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FACT SHEET: Candidiasis  Candidiasis is also known as “candidosis” and “moniliasis”; and “thrush”. It is usually caused by overgrowth of yeast fungus Candida albicans, but occasionally by other species of Candida.1 Clinical forms that manifest orally include: “pseudomembranous”, “erythematous” (also known as “antibiotic sore mouth”), and “chronic hyperplastic” (also known as “candidal leukoplakia” and “hypertrophic candidiasis”). Candida-associated oral lesions include: “angular cheilitis”, “denture stomatitis” (a type of “chronic atrophic candidiasis”), and “median rhomboid glossitis” (also known as “central papillary atrophy”). “Chronic mucocutaneous candidiasis” includes “chronic familial candidiasis” and “candidiasis endocrinopathy syndrome” (also known as “autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy [APECED] and autoimmune polyendocrine syndrome type 1 [APS-1]).

Date of Publication: May 7, 2014
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Unless otherwise indicated, this fact sheet focuses on oral candidiasis. Angular cheilitis is addressed in a separate fact sheet.

Is the initiation of non-invasive dental hygiene procedures* contra-indicated?

  • No.

Is medical consult advised? 

  • Yes, if the candidiasis has not yet been assessed by physician or dentist for definitive diagnosis (clinically or via microscopy of scraping) and management (including potential prescription medication).

Is the initiation of invasive dental hygiene procedures contra-indicated?**

  • No. 

Is medical consult advised? 

  • See above. 

Is medical clearance required? 

  • No. 

Is antibiotic prophylaxis required? 

  • No.

Is postponing treatment advised?

  • Yes, until candidiasis has been treated and is resolved.

Oral management implications

  • Mode of transmission is: contact with secretions or excretions of mouth, skin, vagina, and feces from patients/clients or carriers; by passage from mother to baby during childbirth; and by endogenous spread. Babies with oral thrush can pass the infection to their mothers’ nipples during breast-feeding. Because Candida yeasts are normal microflora of the human mouth2, a positive oral culture does not necessarily make the diagnosis of infection/overgrowth.3
  • Good oral hygiene practices can help prevent oral candidiasis in people with weakened immune systems. This includes regular brushing, including the tongue. Chlorhexidine mouthwash can prevent or reduce thrush in persons undergoing cancer treatment. People who use inhaled corticosteroids (e.g., for asthma or chronic obstructive pulmonary disease) can reduce the risk of developing oral candidiasis by washing out the mouth with water or mouthwash after using an inhaler. Replacing one’s toothbrush frequently, especially during or after an oral candidiasis infection, can reduce risk of future infection.
  • Candida infections of the mouth and throat should be treated with antifungal medication prescribed by a physician or dentist. Pharyngeal treatment is typically required to avoid oral reinfection with Candida. Oral candidiasis usually responds to topical treatments such as nystatin suspension (i.e., nystatin “swish and swallow”) and clotrimazole troches (lozenges), and miconazole mucoadhesive tablets. Systemic antifungal medication such as fluconazole or itraconazole may be required for oropharyngeal infections that do not respond to topical treatments. Posaconazole oral suspension may be used as an initial treatment or when treatment with other antifungal medicines have failed.
  • Adults and children who have oral candidiasis but are otherwise healthy may also consider eating fresh culture yogurt or taking Lactobacillus acidophilus capsules or liquid to help restore normal bacterial flora, and hence decrease opportunistic Candida overgrowth. In addition, oral application of probiotics may serve as an adjuvant in the treatment of oral candidiasis.
  • Chronic hyperplastic candidiasis resolves when treated with antifungal medication. If the leukoplakia lesion does not respond to antifungal therapy, biopsy should be considered for diagnosis. 
  • In denture stomatitis, the patient/client should cease using the denture for at least two weeks while topical oral application of antifungal medication occurs. Nightly removal of the prosthesis and cleaning with antifungal solution can reduce risk of recurrence. Proper denture fit is important.
  • Xerostomia should be appropriately managed.
  • Dietary reduction of sugar intake may help maintain a healthy oral microbiome and reduce risk of candidiasis.
  • All personal dental appliances should be cleaned to minimize oral infection by Candida. This includes retainers, nightguards, continuous positive airway pressure (CPAP) machines, and sleep devices.
  • Smoking is a risk factor for oral candidiasis. Dental hygienists should counsel patients/clients who smoke to stop smoking and refer them to cessation supports in their local communities (e.g., public health unit, smokers’ help line, etc.). In Ontario, the Canadian Cancer Society offers a free, confidential Smokers’ Helpline for smokers via Telehealth Ontario at 1-866-797-0000 or 1-877-513-3333; Smokers’ Helpline Online is available at www.smokershelpline.ca.

