Oral candidiasis was present in nearly 30% of patients admitted to an oncology ward [Bagg et al, 2003]. Oral health requires an intact mucosa, normal production of saliva, and an intact immune system. Alteration to any of these may result in an oral problem developing. Thrush may follow therapy with oral antibiotics or corticosteroids (oral, inhaled, and topical).

Fran asked if Biotene Oral Balance products would help prevent Thrush. From what I understand, the 'Oral Balance' refers to using the mouthwash, gel and toothpaste together to help maintain a healthy balance of oral flora, reducing harmful bacteria while sustaining beneficial bacteria. Biotène products contain antibacterial enzymes found naturally in human saliva. Biotène contains three primary enzymes - Glucose Oxidase, Lactoperoxidase, and Lysozyme, which are carefully balanced for a special function in boosting and replenishing saliva's own defenses. Together, these ingredients re-create the natural oral protection found in the mouth, providing antibacterial and healing properties. So it may help prevent oral thrush but no randomized clinical trials have been carried out to support their use.

quote:

Managing Thrush (oral Candida) infections

Manage predisposing factors for oral Candida, in conjunction with anticandidal therapy:
Dry mouth
Poor diabetic control
Poor denture hygiene
Corticosteroid therapy (oral, inhaled, and topical)

First-line therapy - topical anticandidal treatment (amphotericin, miconazole, and nystatin).
Although topical treatments are widely used, there are few studies comparing their use [Pankhurst, 2003].
Amphotericin and nystatin are not systemically absorbed, so it is important that they are held in the mouth for as long as possible before swallowing. Avoiding eating or drinking for 30 minutes after each dose also helps to increase contact time with the mucosal surface [Regnard and Hockley, 2004]. Note: nystatin is inactivated by chlorhexidine mouthwashes.
Although it is a topical treatment, miconazole is absorbed to an extent that possible interactions (e.g. with warfarin) may need to be considered.

Second‑line therapy - systemic anticandidal therapy
Systemic treatments are reserved for use cases of widespread or severe infection, or when topical anticandidals are not tolerated, or there is no response to topical treatment. However, there are few studies and most are of small sample size [Pankhurst, 2003].
Fluconazole is widely used in the UK.
Ketoconazole is less commonly used following the Committee on Safety of Medicines (CSM) advice that it should not be used for superficial fungal infections because of rare reports of liver damage.
Itraconazole is an alternative, but is less suitable for people at high risk of heart failure. There have only been rare reports of heart failure, but the risk seems to be higher in the elderly, those with cardiac disease, people taking negative inotropic drugs (e.g. calcium-channel blockers), and people taking high doses or receiving longer treatment courses [CSM, 2001].

You could try taking an Acidophilus supplement to your diet with Nystatin. Nystatin is available as oral suspension 100,000 units/mL; and pastilles 100,000 units. Usual dosage is 100,000 units 4 times daily after food, usually for 7 days (continued for 48 hours after lesions have resolved). Good denture care is important. Nystatin may be used as a denture soak for the duration of treatment.

Also, rinsing your mouth several times a day - especially after eating - with a saltwater/baking soda/warm water solution will help keep your mouth clean. Chewing pineapple may also help to clean the mouth - pineapple contains ananase, an enzyme which may help to break down mouth debris. (Unsweetened fresh or tinned pineapple can be used.)

The Cochrane Database of Systematic Reviews for " interventions for preventing oral candidiasis for patients with cancer receiving treatment " however states that while their review found strong evidence from a large number of trials that some of the antifungal drugs (those absorbed and partially absorbed into the body) help prevent fungal infections in the mouth, some other commonly used drugs such as nystatin, which are not absorbed into the body, do not appear to work! But some of you say that nystatin works for you.

Hope that helps those of you who suffer with thrush. Let us know what works for you.

Best wishes
Vinod

This message has been edited. Last edited by: Dr Vinod K Joshi,

Dear Vinod, Thank you for you full reply.
Hubbys regime at present is:
Flourigard mouthwash once daily in am.
Biotene Toothpaste
Biotene mouthwash later in day
I'm picking up Biotene gel tomorrow to add to this regime
Acidophilis x 1 daily
Garlic caps x 1 daily(Candida hates Garlic apparently)
We'll see if this keeps the dreaded Thrush at bay.
How do we use Nystatin as a denture soak?

If a patient has a partial or full denture, they can soak the denture overnight in some nystatin oral suspension for 10 days.

Alternatively, the use of sodium hypochlorite ("Dentural")as an overnight denture soak has been shown to eliminate denture plaque. Recent investigations have demonstrated that Microwave disinfection of dentures at a specified setting (850W) and exposure time (1 minute) is bactericidal and candidacidal. Re-infestation of the denture surface and infection of the adjacent soft tissue were delayed dramatically in patients whose dentures were microwaved compared with those whose dentures were disinfected by being soaked in a chlorhexidine solution. However, microwave treatment is not recommended for all dentures and should be used with caution.

Further reference (PDF):Denture Stomatitis

Thank you Dr Vinod, why are we not informed of all this during our treatment, we are left to suffer pain.
I was told by my dentist not to soak my plate , four molars lower jaw, but since the fungal infection I have been using half a tablet of sterident, overnight, rinsing well and then cleaning with toothpaste,pineapple will I am afraid be too sharp, at present; The Big Bear sends thanks.

Hi, got the pinapple, it almost crucified me with pain, so not quite ready for that yet, will try agian at a later stage.