Oral Thrush

Question 1

What are 5 symptoms of oral thrush?

Answer 1

1. Milky white patches in the mouth that can be wiped off easily, leaving behind red areas that may bleed slightly
2. Redness or soreness
3. Painful, burning sensation in the mouth
4. Cottony feeling in the mouth
5. Loss of taste

Question 2

Does oral thrush require a counselling room?

Answer 2

Yes

Question 3

What are 4 red flags for referral with oral thrush?

Answer 3

1. Diabetic patients
2. Duration > 3 weeks
3. Immunocompromised patients
4. Painless lesion (sinister pathology)

Question 4

Does oral thrush have a PSA self-care card?

Answer 4

Yes (Thrush)

Question 5

What is the preferred over-the-counter treatment option for oral thrush?

Answer 5

Nystatin Oral Liquid 100,000units/mL (Nilstat)

Question 6

What are the directions for Nystatin Oral Liquid 100,000units/mL (Nilstat) in oral thrush?

Answer 6

Adult and Infant: 1mL FOUR times daily until symptoms resolve, then continue for an additional 48 hours.

Question 7

What is 1 non-preferred over-the-counter options for oral thrush and why?

Answer 7

Miconazole Oral Gel 20 mg/g (Daktarin Oral Gel): cannot be used in children under 6 months, hard to measure with the spoon, and CYP3A4 + CYP2C9 interactions.

Question 8

Is Nystatin Oral Liquid 100,000units/mL (Nilstat) safe in pregnancy?

Answer 8

Yes

Question 9

Is Nystatin Oral Liquid 100,000units/mL (Nilstat) safe in breastfeeding?

Answer 9

Yes

Question 10

What is the age range for Nystatin Oral Liquid 100,000units/mL (Nilstat)?

Answer 10

Safe in all ages. For infants, place half of the dose inside each cheek.

Question 11

In which patient group is Nystatin Oral Liquid 100,000units/mL (Nilstat) unsafe in and why?

Answer 11

Not safe for diabetics (contains sucrose)

Question 12

What are 13 pieces of non-pharmacological advice for oral thrush?

Answer 12

1. Rinse your mouth after meals
2. Brush teeth twice a day with a toothpaste that contains fluoride
3. Visit the dentist regularly for check-ups, even if wearing dentures
4. Remove dentures every night, cleaning them with soap and water before soaking them in water with denture-cleaning tablets.
5. Brush your gums, tongue and inside of mouth with a soft brush twice a day if wearing dentures.
6. Visit the dentist if dentures do not fit properly
7. Stop smoking if you smoke
8. Rinse your mouth out after corticosteroid inhaler use
9. Use a spacer when using inhaled corticosteroids
10. Ensure that any underlying conditions (such as diabetes) are well controlled
11. Sterilise bottles, pacifiers, mouth toys and feeding equipment if a baby has oral thrush
12. Mother may also need treatment
13. for nipple thrush if breastfeeding baby has oral thrush

Question 13

What are 3 practice points to consider when treating oral thrush?

Answer 13

1. Best to use the oral liquid after (rather than before) a meal or drink. Swish the liquid around the mouth for as long as comfortable (30-60 seconds) before swallowing.
2. Best to use the gel after (rather than before) a meal or drink; keep it in your mouth for as long as possible before swallowing
3. If you are giving this to a young child or someone who can’t swallow properly, be careful to apply it at the front of the mouth in small amounts so they don’t choke

Question 14

What are 7 potential causes of oral thrush?

Answer 14

1. Courses of antibiotics
   (Especially long courses or high doses)
2. Using inhaled corticosteroids
3. Wearing dentures
   (Especially if they don’t fit properly)
4. Poor oral hygiene
5. Dry mouth
6. Smoking
7. Chemotherapy/Radiotherapy