Oral manifestations

  • Candida organisms in small amounts are normal inhabitants of the mouth, throat, and the rest of the gastrointestinal tract, as well as other mucous membranes. Usually, these yeasts do not cause harm. However, if the microbial environment inside the mouth or throat becomes imbalanced, the organisms can multiply and cause overt infection; i.e., oral or oropharyngeal thrush. Candida is an opportunistic organism, and infection of the mouth and throat is uncommon in healthy adults. 
  • Oral thrush occurs most frequently in babies less than one month old (up to 7% prevalence), the elderly, and persons with immunodeficiency. Other factors associated with overgrowth of Candida species include HIV/AIDS; cancer chemotherapy; organ transplantation (and associated use of immunosuppressive drugs); diabetes; corticosteroid use (systemically, as well as topically via oral inhalation — e.g., for asthma management); dentures; broad-spectrum antibiotic use; xerostomia; overuse of mouthwash (particularly antiseptic types); pregnancy (due to hormonal and immune system changes); oral contraceptive use; nutritional deficiency (such as iron or B-vitamin deficiency); smoking; hypoparathyroidism; bone marrow malignancies; and primary T-lymphocyte deficiency.
  • Candidiasis can happen suddenly as an acute infection or persist for long periods as a chronic infection. Mixed clinical presentations (see below) occur.
  • While oropharyngeal candidiasis is often asymptomatic, symptoms may include sore and painful mouth, burning mouth or tongue, and dysphagia. Signs are typically white or red lesions (see below).
  • Pseudomembranous candidiasis is common in infants and chronically ill patients/clients. It manifests as white, curd-like (“cottage cheese”) material on mucosal surfaces, particularly the tongue and buccal mucosa (although hard and soft palates, gums, and tonsils may also be involved). The soft, slightly elevated plaques consist of tangled masses of fungal hyphae with intermingled desquamated epithelium, keratin, necrotic debris, leukocytes (white blood cells), fibrin, and bacteria. When wiped away, the scrapable white plaques leave an erythematous area. Lesions may bleed slightly when scraped or during tooth brushing.
  • Erythematous candidiasis may occur as a sequela to the use of broad-spectrum antibiotics or corticosteroids. Lesions present as consistently painful, erythematous (red) areas along with central papillary atrophy of the tongue. Antibiotic sore mouth can manifest as a “kissing lesion” when palatal contact (“kiss”) by the tongue results in an erythematous area on the palate.
  • Chronic hyperplastic candidiasis manifests as one of two variants; namely, homogeneous, adherent (i.e., non-scrapable), white, plaque-like type or erythematous, multiple, nodular/speckled type. The lesions on the lips, tongue, and buccal mucosa may persist for years. This rare form of oral candidiasis may have potential for malignant transformation, such as into squamous cell carcinoma.
  • Other signs and symptoms of oral candidiasis include difficulty swallowing (especially if there is also throat involvement) and cracking at the corners of the mouth (i.e., angular cheilitis). 
  • In the denture stomatitis form of chronic atrophic candidiasis, erythematous change is limited to the mucosa covered by a full or partial denture. The lesions may vary from petechiae-like to more granular and generalized. Most common on the palate and alveolar ridge, denture stomatitis is usually asymptomatic and often discovered by the dental hygienist or dentist during a routine examination. Unclean or poorly fitting dentures increase risk of harbouring Candida.
  • A circumoral type of atrophic candidiasis can be found in patients/clients with severe lip-licking habits with extension of the process onto surrounding skin. Fissures develop in the perioral skin, which becomes brownish in colour on a slightly erythematous base.
  • Median rhomboid glossitis is sometimes associated with candidiasis. This condition appears as an erythematous, often rhombus-shaped, flat-to-raised area on the mid-line of the posterior dorsal tongue, anterior to the circumvallate papillae. Loss of filiform papillae results in central papillary atrophy, and the condition is often asymptomatic. When Candida yeast (which disappear with antifungal treatment) are present in the affected area, this condition may be considered a form of erythematous candidiasis.
  • Xerostomia is a risk factor for developing oral candidiasis.
  • Candida can cause secondary infection of other oral conditions, such as lichen planus and geographic tongue.

