Red, Cracked Sore Corners Of The Mouth?

Posted 11/16/17

Ever get red, scaly, swollen patches in the corners of your mouth where your upper and lower lips meet? It can be just an annoying dry feeling spot or can progress to be deeply fissured, burning and very painful. It can be uncomfortable to open your mouth, speak or eat. Some people with the condition report a bad taste in the mouth as well. The condition is known as angular cheilitis, perleche, or angular stomatitis.

What causes the Angular Cheilitis?

The most common initiating factor is the pooling of saliva in the corners of the mouth. This creates a chronic moist environment, a perfect breeding ground for Candida albicans, Staphylococcus aureus and possibly Steptococcus (although this is rare). These organisms normally live in balance in your mouth; however, they are opportunistic and will grow and multiply when given the chance. The most common culprit is the fungus, candida albicans, the thrush organism responsible for mouth infections or vaginal infections after antibiotic use and diaper rash in babies.

Like all infections in there must be a receptive host. What makes an individual more likely to be receptive to the effects of the causative fungus or bacteria? Any condition which compromises the individual’s ability to fight infections such as diabetes, HIV, nutritional deficiencies, cancer, immunosuppressive medications , to name a few. Some early literature report that Vitamin B deficiency directly causes angular cheilitis; however, a study held by the New Hanover Regional Medical Center disputes this. This is not to say that a Vitamin B deficiency cannot contribute as it has an important role in boosting the immune system and promoting skin health. Vitamin B therefore plays a role in modulating host response.

Why does saliva pool in the corners of the mouth?

• Increased folding or wrinkling in the corners of the mouth. Of course some of us are all too familiar with the loose sagging skin of the aging face. But the fact of which many are not aware is that the “overclosed” mouth where the nose and the chin are closer together than in youth, also causes these creases. The overclosure, referred to medically as decreased vertical dimension of occlusion (VDO), occurs when teeth are lost without replacement, excessive rapid wear of the teeth occurs, and also when dentures do not recreate an acceptable VDO.
• Too much saliva.
• Physical injury to the face, particularly where lip closure is affected.
• Facial muscle tone deficits from neuromuscular diseases, Parkinson’s disease or Bell’s Palsy.
• Habitual licking of the lips, biting fingernails chewing on pencils all introduce moisture and bacteria to the area.
• Trauma including dental work which stretches the corners of the mouth.

Treatment

Without treatment angular chelitis can plague the sufferer for weeks if not months, especially when the predisposing factors are still present. In addition to keeping the body hydrated, a prescription ointment which includes a steroid for the inflammation, an antifungal for the most common causative organism, candida albicans, and possibly an antibiotic for the bacterial culprits is most effective. The ointment is applied topically in a very thin film to the effected area 3-4 X per day until the lesion is cleared which is typically a few days. It is important to change your toothbrush at the beginning and end of treatment to avoid re-infecting the site. Your dentist can easily diagnose angular cheilitis and prescribe the appropriate treatment. Patients often tell me that they regret not seeking help earlier as the medication resolved the problem so quickly.

Eliminating Predisposing Factors

Go to a dentist who will do a thorough dental and head and neck exam. Factors such as overclosure, tooth wear and muscular tone will be evaluated. Many times restoring the teeth to the appropriate size and shape or in denture patients, making a new denture will resolve the angular cheilitis and a host of other problems.

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