Background: Oral candidiasis is a common fungal infection, particularly in immunocompromised individuals. Despite the effectiveness of antifungal treatments, recurrence rates, and treatment resistance remain challenges. Probiotics have shown potential as a complementary therapy, but evidence from randomized controlled trials is limited. This study aimed to evaluate the efficacy of probiotics in managing oral candidiasis. Materials and methods: A randomized controlled trial was conducted with 100 participants diagnosed with oral candidiasis, divided into a probiotic group (n = 50) and a control group (n = 50). Participants in the probiotic group received probiotics alongside standard antifungal treatment, while the control group received only antifungal treatment. The primary outcomes were the reduction in Candida colony-forming units (CFUs) and clinical improvement using the oral candidiasis severity index (OCSI). Secondary outcomes included patient-reported pain and discomfort measured by VAS scores. Data were collected at baseline, day 7, and day 14. Results: Out of 100 participants, 75 completed the study. At baseline, both groups had comparable Candida CFU counts and OCSI scores. By day 14, the probiotic group showed a significantly greater reduction in CFU counts (300 vs 600, p = 0.001) and OCSI scores (1.2 vs 2.8, p = 0.0001) compared to the control group. The probiotic group also reported significantly lower pain and discomfort by day 14 (VAS score: 1.5 vs 3.1, p = 0.0001). Adverse events were minimal and included mild gastrointestinal discomfort in the probiotic group. Conclusion: Probiotics, when used as an adjunct to antifungal therapy, significantly reduce Candida colonization and improve clinical outcomes in oral candidiasis. Probiotics were well tolerated and provided a promising complementary treatment option for managing this condition. Further studies are recommended to explore long-term benefits and recurrence prevention.