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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So it’s always gratifying when a patient can leave my office joking and smiling after the experience, such as happened in my office two days ago.
In fact, another patient, actually gave me a big hug after her extraction the following day.
And that got me to thinking about this entire area. . . .
No one (usually*) wants to lose teeth. And we, as dentists, don’t want people to lose them either, but sometimes there is little choice if a tooth has been allowed to get bad enough, or if periodontal disease is so advanced that there is no hope of reversal. [*Though, I did have a young boy actually request a tooth extraction last week — but I’m pretty sure he was really hoping for a visit from the tooth fairy. ]
Nevertheless, I see many people really work themselves up over the thought of the procedure. In fact, the first patient I mentioned actually rescheduled her original appointment when she learned she needed the extraction. She had a hard time confronting the idea of removing her tooth.
Trust me. I get it.
But, to her credit, she did show up for her appointment and when we were done – as I have heard so many times before – she said: “I can’t believe I worked myself up for that.”
Even with her tooth being so badly decayed that there was barely anything to get a hold of, her experience was pretty quick and painless.
So, her worry was just stress on top of stress.
My first piece of advice on this point is try not to need an extraction. Toward that end, try to keep up with regular dental visits, eat a healthy diet, and don’t forget — you control your home care. But, if you do need to have a tooth removed, talk to your doctor about your concerns.
In most cases, your anticipation of what is to come will be far worse than the experience. Still, delaying the inevitable is seldom a good thing. It can make it harder for the doctor too. So why not just make it easier on everybody?
As readers of my blog may know, I have long been an advocate of dietary supplements. While the ideal form of nutrition is always a healthy diet, today’s food is simply not the nutrient-rich, non-chemically altered, or non-genetically engineered food our grandparents ate.
While that might just be a topic for another discussion, I want to point out that whereas supplements have their place, it is always prudent to understand what you are consuming and what potential effects it may produce. This advice holds equally true for vitamins and herbs as it does for medications.
While the side-effects of supplements are typically far less dire than those encountered with many common medications, there can be side-effects nonetheless — especially when used in combination with medications.
As dentists, we are particularly interested in knowing what herbal medications a patient takes that may cause drowsiness, excessive bleeding, cardiovascular problems or that interfere with other drugs.
Here are a few examples:
St. John’s Wort, used as a mood enhancer, can interfere with the effectiveness of many heart and blood pressure medications, as well as blood thinners. On the other hand, garlic, ginseng, ginger, chamomile and gingko, to name a few, can cause bleeding after surgery.
A patient given sedatives by a dentist or oral surgeon before surgery who is also taking Valerian root and kava may experience an interaction that causes excessive drowsiness.
Ginseng has been associated with an increased chance of arrhythmias (irregular heart beats. Patients who take ginseng and also get a local anesthetic with epinephrine (commonly used for fillings and many other dental procedures) may be putting themselves at risk for cardiovascular complications.
Echinacea, while it is widely considered to be an immune system enhancer, may inhibit wound healing and increase the risk of post-surgical infection.
This list is by no means exhaustive, and the simple message here is just because an herbal remedy is considered “natural” doesn’t mean you should neglect to inform your dentist that you are taking them. Neither he nor you want to risk negative effects or complications that can come about as a result of interactions.
More likely than not, your doctor will simply ask you to stop taking a particular supplement before surgery or modify the anesthesia accordingly.
Good communication is the key.
Here is another example of this point. Not uncommonly, patients take “baby aspirin” as a blood thinner. Of course, this is not an herb, but many people feel it is not worth mentioning because it is just a “baby” aspirin. That is, until they fail to stop bleeding after an extraction.
You should always be sure to tell your doctor about ALL of the substances you are taking, including prescriptions and over-the-counter drugs. Even doctors aren’t always fully aware of every potential interaction between herbs and drugs, as new drugs are constantly being developed and introduced into the market. It is in your best interest to let your doctor “know before you go.”
My guess is that it is either because you are compelled to do so by law, or (if you live in the U.S.) you believe the National Highway Traffic Safety Administration (NHTSA), who claim that seat belts save about 13,000 lives a year, nationwide.
The few seconds it takes you to snap on your seat belt buckle reduces the chance of dying in a car crash by 45%, and of being injured by about half. Nevertheless, seat belts are not likely to play a big role in saving your life, because chances are you won’t find yourself in a serious automobile accident. Let’s face it, fortunately, most people never find themselves in that circumstance.
On the other hand, gum disease (either gingivitis or periodontal disease) affects up to 80 percent of the population.
In other articles, you may have heard that periodontal disease is the leading cause of tooth loss among adults. The shocking reality is that this is probably the least notable consequence of periodontal disease.
Periodontal disease is a significant risk factor for stroke, heart disease, certain respiratory problems, low birth-weight infants, and some forms of cancer.
While very few people will die in a car crash, a great deal more will die from a heart attack, stroke, or cancer. Addressing periodontal disease via preventive techniques can significantly reduce your chances of dying from any one of these afflictions.
If this simple logic is not enough to convince you of the need to brush after meals, floss daily and eat a healthy diet, it may help you to know that over the past few decades, there have been hundreds of peer-reviewed medical studies published in journals showing periodontal disease to be a risk factor for heart attacks.
While periodontal disease is certainly not the only factor in the occurrence of cardiovascular diseases or cancer, there is definitely a link. The modern thinking regarding the connection has to do with the long-term inflammatory nature of gum disease. In simple terms, periodontal disease is a bacterial infection of the gums and bone supporting the teeth. As with most any infection in the body, this leads to inflammation.
Often having no symptoms that are detectable by the patient, bacteria from periodontal disease can affect blood vessels on the walls of your heart. If you have gum disease, the bacteria can easily invade the blood stream through one of many open portals. Let’s face it, it is a relatively short trip from the mouth to the heart after all.
Bacteria in the blood may also stimulate liver production of C-reactive proteins and fibrinogen. Both these substances have been linked to heart attacks.
Persons who successfully treated their periodontal disease have also been shown to experience improved cholesterol levels and demonstrated lowered blood pressure. Most readers will recognize these as factors frequently associated with cardiovascular disease.
The bottom line: while we generally don’t hesitate to snap on a seat belt because it may save our lives, not enough of the population understand that oral health basics save more lives than buckling-up! Added benefits? Saving teeth (which leads to better digestion and less need for heartburn medications), fresher breath, and avoiding painful toothaches or complicated dental procedures — which also translates to more dollars in your pocket.
Welcome!
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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