Oral thrush is a common infection that can cause significant discomfort for individuals undergoing chemotherapy. Chemotherapy drugs suppress the rapidly dividing cells of the immune system, including the infection-fighting white blood cells, leading to neutropenia. This temporary lowering of the body’s defenses, combined with the disruption of the mouth’s natural balance of microorganisms, allows the fungus Candida albicans to overgrow. Prompt identification and treatment are necessary to manage the infection.
Identifying Oral Thrush and When to Contact a Doctor
Oral thrush typically presents as creamy white, slightly raised lesions or patches inside the mouth and throat. These patches are commonly found on the tongue, inner cheeks, gums, or tonsils, often resembling cottage cheese. Attempting to scrape these lesions away may cause the underlying tissue to bleed, which is a distinguishing feature of the infection.
The physical symptoms are often accompanied by significant oral pain or burning, a cottony feeling in the mouth, and an altered sense of taste. When the infection extends down the throat, it can cause difficulty and pain when swallowing, a condition called dysphagia. Patients undergoing chemotherapy must contact their oncology team immediately upon noticing any of these symptoms.
Self-diagnosis and over-the-counter treatments are not appropriate for immunocompromised patients. A doctor usually confirms the diagnosis through a visual examination of the mouth, and may take a swab of the lesions to confirm the presence of Candida. Timely medical consultation ensures the infection is properly managed before it spreads beyond the mouth and esophagus.
Prescription Antifungal Treatments
Treatment for oral thrush focuses on eradicating the fungal overgrowth using prescription antifungal medications. For localized infections, the first-line approach often involves topical treatments designed to come into direct contact with the fungus. Nystatin is a common option prescribed as a liquid suspension that the patient swishes around the mouth for a minute or two before swallowing.
Another localized option is Clotrimazole, which comes in the form of troches or lozenges that dissolve slowly in the mouth. These treatments work by delivering a high concentration of the antifungal agent directly to the infected areas. Patients must follow the prescribed regimen, holding the medication in the mouth for the full recommended time to maximize contact with the lesions.
If topical treatments are ineffective or the infection has spread into the esophagus, systemic antifungal agents may be prescribed. Fluconazole is a common prescription oral medication that is absorbed into the bloodstream. Systemic treatment is reserved for more resistant or widespread cases and is administered under the guidance of the patient’s medical team.
Practical Home Management and Symptom Relief
While medical treatment targets the fungus, patients can take several practical steps at home to soothe symptoms and maintain oral health during chemotherapy. Careful and consistent oral hygiene is necessary to reduce the fungal load without causing further irritation to the delicate mouth tissues. Using a soft-bristled toothbrush or even a piece of gauze to gently clean the teeth and tongue is advisable.
Rinsing the mouth several times a day with soothing, non-irritating solutions can help cleanse the oral cavity. A simple rinse can be made by dissolving a half-teaspoon of salt in one cup of warm water. A baking soda rinse, made with the same proportions, can also help soothe inflammation and provide a cleansing action.
Dietary modifications are necessary to minimize pain and avoid feeding the fungus. Patients should choose soft, bland, and non-acidic foods, such as mashed potatoes, scrambled eggs, and smoothies, which are easier to swallow. Highly acidic foods like citrus fruits and tomatoes, along with sharp or very hot foods, can irritate the already tender lesions. Reducing the intake of sugary foods can also be helpful, as the Candida fungus thrives on sugar.