Improving Clinical Dentistry

Oral thrush, also known as oropharyngeal candidiasis, is a common fungal infection of the mouth caused by an overgrowth of Candida species, most notably Candida albicans. Although the infection is generally harmless, it can cause discomfort, and in certain populations such as immunocompromised patients, it can become a severe health issue. Understanding the latest treatment guidelines is crucial for effectively managing this condition in a clinical setting.

By using our updated evidence-based guidelines you can better assist your patients in diagnosing and treating oral thrush. These recommendations aim to help you enhance patient care by ensuring accurate diagnosis, effective treatment, and appropriate follow-up to prevent recurrence.

Dentists as Primary Care Providers

Treating oral thrush requires a comprehensive approach that considers the patient’s overall health, potential risk factors, and the severity of the infection. Dental professionals are often the first point of contact for patients with oral thrush, making it essential for them to be well-versed in the latest treatment protocols.

The following updated guidelines emphasize targeted antifungal therapy, personalized treatment recommendations, and patient education to prevent recurrence.

Risk Factors for Oral Thrush

Oral thrush can affect individuals of all ages, though certain populations are at higher risk. These include the following:

• immunocompromised individuals,

• those using inhaled corticosteroids,

  • increased incidence when the patient does not rinse their mouth after inhaler use

• patients undergoing chemotherapy, and

• individuals with poorly controlled diabetes.

Infants and elderly patients with dentures are also more prone to developing oral thrush. The Candida fungus, while normally present in small quantities in the oral cavity, can overgrow when the body’s immune defences are weakened or when oral conditions change.

Oral Thrush Treatment Options

The first order of business for a patient with oral thrush is to treat the infection. Oral thrush treatment typically involves antifungal medications that can be delivered topically or systemically, depending on the patient’s needs and the infection’s severity.

The following evidence-based recommendations outline the standard treatment protocol for 2025:

Treatment Recommendations for Oral Thrush

Mild to Moderate Oral Thrush (Topical Treatment Indicated)

• Indication: For patients with mild to moderate oral thrush where topical treatment is sufficient.

• Dosage:

  • Clotrimazole: 10 mg lozenge, five times daily for 7–14 days.

  • Nystatin suspension: 100,000 units/mL, 5 mL swish and swallow 4 times daily for 7–14 days.

• Alternative:

  • Miconazole buccal tablets: Can be considered for patients who prefer once-daily dosing or do not respond to the above treatments.

Severe Oral Thrush or Immunocompromised Patients (Systemic Treatment Indicated)

• Indication: For patients with severe oral thrush or those who are immunocompromised, where systemic treatment is required.

• Dosage:

  • Fluconazole: 200 mg loading dose, followed by 100–200 mg daily for 7–14 days depending on severity.

• Alternative:

  • Itraconazole: 200 mg daily for 7–14 days for patients resistant to or intolerant of fluconazole.

Systemic therapy is required for severe infections or when the infection spreads beyond the oral cavity, such as in esophageal candidiasis. Screening and monitoring for potential drug interactions, especially in patients on multiple medications, is crucial.

To view all of the relevant drug interactions between systemic antifungal medications and your patients’ medications, consider downloading the DentalRx app! There we have included drug monographs for the medications mentioned above, as well as this guideline and others which include relevant safety information and informational handouts for your patients.

Preventing the Recurrence of Oral Thrush

Now that our patient’s oral thrush has been treated, prevention should be our next priority. Since oral thrush can reappear in individuals with underlying conditions or those undergoing treatments that compromise the immune system, addressing these factors is key to minimizing recurrence.

Here are some evidence-based strategies to help prevent future infections:

Preventive Measures for Oral Thrush

Oral Hygiene

• Brush teeth twice a day.

• Floss daily.

Rinsing After Inhaler Use

• Rinse mouth with water after using inhaled corticosteroids.

• Spit out the water (do not swallow).

Control of Underlying Conditions

• For patients with dry mouth, consider a saliva spray like Biotene.

• Keep blood sugar levels in control (for diabetic patients).

Adjusting Denture Care

• Ensure dentures fit properly.

• Clean dentures thoroughly.

• Soak dentures overnight in chlorhexidine 0.12% if necessary.

• Avoid wearing dentures overnight.

Nutritional Support

• Eat a balanced diet with probiotics.

• Avoid excessive sugar and refined carbohydrates.

Monitoring in Immunocompromised Patients

• Closely monitor for signs of thrush in immunocompromised patients (e.g., chemotherapy or HIV).

• Consider preventive antifungal therapy in high-risk patients.

By educating patients on these preventive measures and reinforcing the importance of follow-up care, you can help reduce the likelihood of recurrence and improve long-term outcomes for those at risk of oral thrush.

Conclusion

Oral thrush is a common yet manageable infection, and having these treatment guidelines freely available for use in your clinic is one of our driving purposes at DentalRx. By following these guidelines, you can ensure your patients receive effective treatment, reduce their risk of recurrence, and prevent complications in vulnerable populations.

Feel free to use these resources in your dental clinic, and let us know if they are helpful for you!

References

• Candida infections of the mouth, throat, and esophagus. (2021). In NCBI Bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK545282/

• Infectious Diseases Society of America (IDSA). (2016). IDSA practice guidelines for the diagnosis and management of candidiasis. https://www.idsociety.org/practice-guideline/candidiasis/

• Coronado-Castellote, L., & Jiménez-Soriano, Y. (2013). Clinical and microbiological diagnosis of oral candidiasis. Journal of the Canadian Dental Association, 79(d122). https://jcda.ca/article/d122