Understanding Angular Cheilitis: Causes, Symptoms, and Solutions

Understanding Angular Cheilitis: Causes, Symptoms, and Solutions

by | Jan 31, 2024 | Dentistry, Dentures, Medical Issues, Nutrition, Vitamins

Have you ever experienced sore, red cracks at the corners of your mouth that just won’t seem to go away? If so, you may be dealing with a condition known as angular cheilitis.

What is Angular Cheilitis?

Angular cheilitis, also referred to as perleche or angular stomatitis, is a common inflammatory condition characterized by painful cracks or fissures at the corners of the mouth. These fissures can cause discomfort, pain, and even bleeding, making simple tasks like eating or speaking a challenge.

Causes of Angular Cheilitis

Angular cheilitis can have various underlying causes, but two primary factors are often associated with its development:

  1. Loss of Vertical Dimension: In some cases, angular cheilitis can be caused by a loss of vertical dimension, where the mouth fails to close properly due to factors such as missing teeth or ill-fitting dentures. This can create an environment conducive to moisture retention and bacterial growth, leading to inflammation and infection at the corners of the mouth.
  2. Nutritional Deficiencies: Deficiencies in certain vitamins, particularly vitamin B2 (riboflavin), vitamin B3 (niacin), and vitamin B12, have been linked to angular cheilitis. These vitamins play essential roles in maintaining healthy skin and mucous membranes, and their deficiency can weaken the skin’s barrier function, making it more susceptible to irritation and infection.

Symptoms of Angular Cheilitis

The symptoms of angular cheilitis can vary from person to person but often include:

  • Pain, tenderness, or burning sensation at the corners of the mouth
  • Redness, swelling, or inflammation
  • Cracks, fissures, or splits in the skin, which may bleed or crust over
  • Itching or discomfort when opening the mouth or eating

Treatment and Prevention

The treatment of angular cheilitis depends on the underlying cause but may include:

  • Addressing Nutritional Deficiencies: If angular cheilitis is associated with vitamin deficiencies, supplementing with vitamin B complex or specific vitamins such as riboflavin, niacin, and B12 may help improve symptoms and prevent recurrence.
  • Maintaining Oral Hygiene: Practicing good oral hygiene, including regular brushing, flossing, and using an antifungal or antibacterial mouthwash, can help reduce the risk of infection and inflammation at the corners of the mouth.
  • Addressing Dental Issues: If angular cheilitis is caused by a loss of vertical dimension or ill-fitting dentures, addressing these dental issues may be necessary to alleviate symptoms and prevent recurrence.

By addressing the underlying causes and taking steps to promote oral and overall health, individuals can effectively manage and prevent angular cheilitis. If you’re experiencing persistent symptoms, it’s essential to consult with a healthcare professional for proper diagnosis and treatment.

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Shining Lights Through Senior Smiles: Navigating Oral Care in Later Years

Shining Lights Through Senior Smiles: Navigating Oral Care in Later Years

by | Jan 17, 2024 | Dentures, Elder care, Medical Issues, oral surgery, Tooth Extractions, Tooth Loss

As a dentist with over three decades of experience as of this writing, I’ve witnessed the magic a healthy smile can bring. But recently, my journey took a turn, opening my eyes to the heartbreaking reality of oral care in senior living facilities. While many facilities provide excellent care, it’s crucial to acknowledge the challenges older adults face and the ways families can advocate for their loved ones’ well-being.

Let’s break down the landscape:

Independent Residents:

  • Self-care challenges: Arthritis, dexterity issues, and cognitive decline can hinder independent oral care.
  • Denture struggles: Difficulty cleaning, inserting, and removing dentures can lead to infections and discomfort.
  • Overlooked needs: Regular dental checkups are often neglected, potentially allowing problems to worsen unnoticed.

Family members can:

  • Provide gentle assistance: Help with brushing, flossing, and denture care.
  • Schedule regular checkups: Remind and accompany loved ones to dentist appointments whenever possible.
  • Advocate for support: Request additional assistance from facility staff for those struggling with self-care.

Dependent Residents:

  • Lack of oral care focus: Limited staff time and resources can lead to inadequate oral hygiene routines.
  • Communication barriers: Understanding and responding to residents’ needs may be difficult due to cognitive decline or physical limitations.
  • Pain and discomfort: Untreated oral issues can cause significant pain and impact quality of life.

Family members can:

  • Express concerns: Speak up to facility staff about suspected oral issues and request better or more attentive care.
  • Educate the staff: Provide information about loved ones’ specific needs and preferences.
  • Seek additional support: Advocate for involvement of dentists or specialists if necessary.

