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:
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.
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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Many people believe that since they aren’t experiencing dental symptoms – like tooth pain or bleeding gums – then all must be well.
Unfortunately, a sizable number of dental problems, including cavities and periodontal disease (bone loss around your teeth), just don’t produce obvious symptoms in their early stages. At least not symptoms that tend to be obvious to patients.
In fact, by the time people the average person experiences pain, his dental issue is typically pretty far along. And all too often, by then, the problem can also be quite expensive to handle.
It might amaze you to discover the types of problems your average dentist encounters every week, many of which you would expect to be painful, but they just aren’t. They can still result in tooth loss though.
Pretty much anyone who has ever worked in a dental office for any length of time will tell you this is so. And they will tell you that you can inform some people that they have a problem, but unless it is “real” to them, they just won’t do anything about it.
They may come back a few years later (or maybe sooner) – usually with an emergency – desperately wanting to save the tooth that you told them about earlier. Of course, by now, it may be too late. And very often they will have forgotten it was ever discussed at all, because it was never a realistic problem for them to begin with.
Human nature can be funny that way.
So, keeping that in mind, it’s generally a good idea to get checked out by a dentist. Regularly.
The best news you can hear is that everything looks great.
But sometimes getting a confirmation that you don’t have cavities or gum disease is not the only reason to get a dental exam. Over the years, I have detected cancer (not just oral cancer) – as well as a host of other non-dental problems – that might have been overlooked had the patient not scheduled an exam. Obviously, we refer patients to an appropriate specialist for treatment when we discover medical problems outside the scope of dental practice.
Other benefits of getting a dental exam: I can recall many patients who told me that what they thought were unrelated health problems simply resolved when their oral problems were gotten under control. These have included digestive problems, low energy problems, elevated blood cell counts, hypertension, and more.
Over the years, some people have told me they don’t want to get a dental exam because they don’t want to discover they have any problems. I guess that works.
Just maybe not too well.
Your overall health is connected to your oral health. Take a look at this infographic. Then think it over. . . .
Common sense. Does it seem to you that this has become a rare commodity nowadays? Possibly, then, it is really uncommon sense that we should be talking about.
The latest example of an affront to logic – at least for me – lies in the latest media challenge to oral health. This morning various news agencies including The New York Times, suggested that maybe flossing is really overrated. Apparently, “officials” have never researched the effectiveness of regular flossing.
Now, millions of people are likely to jump on this as a justification for not flossing. But, in reality, the new media sensation is probably not going to change very much at the end of the day. Why? Because I can confidently tell you – based on more than 25-years of personal experience – most people don’t floss anyway. About all this latest “research” will promote is the possibility that some people will feel just a little less guilty about what others with any sense (common or uncommon) already understand is a pretty good idea.
But, it makes for good press. Doesn’t it?
Just for the sake of argument, let’s assume that flossing doesn’t remove plaque. Heck. Some people fail to remove plaque with a toothbrush. That doesn’t mean either fails to benefit the patient, if done properly. I can think of several reasons why flossing helps, though:
Passing floss between the teeth sweeps out the contact point between them – meaning the points where they touch. That’s a source of about 30% of all tooth decay. Your toothbrush typically doesn’t reach those areas, unless you have gaps between your teeth. Floss does reach those areas.
Flossing stimulates blood flow in the gums. One of the body’s first-line mechanisms of defense is to increase blood flow to an affected area. You are effectively helping your body do this in a controlled manner by flossing.
A number of the bacteria under your gums are anaerobic bacteria. That means they don’t grow in room air. So what is a person introducing into the gum pocket when they pull back their gums by flossing? Could it be . . . air? Is it possible that the oxygen in the air could kill some of those bacteria as well?
Think about it.
If we can set aside this newly created question of doubt for just a moment, I would propose that you ask yourself the following question:
“Have I ever flossed consistently?”
By this, I mean every day, and it would have to have included doing so for at least two weeks.
This question is particularly directed to someone if they ever had a gum problem like gingivitis or periodontal disease. Sure, one needs to get rid of tartar and control bacteria as well, but for patients that make the effort to floss (and with only a few qualifications that I can think of), it is almost a sure bet that their gums got better as a result of the daily exercise. First of all, the gums probably bled less afterward. Not in the beginning – to be sure – but after about two weeks of flossing every day, we typically see positive change. Breath improves too. An overall sense of well-being is not out of the question either.
