Recognizing and Treating Oral Thrush on the Lips

A yeast infection on your lips and mouth is caused by a common fungus called Candida albicans. The infection, also known as oral thrush or orolabial candidiasis, causes creamy white patches on the lips that can extend into your mouth, tongue, and throat. Lip cracking, redness, and pain are also common.

Oral thrush tends to affect people with weakened immune systems but is also seen in people who smoke, wear dentures, or take antibiotics. Treatments include antifungal creams, lotions, and ointments. Good oral hygiene can go a long way toward preventing oral yeast infections.

This article describes the symptoms and causes of a yeast infection on the lips and mouth. It also includes oral thrush pictures and explains how the condition is diagnosed and treated.

Symptoms and Oral Thrush Pictures

Oral candidiasis commonly affects the lips, tongue, throat, roof of the mouth, and the lining of the cheeks and back of the lips.

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Symptoms of oral thrush include:

• White patches on the tongue, throat, and lips
• Redness or soreness
• Cracks and tiny cuts at the corner of the mouth
• Cotton-like feeling in the mouth
• Loss of taste
• Pain when eating and swallowing
  

In babies, symptoms of oral thrush may also include:

• Mood changes (such as crankiness)
• Refusal to feed (due to soreness)
• Diaper rash

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Complications

Oral candidiasis is relatively uncommon in people who are healthy. When it occurs, the infection may be limited to the mouth and be readily treated with antifungals.

However, if a person is severely immunocompromised, a yeast infection might spread from the mouth to the feeding tube (esophageal candidiasis), develop on the skin (cutaneous candidiasis), or even spread through the blood to affect multiple organs (invasive disseminated candidiasis).

These complications are most often seen in people with advanced, untreated HIV.

Causes of Oral Thrush

Candida albicans is a naturally occurring fungus found on the body that the immune system can usually control. But when the immune system is substantially weakened, the fungus can suddenly grow out of control and cause a yeast infection.

Oral candidiasis is common in people with a compromised immune system. This is why it is often referred to as an "opportunistic infection" because it only occurs when a weakened immune system gives it the opportunity to thrive.

Oral thrush can also affect relatively healthy people if the yeast is given the "fuel" it needs to grow, such as high sugar levels in saliva.

Risk factors for oral candidiasis include:

• Immunosuppressive conditions like HIV and cancer
• Diabetes (in which high salivary sugar promotes fungal growth)
• Being very young or very old (both of whom tend to have weaker immune systems)
• Immunosuppressive drugs (commonly used for organ transplant recipients)
• Oral or inhaled steroids (which also temper the immune response)
• Broad-spectrum antibiotics (which alter the balance of bacteria and yeast in the mouth)
  
• Smoking (which also alters the balance of microorganisms in the mouth)
• Salivary gland disorders like salivary stones or Sjögren's syndrome
• Wearing dentures (particularly if they aren't regularly cleaned)
• Eating a high carbohydrate diet (which increases sugar levels in the mouth)

Oral candidiasis is common in young children, elderly persons, and those with certain risk factors. It can also affect babies, particularly those under 6 months, as they don't yet have a fully developed immune system. Thrush can be passed to the infant during breastfeeding if the nipples are also infected.

Diagnosing Thrush on Lips

Oral thrush can often be diagnosed by visual inspection of your mouth and lips. Your healthcare provider will also review your medical history and perform a physical exam.

• Because other diseases can cause white patches on the lips and mouth, your healthcare provider may take a swab or a scraping of the patch. The sample can then be placed under a microscope and stained with dyes to determine if Candida or some other microorganism is present.

A biopsy may be performed if a condition called chronic hyperplastic candidiasis (CHC) is suspected. This is an uncommon variation that causes persistently raised lesions that are difficult to treat. By obtaining a tissue sample, the lab can make a positive diagnosis and deliver the appropriate treatment.

Differential Diagnosis

Several conditions look similar to oral thrush and may need to be investigated in the differential diagnosis. These include:

• Leukoplakia: This is a condition where cells in the mouth grow excessively and appear as white patches. It often occurs in people who use tobacco products and may be a precursor to oral cancer. Unlike Candida, the white patches cannot be scraped off.
• Oral lichen planus: This is an immune-related condition that causes painless, raised white lines on the tongue. It can affect the insides of the cheek and gums.
• Geographic tongue: This is the loss of the hair-like projections on the tongue causing smooth, red patches with white borders. It is considered harmless and usually resolves on its own.

Treating Thrush on Lips

The treatment of oral candidiasis can vary by the severity of symptoms and the underlying cause. While antifungal drugs are considered the first line of treatment, there are home remedies and lifestyle changes that may help.

Home Remedies and Lifestyle

Mild cases of oral candidiasis may resolve on their own without treatment or with simple changes in habits (such as improved oral hygiene and cleaning dentures regularly). In other cases, the infection may clear once you stop taking antibiotics.

Other remedies include:

• Eating lactobacillus-rich foods like yogurt, kefir, or sauerkraut or taking a probiotic supplement can help restore the natural balance of bacteria and yeast in the mouth
• Reducing your intake of carbohydrates (including simple carbs found in fruits, milk, refined sugar, and processed foods) if you have recurrent oral thrush
• Rinsing with salt water, which may help ease mouth pain and inflammation

Medications

The standard treatment for mild to moderate oral thrush is a topical antifungal medicine applied to the inside of the mouth for seven to 14 days.

These prescription medications include:

• Oravig (miconazole)
• Bio-Statin (nystatin)

For people with severe cases of thrush, the oral antifungal Diflucan (fluconazole) may be prescribed on its own or alongside topical antifungal therapy. The recommended dose is usually 200 milligrams (mg) for the first day, followed by 100 mg per day for the next 13 days.

How to Prevent Lip Thrush

If you are vulnerable to lip thrush for whatever reason, there are things you can do to reduce your risk:

• Stop smoking: Ask your healthcare provider about smoking cessation aids, many of which are fully covered by health insurance.
• Use a spacer on inhalers: Spacers are attachments that you place on the mouthpiece of aerosol inhalers. They limit your exposure to steroids and other inhaled drugs and keep them from coating your mouth.
• Maintain good oral hygiene: In addition to regular brushing and flossing, you can use an antibacterial mouthwash to reduce the host of infectious microorganisms in your mouth.
• Clean your dentures regularly: Remove, soak, and brush your dentures daily using a non-abrasive denture cleaning solution and a soft-bristled brush.
• Manage your diabetes: This not only means taking your antidiabetes medications as prescribed but also managing your diet, maintaining your ideal weight, and exercising regularly.
• Reduce your sugar intake: Even if you don't have diabetes, sugar fuels Candida growth. Make a special effort to cut back on sugary drinks, candies, and any sweets that coat your mouth.

Summary

Oral thrush, also referred to as oral candidiasis, is a yeast infection that can cause white patches on the lips and inside the mouth. Other symptoms may include, redness, soreness, and cracking at the corners of the mouth. Babies, the elderly, and those with certain underlying conditions are at higher risk of developing oral thrush. This type of infection can be successfully treated using antifungal medications.