Thrush

Apr 19, 2017

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

The Qu'Appelle Valley in Saskatchewan is a lovely place to get lost. Cool stuff always happens when you get lost. We were driving south from Yorkton down gravel roads, past scrub trees, and fences when suddenly the road dropped away into a great green gorge. There were trees, hills, a huge flat flood plain and what I assume was the Qu'Appelle River in the middle. It was gorgeous. It was hard to believe we were still in Saskatchewan. We eventually got to the Chief Denton George Memorial Multiplex on the Ochapowace First Nation thanks to Google Maps on my phone. Kurt Koshowski said it reminded him of when at 1 am he ended up on the narrow streets of China Town in downtown Vancouver while hauling a huge boat thanks to his GPS. I chuckled to myself as I thought about how a month earlier, I found Inglis, stomping grounds of Don Zetaruk. Eric and I found Inglis when we let the truck GPS take us on a short cut to Russell. Then I thought of how the lack of GPS 30 years ago. I had goten lost in another pretty place two provinces away, and Don Zetaruk had to rescue me.

You don't need GPS to find thrush in someone's mouth. Thrush looks like little white spots in the mouth and is caused by a fungus or yeast. More technically it is an oropharyngeal candidiasis which is a superficial fungal infection of the oral mucosa caused by the Candida genus of yeast. Most often it is Candida albicans. Up to 75% of us have C. albicans living in our mouths all the time. If we are healthy, that is no problem. But if our immune system gets run down, the C. albicans can cause thrush.

Thrush is more common in babies and the elderly. Thrush is also more common if you are pregnant, if you smoke or if you have poor dental hygiene. Diet can affect how often your get thrush. If you eat a lot of carbohydrates, or too little iron, folic acid and vitamin b12, you are more likely to get thrush. Dentures make thrush more likely. Medications like antibiotics and inhaled steroids can increase your chance of getting thrush.

Thrush lesions are most often described as pseudomembranous plaques. They are creamy white, raised mottled plaques on the tongue, the roof of the mouth and inside the cheeks. They can spread to the tonsils and down the throat. The white plaques can be easily scraped off and underneath it is very red and there might be minor bleeding. Thrush might be completely without symptoms in some people. Others might experience tingling, burning, pain, less appetite, unpleasant taste in the mouth or bad breath.

Mild thrush usually clears up in a few days without treatment. But it can reoccur or become a chronic problem. How do we treat thrush? The first line treatment for initial and mild cases of thrush is nystatin oral suspension. Children and adults get different strengths, but they both use the suspension 4 times a day for 7 to 14 days. We usually tell patients to keep using the nystatin suspension for 2 days after the symptoms have gone away.

How to use nystatin suspension varies a little from infants to adults. Young infants don't listen well when you tell them to swish something in their mouths. I usually tell parents to put a little nystatin suspension on a Q-Tip and dab it on a white spot until they have covered all the white spots in the child's mouth and the parent has used up the whole dose. Parents should give young children their nystatin after a feeding, so it hangs around a while. Wash all the child's bottles, pacifiers, and toys they put in their mouth. If the infant is breast feeding, it is a good idea for the mother to be treated with an antifungal cream at the same time to stop passing the thrush back and forth to baby.

In older children and adults, we tell the patient to swish the nystatin suspension around in their mouth for at least a minute before either spitting it in the sink or swallowing it as per the doctor's direction. One minute will seem like a long time as you stand in front of the sink, but it is the contact time between the nystatin and the thrush that will actually kill the fungus. Older children and adults should also use the nystatin after they eat so the nystatin will hang around in the mouth the longest.

It was interested to learn about angular cheilitis while reading up on thrush. Angular cheilitis is red painful cracks at the corner of the mouth. Sometimes it is caused by vitamin b12, iron or folic acid deficiency. But it can be caused by a fungus sim

ilar to the one that causes thrush. Under a doctor's direction, the patient can apply clotrimazole or miconazole creams outside and inside the corner of the mouth twice a day for a week.

Every May Long weekend, we would drive 5 hours east of Pinawa to go lake trout fishing in Sioux Lookout, ON. We stayed at Abraham's Lake Campground and fished on Big Vermillion Lake. We often went with another family from Pinawa, the Zetaruk's. Don and Glenna had a daughter Leslie and a son Trevor. Trevor and I still squeeze in a fishing trip in most summers. One May Long on Big Vermillion, we were fishing off an island. I got bored and decided to explore. The island was beautiful. There were huge moss beds that looked like you could have a nap in in them, multi-colored mushrooms on the forest floor and rotten dead fall that exploded when you jumped on them. It was a perfect spot for a 13 year old boy, until I realized I had no idea which way our fishing spot was. The good news is I realized that if I found the shore and followed it, it would eventually lead me back. The bad news was, we were on an enormous island and I was unknowingly walking the wrong way. But it in relatively short order, Don Zetaruk, originally of Inglis, found me while circling the island with his boat. With or without GPS getting lost is still the best way to find cool stuff.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca

 


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