When it comes to flossing sporadically, I agree. It doesn’t help much. It’s kind of like exercising once or twice a month. And let’s face it, that’s where most of the population lives when it comes to flossing — once in a blue moon. Is regular exercise effective, though? What does your common sense tell you?
Why would I hold on to this idea in the face of “new evidence”? Well, I have seen flossing help too many times to just call it a coincidence. Hard core scientists might say “Oh, well, that’s just anecdotal evidence. It doesn’t stand up to real scientific scrutiny.” OK. Then survey practicing dentists. Let’s see if I’m the only one with that observation and experience. I doubt it.
I’m not saying flossing is the only thing you need to do to have healthy gums. It isn’t. Diet and good nutrition are paramount. A healthy immune system doesn’t hurt either. But for Pete’s sake, flossing is cheap, really not all that hard to do once you have practiced it for a while, and it can end up saving you a lot of money in the long run. With health care costs being what they are, I can’t think of too many actions a person can take that bear as much fruit and keep money in their pockets.
But, if the media has just succeeded in making you feel better about not flossing, then OK. Bully for them. (Heaven knows, they do a top notch job spending most of their time getting people to feel less than great.)
And, I suppose there are other ways to handle tooth loss – which, by the way, happens a lot more from gum disease than tooth decay.
I have little doubt that some patients who visit a dentist and are told they have decay, but don’t experience any symptoms, are convinced that someone is trying to pull the wool over their eyes. There are probably several reasons for this. Possibly, they had been to some unscrupulous person in the past who suggested they had a problem, when they really didn’t.
I can see how that might create skepticism. I mean, it’s conceivable that sort of thing could happen.
But even if that were the case, I sincerely don’t believe it represents the behavior of a majority of dentists. Most of the dentists I know genuinely care about what they do and the people they treat. So maybe these skeptics are just people who don’t trust anyone. I don’t know.
The reality, though, is that these patients will eventually be in for a big surprise when the you-know-what hits the fan. Or – and let’s keep this a family column — when the decay hits the nerve.
But that could take a while.
And I believe that could be where some of the problem lies. A patient tries to use this to their advantage — they want to buy some time. After all, it’s not really being a “problem” for them in that they don’t perceive anything as being different. When the problem eventually does occur, I usually hear: “I never thought it would happen to me.”
A doctor detecting treatable decay usually recommends that the patient handle it at their earliest opportunity.
Why? Well, the patient can catch the problem when it is small, when it is less likely to cause post-operative discomfort, and when it will generally cost them a lot less.
But, first, let’s back up a little and explain why it’s possible to have a cavity – several in fact – and have absolutely no symptoms.
Most decay starts on the outer surface of the tooth called the enamel. It’s roughly 97% mineral in consistency and does not contain nerves. That means it has no feeling. Practically zero. Your dentist could DRILL on that part of the tooth and most of the time you won’t feel it.
Notice that in the earlier paragraph I mentioned “treatable” decay. Well, when would decay not be treatable right away? I can’t speak for other dentists, but I typically won’t treat decay when it is confined to the enamel. Why? It has the potential to re-mineralize. In other words, it has the capacity to fix itself – that is, if you don’t continue to do the things that led to the cavity in the first place. Usually, this is related to your diet, but it can be affected by hormones, or even medications.
Why not mention home care first? Isn’t that important too? Of course it is. It just may not be the most important factor.
Another time a dentist might not treat a cavity could relate to the age of the patient. For a much older patient, there are times when the pain or infection are not likely to come up before the patient passes. Of course, your dentist doesn’t have a crystal ball on that point. (Well, probably not.) But, it wouldn’t make sense to recommend treatment in the majority of those cases.
And this takes us back to the nature of a cavity. They often take a long time to get bigger. (But not always…. Again, no crystal ball here.) The reason has to do with the hardness of the enamel itself. Enamel, for you trivia lovers, is the hardest substance in your body. It’s harder than bone, and that property, along with the lack of sensation, can be problematic.
