Ask the Expert: Painful, burning mouth from oral thrush

“I often have burning pain in mouth from oral thrush. Is this because of my Sjögren’s and what are some tips that can help?”

Oral candidiasis, or thrush, is a common problem in dry mouth and Sjögren’s patients. Thrush can cause oral burning and pain. The appearance of thrush in a dry mouth patient is often atypical and appears as red and irritated instead of the typical white cottage-cheesy. The tongue may show grooves, and the corners of the lips appear red and crusty (called angular cheilitis). Here are a few tips that can help manage and treat oral thrush:

• Practice excellent oral hygiene and change your toothbrush frequently when oral candidiasis is active.
• Talk to your dentist or rheumatologist about taking Evoxac® (cevimilene) or Salagen® (pilocarpine) to increase salivary flow.
• Don’t use mouthwashes containing alcohol.
• Limit sugar and foods that contain yeast, such as wine, beer and bread. And increase your intake of acidophilus through unsweetened yogurts with live lactobacillus acidophilus or capsules. 
• Avoid caffeine and alcohol, both of which can increase dryness.
• If you smoke – Stop!
• Clean dental prostheses every day with an anti-fungal preparation and avoid wearing them at night. Talk to your dentist about prescription therapies available to help with oral candidiasis. Sometimes a combination of treatments is necessary if the problem is severe.
• For maintenance once thrush is under control, discuss with your dentist frequent use of a magic mouthwash with diphenhydramine, nystatin, and Maalox. A chlorhexidine gluconate rinse can also be helpful (and if you wear dentures, it’s good for cleaning those!)

This information is taken from the Foundation's Patient Education Sheet, by Nelson L. Rhodus, DMD, MPH, FICD.