Related signs and symptoms

  • Candida infection is not restricted to the mouth and pharynx. It can occur in other parts of the body, causing fungal diaper rash in infants, vulvovaginitis in women (“yeast infection”), balanitis4 (infection of the glans [head of the penis]) in men, intertrigo (rash in skin folds), paronychia (infection around nail), and onychomycosis (infection of nail). Infants with oral thrush often have concurrent fungal diaper rash.
  • Candidiasis is usually confined to the superficial layers of skin or mucous membranes. 
  • Candida overgrowth in the esophagus is called Candida esophagitis, or esophageal candidiasis. It is associated with pain and difficulty swallowing. In particularly severe cases, intravenous antifungal therapy may be required.
  • Chronic mucocutaneous candidiasis (CMC) is a severe form of candidiasis, which typically occurs in patients/clients who are severely immunocompromised. The patient/client has skin lesions as well as chronic or recurrent oral and genital mucosal candidiasis. The nails and skinfolds are also usually involved. CMC includes chronic familial candidiasis, which usually begins in early childhood and is due to inheritable, genetic mutations that impair the immune system’s ability to fight off Candida infections. CMC also includes candidiasis endocrinopathy syndrome, which is a rare, inherited autoimmune disease, usually manifesting in childhood or adolescence and which is associated with hypoparathyroidism and adrenal gland insufficiency.
  • In susceptible persons, untreated oropharyngeal Candida infections can uncommonly lead to invasive (i.e., systemic) candidiasis, which entails infection of the bloodstream (candidemia) and/or internal organs (such as eyes, heart, kidneys, and brain). This life-threatening condition occurs most often in immunocompromised persons and usually in hospital settings.5 Signs/symptoms can be similar to those of bacterial infection, including fever, chills, myalgia (muscle pain), abdominal pain, weakness, and fatigue.
  • Breast-feeding women whose breasts are infected with Candida may experience red, sensitive, or itchy nipples; shiny or flaky skin on the areola; pain during nursing; painful nipples between feedings; and stabbing pains within the breast. Both mother and child should be treated with appropriate antifungal therapy in order to break the cycle of passing Candida back and forth between mother’s breasts and baby’s mouth.

References and sources of more detailed information


Date: February 2, 2014
Revised: April 20, 2020; June 29, 2025


FOOTNOTES

1 At least seven other species of Candida also cause oral candidiasis. These include C. tropicalis, C. glabrata, C. kruesi, and C. dubliniensis. Furthermore, mixed Candida species infections occur.
2 30% to 50% of people carry Candida albicans in their mouth. The rate of carriage increases with age of the patient/client.
3 Diagnosis of oral candidiasis is usually made clinically. In some cases, microscopy of mucosal smear (cytologic preparation) may be indicated. If the oral infection does not respond to treatment or there is suspicion of a resistant strain, culture can be used to confirm the presence of Candida and identify the specific species. If signs/symptoms suggest esophageal involvement, endoscopy and biopsy of the esophagus may be necessary.
4 Infection of both the glans and the foreskin (in uncircumcised men) is referred to as balanoposthitis.
5 Intravenous lines, various catheters, and related medical devices are often implicated in causation of invasive candidiasis.


* Includes oral hygiene instruction, fitting a mouth guard, taking an impression, etc.
** Ontario Regulation 501/07 made under the Dental Hygiene Act, 1991. Invasive dental hygiene procedures are scaling teeth and root planing, including curetting surrounding tissue.