Here’s why: a cavity is often quite small on the outside of the tooth. It’s actually difficult for decay to work its way through that hard enamel. Most of the time it burrows a narrow channel down to the dentin (only a couple of millimeters away) and then it really starts to spread. Because dentin is softer than enamel, it’s just easier for it to spread more quickly there. By the way, this additional, and deeper, decay – very often still doesn’t hurt – as long as it is far enough away from the nerve.
Meanwhile, your enamel is, for the most part, continuing to hold its form. That stuff is hard. But things are generally hollowing out on the inside of the tooth now — out of sight and out of mind — as the decay continues to spread. Painlessly.
Eventually, your tooth can become very much like an eggshell.
Then one fine day you bite on something, and the hard enamel that was still doing its job holding the form of the tooth caves into the hole below. It just got too thin.
Now, at this point, does the skeptic understand that he got a cavity? Sure. Some of them finally get it. But for others –no! It’s more like: “Hey that blowhard dentist was obviously wrong because he talked about me having cavities years ago, and look – I did fine until now. In fact, I probably just lost a filling! Jeez, this hole just came out of nowhere. It’s probably the fault of some earlier dentist.” (Um, Mr. Skeptic never got the filling though. Remember?)
“Hey doc, how much is this going to cost me? $2,400?!!! (For a root canal, buildup and crown.) Are you insane? Just pull it.”
Now you are going to be missing a tooth, and may lose even more teeth as a result. Yet, when the doc first mentioned it, that cavity was only going to cost $150. How can it suddenly become sixteen times more expensive?!
“Rip-off artist. Seems you can’t trust anyone. . . .”
The idea that losing teeth is an inevitable part of aging is a common misconception. While it’s true that tooth loss occurs more frequently among older adults, it’s not a foregone conclusion. With proper oral care and preventive measures, you can keep your natural teeth healthy and strong well into your later years.
Why Tooth Loss Occurs
Tooth loss can be caused by various factors, including:
Gum disease: This is the leading cause of tooth loss in adults. Gum disease is an infection that affects the soft tissues around the teeth, eventually destroying the bone that supports them.
Tooth decay: This is caused by bacteria that build up on the teeth and form plaque. Plaque produces acids that can erode the enamel, the hard outer covering of the teeth. If left untreated, tooth decay can lead to cavities and eventually tooth loss.
Trauma: Injuries to the mouth or teeth can also cause tooth loss.
Other health conditions: Certain medical conditions, such as osteoporosis and diabetes, can increase the risk of tooth loss.
Preventive Measures
The good news is that you can take steps to prevent tooth loss and maintain healthy teeth for a lifetime. Here are some key strategies:
Practice good oral hygiene: This includes brushing your teeth twice a day for two minutes each time, flossing daily, and using a mouthwash.
Visit your dentist regularly: For professional cleanings and checkups.
Eat a healthy diet: Limit sugary foods and drinks, which can contribute to tooth decay.
Quit smoking: Smoking increases the risk of gum disease and other oral health problems.
In addition to these general recommendations, there are some specific things you can do to protect your teeth as you age:
Use a toothbrush with soft bristles: Hard bristles can damage your gums and enamel.
Consider using an electric toothbrush: Electric toothbrushes can be more effective at removing plaque and bacteria than manual toothbrushes.
Get regular fluoride treatments: Fluoride can help strengthen your teeth and prevent decay.
Myths about Tooth Loss and Aging
There are several common myths about tooth loss and aging. Here are a few of the most prevalent:
Myth: Losing teeth is a natural part of aging.
Fact: While tooth loss is more common among older adults, it’s not inevitable. With proper oral care, you can keep your teeth healthy for a lifetime.
Myth: You don’t need to see the dentist as often as you get older.
Fact: It’s important to continue seeing your dentist regularly for checkups and cleanings, even as you get older. Regular dental care can help detect and prevent problems early on.
Myth: There’s nothing you can do to prevent tooth loss.
Fact: There are many things you can do to prevent tooth loss, including practicing good oral hygiene, eating a healthy diet, and quitting smoking.
Losing teeth doesn’t have to be a part of aging. With proper care and preventive measures, you can enjoy a healthy smile for a lifetime. Talk to your dentist about ways to keep your teeth healthy and strong as you age.
Dr. Richard Walicki is a dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.
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