, rinse the mouth with warm saltwater, rinse your mouth or brush your teeth after taking corticosteroid medications, good oral hygiene, check dentures, people with diabetes mellitus should keep blood sugar under control, brush your teeth twice a day and floss, and treat dry mouth, clean all bottle nipples, and mothers should keep breast clean to avoid infection of oral thrush.

Mayo Clinic, (2018)

PROGNOSIS The prognosis of oral thrush depends on the severity of the infection and the state of the persons immune system. The prognosis for mild cases of thrush is good. Symptoms go away in two weeks once treatment is started. If not treated properly thrush can recurr. Thrush in infants and children is rarely serious or life-threatening and often goes away on its own without any need for medical treatment. People with weak immune systems can have severe and life threatening complications, they can get critically ill or worse case die from a severe candida infection. This is due to the spread throughout the body and causes dysfunction of other organs. Long-term hospitalization and systemic antifungal treatment would be necessary (Cunha, J.P., 2018).

CANDIDA- ORAL THRUSH REFERENCES

Center for Disease Control and Prevention, (2017). Candida infections of the mouth, throat, and esophagus. Retrieved from https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.html Cunha, J.P., (2018). Thrush (Oral Candidiasis). Retrieved from https://www.medicinenet.com/thrush/article.htm#thrush_facts Green, S. (2016). Yeast infections: Have you got one. Retrieved from https://www.saga.co.uk/magazine/health-wellbeing/conditions/yeast-infection The University of Chicago (2013). Thrush (Oral Candidiasis). Retrieved from https://pedclerk.bsd.uchicago.edu/page/thrush-oral-candidiasis Larcard.me, (2018). Indiana State on us Map. Retrieved from http://larcard.me/indiana-state-on-us-map.html Mayo Clinic, (1998-2018). Oral Thrush. Retrieved from https://www.mayoclinic.org/diseases-conditions/oral-thrush/symptoms-causes/syc- 20353533 Mudra, K. (2017). Thrush. Retreived from