A Word on Mobile Dental Services:

Many facilities are contracted with mobile dental services, which can offer some relief. However, it’s important to know that these services often have limitations:

  • Limited scope: They may primarily focus on extractions, denture maintenance, diagnosis, and referrals for more complex care.
  • Long wait times: Due to serving multiple facilities, appointments can take weeks or even months to schedule.

While mobile services can be a valuable resource, they might not always provide the full range of care needed. If you feel your loved one requires more comprehensive treatment, explore options like advocating for involvement of local dentists or specialists, even if it means seeking additional appointment slots outside the facility contract.

Remember, a healthy smile is more than just aesthetics for seniors. It’s about pain management, nutrition, and overall well-being. By shedding light on these challenges and empowering families to be advocates, we can work together to illuminate the path towards brighter smiles for our loved ones in their later years.

Dentures: Holding On or Letting Go?

Dentures: Holding On or Letting Go?

by | Jan 10, 2024 | Dentistry, Dentures, Implant, Nutrition, Prevention, Tooth Replacements

I’m willing to bet that many people have a favorite pair of shoes – worn, comfortable, familiar. But what if those shoes start causing more harm than good? The same can be true for dentures, especially when we cling to them long after they’ve overstayed their welcome. In my years as a dentist, I’ve seen countless patients holding onto ill-fitting dentures. Often, the only reason they were I my office at all is that they were brought in by concerned family members who noticed that their dentures looked more like dancing puppets than teeth.

Holding on to dentures for too long is like driving a car with bald tires. You might convince yourself it’s okay, but the risks lurk beneath the surface. Over time, dentures lose their fit as bone recedes, causing instability and potentially painful sores. And let’s not forget the impact on digestion and even your appearance. That sunken profile you’ve gotten used to? A new, properly fitted denture can restore it, sometimes even shaving years off your look.

The American Dental Association recommends a refresh about every five years. That could be a reline or a remake, to keep your dentures in harmony with your changing mouth. Some scoff at that, claiming their ten-year-old choppers are doing just fine. But here’s the secret: small, incremental changes are much easier to swallow than a giant leap many years down the line. When you update regularly, the transition is seamless, like slipping into a well-worn but freshly polished pair of shoes. When you wait fifteen, twenty, or twenty five years before replacing dentures, getting use to the new set can seem impossible.

Implants offer a revolutionary option for some, anchoring dentures like sturdy roots. But not everyone can or wants to go that route. For them, the choice boils down to two paths: hold on to the familiar, wobbly comfort, or take a leap of faith with new dentures.

Today, I wear a different hat. Experience has taught me to read the situation, to gauge whether my efforts will truly benefit the patient. If stubbornness trumps logic, it might be time to let go of the case, especially if it doesn’t appear that any help will be well received. But for those open to rediscovering the joys of proper fit, improved digestion, and a revitalized smile, I am ready to guide them on that journey.

Holding onto old dentures, like those worn-out shoes, can be tempting. But remember, comfort shouldn’t come at the cost of your health and well-being. Talk to your dentist, explore your options, and embrace the possibility of a brighter, healthier smile. After all, sometimes, letting go is the best way to move forward.

Do Dental Implants Make Financial Sense?

Do Dental Implants Make Financial Sense?

by | Mar 5, 2017 | Bridge, Cavities, Cavity, Dentistry, Dentures, Implant, Periodontal Disease, Tooth Loss, Tooth Replacements

Because tooth-loss so often creates long-lasting and generally negative effects for personal health and, not infrequently, appearance – the entire array of tooth replacement options has long been an important subject in the dental field.  Dentists not infrequently discuss which options are best for their patients, given different circumstances.  And if there is any debate in the profession at all, you can be sure the public will also question which options make the most sense for them.

The truth is there is no one right answer.  Each person’s circumstances differ – whether the reasons are anatomic, functional, emotional, or financial.

But the question is still an important one to ask, because patients face new realities when they lose even one tooth.  These changes include (but are not limited to):

  • Difficulty chewing
  • Altered speech
  • Food impaction
  • Jaw pain
  • Drifting teeth

And, then there are the secondary effects:

  • Poor health resulting from a changing diet
  • Compromised appearance
  • Self-consciousness/embarrassment
  • An inability to wear dentures
  • Financial challenges created by the need to address these problems

It is this last point that I want to touch upon here, because I have observed a good deal of confusion surrounding dental implants.  As a dentist, I am obligated to review all options with an individual when discussing their tooth replacement options – regardless of affordability.  I can’t, and don’t, pre-judge anyone financially when discussing their choices.

Commonly, though, when I raise the subject of dental implants, I get an immediate reaction along the lines: “Oh, forget it. I could never afford that.  How about a bridge?”

