Angular cheilitis, also known as angular stomatitis, is a common condition that affects the corners of the mouth, leading to inflammation, cracking, and discomfort. Dentists play a crucial role in identifying, managing, and educating patients about this condition. This article provides a comprehensive overview of angular cheilitis, its causes, diagnosis, and treatment options, tailored for dental professionals.

What Is Angular Cheilitis?

Angular cheilitis is an inflammatory condition characterized by:

• Redness and swelling at one or both corners of the mouth.

• Painful cracks or fissures that may bleed.

• Crusting or scabbing of the affected areas.

• Itching or a burning sensation.

The condition is not contagious but can significantly impact a patient’s quality of life by causing discomfort during eating, speaking, and other oral functions.

Causes of Angular Cheilitis

Angular cheilitis is often multifactorial, with common causes including:

1. Infectious Etiology

• Fungal infections: Candida species are the most common culprits, often thriving in the warm, moist environment of the oral commissures.

• Bacterial infections: Staphylococcus aureus and Streptococcus species can also contribute to the condition, either alone or in combination with fungal infections.

2. Mechanical Factors

• Ill-fitting dentures or orthodontic appliances.

• Excessive drooling or saliva pooling, particularly in edentulous patients.

3. Nutritional Deficiencies

• Deficiencies in iron, vitamin B2 (riboflavin), vitamin B3 (niacin), or vitamin B12 can weaken the skin’s defenses.

• Zinc deficiency is also implicated in some cases.

4. Underlying Medical Conditions

• Diabetes mellitus increases the risk due to impaired immune function and increased candida colonization.

• Immune-compromised states such as HIV/AIDS.

• Systemic conditions like lupus may also increase susceptibility.

5. Environmental and Lifestyle Factors

• Cold weather and wind exposure.

• Excessive lip licking or habits that dry out the corners of the mouth.

• Certain medications, such as Accutane, can exacerbate dryness and increase the risk of angular cheilitis.

Diagnosing Angular Cheilitis

Clinical Examination

The diagnosis is typically clinical, based on the characteristic presentation of erythema, fissures, and discomfort at the oral commissures.

History Taking

A thorough medical and dental history is essential to identify potential underlying causes, such as:

• Nutritional deficiencies.

• Systemic illnesses.

• Recent changes in oral appliances.

  
  

  Learn more about how to take a comprehensive medication history here.

Diagnostic Tests

• Microscopy or culture: Scraping the lesions for fungal or bacterial cultures can confirm infectious agents.

• Blood tests: Assessing for deficiencies in iron, B vitamins, or zinc can reveal nutritional contributions.

• Tests to rule out systemic conditions like HIV or lupus, if suspected.

Treatment Options

1. Topical Therapies

• Antifungals: In some cases, an antifungal gel for the mouth may be recommended for concurrent oral infections. Clotrimazole, miconazole, or nystatin are effective against Candida-related cases. Patients often ask about natural remedies, but there is limited evidence supporting options like tea tree oil or coconut oil as effective treatments.

• Antibacterials: Mupirocin or fusidic acid for bacterial involvement.

• Combination creams: Products containing both antifungal and antibacterial agents can address mixed infections.

2. Addressing Underlying Causes

• Nutritional supplementation: Correcting deficiencies in iron, B vitamins, or zinc.

• Oral appliance adjustments: Ensuring the proper fit of dentures or orthodontic devices.

• Saliva management: Recommending barrier creams like petroleum jelly to prevent pooling at the commissures.

3. Lifestyle Modifications

• Educating patients on avoiding habits like lip licking or excessive use of lip balms.

• Promoting good oral hygiene practices to minimize microbial growth.

4. Severe or Recurrent Cases

For persistent or recurrent angular cheilitis, consider:

• Referral to a specialist (e.g., dermatologist or infectious disease expert).

• Systemic antifungals like fluconazole for extensive fungal infections.

• Investigating and managing underlying systemic conditions like diabetes, HIV, or lupus.

Prevention Strategies

Dentists can educate patients on preventing angular cheilitis by addressing modifiable risk factors. Key strategies include:

• Ensuring dentures fit well and are regularly cleaned.

• Using humidifiers during dry seasons.

• Maintaining a balanced diet to prevent nutritional deficiencies.

• Encouraging regular dental check-ups to monitor oral health.

Angular Cheilitis in Special Populations

Angular Cheilitis and Pregnancy

Angular cheilitis can occur during pregnancy due to hormonal changes, increased risk of Candida overgrowth, and potential nutritional deficiencies. Dentists should emphasize the importance of maintaining oral health during this period. Check out our article on dental pregnancy guidelines here to find out precautions related pregnant patients.

Angular Cheilitis on Accutane

Medications like Accutane (isotretinoin) can significantly increase skin dryness and predispose patients to angular cheilitis. In fact, all vitamin A (retinol) analogues have this effect on the skin. This dryness often disrupts the protective barrier of the skin, making the oral commissures more susceptible to inflammation and microbial infections.

Consider educating patients about the importance of moisturizing, using barrier protection like petroleum jelly, and avoiding irritants that exacerbate dryness. Additionally, prescribing antifungal or antibacterial treatments when necessary can help manage symptoms effectively.

Why Dentists Play a Critical Role

Dentists are often the first healthcare providers to notice early signs of angular cheilitis during routine exams. By identifying and addressing the condition promptly, dentists can:

• Relieve patient discomfort.

• Prevent complications, such as secondary infections.

• Enhance overall oral and systemic health.

• Help patients understand angular cheilitis.

Conclusion

Angular cheilitis, though often benign, can significantly impact a patient’s comfort and quality of life. Dentists should be able to recognize signs, causes, and provide effective, tailored treatments. By addressing both symptoms and underlying factors, dental professionals can play a pivotal role in the prevention and management of this common condition.

References

• Cleveland Clinic. (n.d.). Angular cheilitis. Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/21470-angular-cheilitis

• StatPearls. (2022). Angular cheilitis overview. National Center for Biotechnology Information. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK536929/

• Healthline. (n.d.). Angular cheilitis. Healthline. Retrieved from https://www.healthline.com/health/angular-cheilitis#diagnosis