Getting rid of thrush means big battle on multiple fronts

DEAR DR. ROACH: I have been prescribed an inhaler for asthma, and recently have been developing thrush after using it.

I rinse out my mouth after each use, brush my teeth like I am supposed to do and even have tried using a spacer to avoid thrush.

I’ve been through two prescriptions for nystatin mouth rinse. The thrush seems to clear up with just a few days of using it. But as soon as my prescription ends, it comes back.

Do you have any other suggestions? (I have a partial denture, which I clean with Polident.)

ANSWER: Thrush is an overgrowth of a fungus, usually Candida albicans. In the mouth, it can happen when the bacteria are altered, such as when taking powerful antibiotics, especially for a long time, or when the immune system response is decreased, such as in people getting chemotherapy.

Of the many different inhalers used in asthma, the only type that increases the risk for thrush is the steroid inhalers. Flovent is a popular brand, but all of that type can do it.

Using a spacer delivers more medicine to the lungs and less to the mouth, so always using one is a good idea. Brushing the teeth afterward gets rid of most of the steroid in the mouth, which also is a good idea. Most people wouldn’t get thrush if they were doing what you are doing. So the concern is that you are never really getting rid of the thrush. Nystatin is only modestly powerful, and there are resistant strains.

Perhaps you can consider using a different antifungal, such as clotrimazole troches or miconazole adhesive oral tablets.

I’d also be concerned that your partial dentures are infected, and that Polident, while good for daily use, isn’t killing all the yeast. I recommend disinfection with a medical cleanser — chlorhexidine or a dilute bleach solution (10 drops of bleach in a denture cup filled with water). Do that every day during treatment. People with diabetes are more likely to get thrush, so it may be worth a blood test to be sure, if you haven’t been tested recently.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803.