Now, I’m not going to try to convince you that implants are cheap. Restore a full mouth with dental implants and it is likely to be costly.  Nevertheless, cheap is relative.  For some of my patients, even a small filling can be perceived as expensive.  For my wealthy patients, they might be prepared to spend any price for what they perceive will serve them best.  Lucky them.  Right?

What I hope to do here, however, is to show you when an implant may make the most sense for a person. And — at least, when when it comes to replacing a single tooth — a dental implant may just be the way to go.

But first, permit me to remind you again – there is no one right answer for everybody.  Your choices may be very different depending upon whether you are 25 or 85 years old, for example.

I’m sure you can fill-in still other reasons that affect your decision-making process.  But for now, let’s consider the following scenario:

A patient loses one tooth.

For the sake of argument, we’ll call it a lower right first molar.   Suddenly, the patient realizes this is annoying.  Their bite is changing; their gums are sore.  They feel the need to do something.  Now.

Here are a few options. I’m just going to list the main ones, but there are sub-sets to some of these:

  1. Do nothing anyway.
  2. A removable denture.
  3. A non-removable bridge,
  4. A dental implant.

For the purposes of this discussion, the patient has already decided that doing nothing isn’t working for them.

So, the next option is a removable denture.  I usually get “the face” on this one.

And with good reason.  Food gets caught around partial dentures every time you eat.  You will have to remove the appliance after EVERY meal and clean it separately from your own teeth.  Certain foods will also cause it to dislodge as you eat, allowing some of the food to get caught between the denture and your gums.  The cost – depending upon what kind of partial you have made – will typically range between $750 and $1,500.† The recommended replacement time: every 5 to 7 years.  The reality – people replace them roughly every 15 years.  Sometimes more.  The longer they put off the replacement though, the more issues they may face with the replacement.

Bottom line:  Removable dentures are potentially uncomfortable.  Average lifetime replacement cost if you are 25 years old, (based on an average life expectancy of about 79 years, and an average 10-year replacement rate – not adjusting for inflation) is going to be nearly $7,000.

Next, we’ll take up considering a “bridge.”  It’s called a bridge because it spans a gap (like a bridge spans a body of water) with a fake tooth, or teeth, in between the ones that are still there.  The trouble is that you must shave down the supporting teeth to little stubs so that the result will look natural and be strong enough to take the force of daily chewing.  For the most part, bridges look, and can often feel like, your natural teeth; but you do have to floss under the fake tooth after every meal.  Food will get caught under there, whether you perceive it or not.  If you don’t clean it regularly, the life expectancy of your bridge will be shorter.

Now, the cost on this option can really be widely variable, because some teeth need to have fillings replaced before they can be used as supports for the bridge.  In other cases, the teeth may end up with root canals if the process of shaving them down results in lingering sensitivity.  This doesn’t always happen, but it is a risk.  If the tooth needs that additional treatment it will cost you more.

The average cost to replace a single tooth with a bridge is about $3,500.  Again, that can be a little more, or less, depending upon what part of the country – or even what part of a city, you live in.

If, on the other hand, you also need to place or replace fillings on the teeth being used as supports, and you need to do root canals as well, it could be as much as $7,000.

Roughly, double.

The average lifetime replacement cost with the same parameters given above (25 years old with an average life expectancy of 79 years and a 10-year average replacement rate) is going to be: $31,500.  And that assumes that the underlying teeth will be strong enough to survive that many replacements.

That brings us to dental implants.

Here is the breakdown:  The average implant cost in many metropolitan areas is around $1,800 – $2,200.  If you end up needing a bone graft before the implant can be placed, though, add another $550.  (Basically, a graft is adding bone to your jaw when you don’t have enough for the implant.) So far, these costs are just for the implant.  It doesn’t include the cost of the crown.  Add about another $2,100 for the parts needed to make up what supports the crown above the gumline, and the crown itself.  If your tooth is short, and there isn’t enough tooth height to which your crown can be easily cemented, you might need something called a UCLA abutment — it lets your dentist screw down the crown instead of cementing it.  That could cost you more.  How much depends upon the lab your dentist uses, but $500 more wouldn’t be unusual.

On the low end, one implant may cost $3,900.  On the high end, let’s round up to $4,900.

So, what about the average lifetime cost?

$4,400.

That’s less than either partial dentures or bridges!

Why?

Because, unless you bite into a rock, grind your teeth uncontrollably, or have some serious illness that causes you to lose bone around the implant – any of which can happen to you with the other options as well – you will probably have your implant for life.  Still, no one can guarantee this because, sometimes, plain ol’ dumb luck will factor into any equation.

But, you can’t get a cavity on an implant.  On the other hand, you still can get a cavity on the teeth that support your partial denture, or bridge (and crowns, for that matter).

