Persistent Oral Candidiasis: Seeking Solutions for Recurrent Symptoms

Oral mucosal desquamation and candidiasis?

I have been experiencing oral candidiasis approximately every three to four months for the past two years.
My mouth consistently has a white film that peels off, and there are white strands emerging from between my teeth.
I have not undergone any specific treatment, except for occasionally taking medication for gastroesophageal reflux.
I have not taken any other medications.
I visited a large hospital to get checked and understand the cause, but the doctor only prescribed Nystatin oral rinse and did not provide further information.
Due to my dry mouth, I suspected I might have Sjögren's syndrome, which could be causing these recurrent infections.
I consulted with a rheumatologist, and blood tests indicated no issues.
Recently, I have noticed the white, sticky strands reappearing in my mouth and between my teeth.
Due to the pandemic, I purchased Nystatin oral rinse myself, but after nearly a month of using it, my symptoms have not improved.
What should I do? I am worried and scared, so I am seeking advice from a physician.

Abo, 60~69 year old female. Ask Date: 2021/07/01

Dr. Zheng Jueyi reply Otolaryngology

Hello, the presence of white, sticky strands does not necessarily indicate a Candida infection.
If the condition persists without improvement or if you have concerns, it is advisable to return for a check-up with an otolaryngologist or dentist for confirmation.
Wishing you peace and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2021/07/01

More Info

Persistent oral candidiasis, or oral thrush, can be a frustrating and recurrent issue for many individuals. Your symptoms of white patches in the mouth, white strands in between teeth, and a dry mouth suggest a possible overgrowth of Candida, a type of yeast that can thrive in certain conditions. Given your history of recurrent infections every few months, it’s essential to explore the underlying causes and potential treatment options.

Understanding Oral Candidiasis
Oral candidiasis is often associated with several risk factors, including:
1. Dry Mouth (Xerostomia): A lack of saliva can create an environment conducive to yeast overgrowth. Saliva has natural antifungal properties, and when its production is reduced, it can lead to infections.

2. Immune System Status: Conditions that compromise the immune system, such as diabetes, HIV/AIDS, or autoimmune diseases, can increase susceptibility to infections like candidiasis.

3. Medications: Certain medications, particularly antibiotics and corticosteroids, can disrupt the natural balance of microorganisms in the mouth, allowing Candida to flourish.

4. Oral Hygiene: Poor oral hygiene can contribute to the growth of Candida. Regular brushing and flossing are essential to maintain oral health.

5. Underlying Conditions: Conditions such as Sjögren's syndrome, which causes dry mouth, can predispose individuals to oral thrush.

Steps to Address Your Symptoms
1. Consultation with a Specialist: Since you have already seen an immunologist and had blood tests that ruled out systemic issues, consider consulting an oral medicine specialist or a dentist with experience in managing oral fungal infections. They can provide a more targeted approach to your symptoms.

2. Antifungal Treatment: While you mentioned using Nystatin mouthwash, it’s important to ensure that you are using it correctly and for an adequate duration. Sometimes, a stronger antifungal medication, such as fluconazole, may be necessary, especially if over-the-counter options are ineffective.

3. Hydration and Saliva Production: To combat dry mouth, increase your fluid intake and consider using saliva substitutes or stimulants. Chewing sugar-free gum or sucking on sugar-free candies can help stimulate saliva production.

4. Oral Hygiene Practices: Maintain rigorous oral hygiene by brushing your teeth at least twice a day and flossing daily. Consider using an antibacterial mouthwash to help reduce the overall microbial load in your mouth.

5. Dietary Considerations: Some individuals find that reducing sugar and refined carbohydrates in their diet can help decrease the frequency of candidiasis episodes. A diet low in sugar can help starve the yeast.

6. Regular Monitoring: Keep track of your symptoms and any potential triggers. If you notice patterns related to your diet, stress levels, or other factors, it may help in managing your condition.

7. Stress Management: Since stress can impact your immune system, incorporating stress-reducing techniques such as mindfulness, yoga, or regular exercise may be beneficial.

Conclusion
Persistent oral candidiasis can be challenging to manage, but with a comprehensive approach that includes medical treatment, lifestyle adjustments, and good oral hygiene practices, you can work towards reducing the frequency and severity of your symptoms. It’s crucial to maintain open communication with your healthcare providers and advocate for your health, especially if your symptoms persist despite treatment. If necessary, don’t hesitate to seek a second opinion or further evaluation to explore all possible underlying causes. Remember, you are not alone in this, and with the right support, improvement is possible.

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