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Oral Thrush Definition Description of symptoms Criteria for INCLUSION Criteria for EXCLUSION Advice to be given OTC medication Oral candidaisis is a fungal infection of the oral mucosa most commonly caused by Candida albicans, although it can be caused occasionally by other Candida species Red areas under dentures White spots on the mouth and tongue. These may join together to form larger spots or plaques. When wiped off, the underlying tissue may be red and raw. After antibiotics or steroids, thrush can appear as just red and sore. There may also be red sore areas at the corner of the lips known as angular cheilitis or angular stomatitis. Many mild oral thrush infections are painless, although the condition can sometimes become quite sore. Babies may drool saliva or refuse to feed properly because of the soreness. (Children: 2-12 years) & (Adults and children over 12 years) Children < 2 yrs Patients with hepatic impairment Diabetic patients (on sulphonylureas) Patients on Warfarin and Simvastatin (possible interactions) Any potentially hazardous drug interactions as listed in Appendix 1 of current BNF Leaflet Encourage appropriate dental hygiene Encourage appropriate management of conditions e.g. use of steroid inhalers or management of blood glucose levels` Daktarin oral gel 15g Adults and children over 12 years: One to two 5 ml spoonfuls QDS after food; retain near lesions before swallowing 6-12 yrs: One 5ml spoonful QDS after food; retain near lesions before swallowing 2-6 yrs: One 5ml spoonful BD after food; retain near lesions before swallowing Frequency of consultation Number of products allowed in one consultation. When to refer Resources and leaflets The gel should be kept in the mouth for as long as possible. Treatment should be continued for up to 2 days after the symptoms have cleared. Dentures should be removed at night and brushed with the gel. One per month ONE. Lesions that are bleeding or look infected HIV positive patients If the patient has got persistent thrush despite treatment If patient is on a long term course of antibiotics or immunosuppressant drugs (e.g. azathioprine, methotrexate) Thrush not clearing after 7 days of treatment Conditional referral: consider supply and then sign posting to a dentist Patients with ill fitting dentures CKS topic & patient.co.uk leaflet Denture stomatitis (British Dental Health Foundation) For use as guidance in the Pharmacy First Service NHSLC Updated March 2013 Review March 2014