So, do the math.  Look at your circumstances, and decide what is right for you.  But when your dentist starts talking to you about dental implants, hear them out.  It just might be more cost effective than you realize.

† [Note: The prices mentioned here are just averages in US Dollars at the time of this writing.  Actual costs could be more, or less, depending upon where you live.]

Full Dentures – Problems and Solutions

Full Dentures – Problems and Solutions

by | May 18, 2015 | Communication, Dentures, Medical Issues, Nutrition, Tooth Loss, Tooth Replacements

Millions of people worldwide wear full dentures.  While we often associate this aging, wearing full dentures is not just limited to older adults.  Illness, accidents — sometimes even pregnancy — can contribute to tooth loss and, in a number of cases, this affects younger individuals as well.

Young or old, the psychological consequences of losing teeth can be severe.

Several studies have suggested that a smile is very often the first thing people notice about another person.  So, losing one’s teeth can be devastating in a variety of ways.

Toothlessness may affect digestion. This, in turn, can influence nutrition and health.   There can be issues with self-esteem, intimacy, and a host of other areas most people wouldn’t normally take the time to consider.

This is stressful enough.  But having to now replace the teeth can also become stressful for some.

Many people worry about whether they will be able to eat with their dentures.  Will people notice that they are wearing them?  Will they sound funny when they speak?  Will it hurt to eat with the dentures? Will they be able to chew their food?  How will the dentures affect the ability to taste food? Will the dentures slip when they talk?  What can they afford?

Denture Profile

Dentures

These are natural concerns, but for the first-time wearer, they add up to a lot of unknowns.

The truth is that no two situations are alike. But almost all denture challenges have solutions.

Another thing to consider is that there are many ways to go about addressing total tooth loss.  The solutions depend upon a person’s preferences, financial options, and — frankly — anatomy.

If a person were building a house and they decided to hire an architect, the architect would undoubtedly first gather a lot of information about the project.  For example:  Where is he going to be building? What does the client want: a log cabin or a mansion?  What does the foundation look like?  What is the client’s budget?

In some ways, restoring a person’s smile is not too dissimilar.

For the person without teeth, they may be surprised to learn that there are multiple ways to go about replacing the teeth.  The length of time will vary with each approach, as well as the cost.

To help clarify the options and give some sense of the costs, I put together a free report that helps discusses different levels of care, from simple to more complex. Included is a sense of the pros and cons of each approach, and a general price range at today’s rates.  Of course, this can vary widely from area to area and doctor to doctor.

Do You Have a Spare? (Denture)

Do You Have a Spare? (Denture)

by | May 26, 2013 | Cosmetic Dentistry, Dentistry, Dentures, Prevention

Very often the ideas that I have for articles in this blog come from real-life experiences in my dental practice. One of the things that caught my attention most recently was the prevalence of patients who come in for emergency treatment of broken dentures (typically rather old dentures) and who only have the single set to work with.

Now this creates a real problem for them because it is difficult to go out in public without teeth. People at work who may not know they wear dentures will suddenly become acutely aware of the fact. This can create considerable embarrassment and, even for a retiree, is often enough to prevent attendance at important milestone events such as a graduations, weddings, or anniversaries.Embarrassed

Some repairs can be handled quickly and relatively easily in the office, whereas others have to be sent to a dental laboratory. Depending upon the severity of the problem, that can take time: days, or even up to a week with certain types of dentures.

If you don’t wear dentures, this post may not appear to have anything to do with you. That is, until your mother, father, or grandparent call you in a panic, reporting they just dropped and broke their denture. (Or lost it.) You may find yourself pressed to leave work to bring them to the dentist’s office.

While it may be easy to say that every denture wearer should have a spare set, I understand the economics of the situation. Since I started practice some 20+ years ago, I have seen the cost of producing dentures nearly triple. Nevertheless, there are still many good reasons to think about having a spare set made.

Very often, when making a new denture, your doctor can manufacture a spare set at a reduced cost because he does not have to do the work twice. Similarly, an “economy” version can sometimes be produced by the laboratory which can make a duplicate of your existing denture. It may not be as cosmetic or “perfect” as the original, but it sure is nice to have something to go out and eat with while your main set is being repaired.

And sure, a denture costs more than your average article of clothing — but can you imagine having only one set of pants?! How do you even go out to buy another if you lose it? I suspect that even people who wear hair-pieces have back-ups. They may not want to go out in public without hair, but at least they can still eat.

If you or a loved one only have one denture, seriously consider a spare. And if the denture is older than seven years, it is a good idea to think about a new one. (For more information about why this is recommended see our earlier blog post on the subject.) No one needs the stress or embarrassment caused by having to be without teeth.