Angular Cheilitis – Definition, Clinical Features and Treatment

Angular cheilitis can be divided into two parts in which Angular meaning corner of the mouth and Cheilitis meaning inflammation of the lips which means inflammation of the corner of the lips.

Synonyms for Angular Cheilitis: Angular Cheilosis, Perleche, Stomatitis

Definition of Angular Stomatitis: It is a multi factorial disease affecting the commissures of the lips and is commonly seen in Denture wearers.

Associated Factors: Nutritional deficiency, infections and with other lesions such as herpes labialis and syphilis, environmental exposure and trauma due to ulceration. 80% of Angular Cheilitis cases are associated with Denture wearers. Atopic

Deficiencies in general Nutrition, Iron, Folic Acid is commonly seen in patients suffering from Angular Cheilitis. Candidial petichae can be seen associated with diabetes, patients with low immunity, patients on prolonged antibiotic usage and also in HIV patients. Nocturnal drooling in some patients, Orthodontic appliances will change the lip contour initially and lead to drooling.

It is most commonly seen in long term denture wearers due to loss of Occlusal height in Old age or decreased inter maxillary space or decreased Vertical dimensions. In long term denture wearers due to attrition of the teeth because of prolonged usage the vertical dimension is decreased which results in deep folds of skin at the corners of the mouth which leads to collection of saliva in these areas resulting in skin becoming dry and fissured.

In majority of the cases 20% are due to Candida Albicans and 60% are due to Candida Albicans and Staphylococcus Aureus and the remaining 20% are only due to Staphylococcus Aureus.

Clinical Features of Angular Cheilitis or Stomatitis:

1. Angular Cheilitis occurs both in young children and adults
2. Dryness and burning sensation at the corners of the mouth
3. Clinically the corners of the mouth appear to be wrinkled and fissured
4. Lesion may be unilateral or bilateral
5. You can find an alteration in the labial commissures which can be whitening or pallor
6. If this continues without treatment for a long period of time these deepen more leading to cracks and ulcers without much of bleeding in these lesions.
7. These Fissures do not involve the mucosal surface of corners of mouth and stop at the muco cutaneous junction.

Treatment of Angular Cheilitis or Stomatitis:

1. Due to its varied Etiology unless the primary cause is corrected the infection is not primarily cured.
2. The cause of the lesion which can be old dentures leading to loss of vertical dimension or due to collapsed bite in partially edentulous patients ( Raise the bite using partially or fixed dentures) and also completely edentulous patients (Giving Complete Dentures to raise the bite) who are not wearing dentures for a long duration of time.
3. And treating the additive factors like Candida Albicans can help in controlling the lesion.
4. Applying Anti inflammatory or Anti microbial suspensions frequently in the location of the lesion after relieving the cause will lead to permanent treatment of the lesions.
5. To decrease the inflammation Intra lesion-al injections of Triamcenalone should be given.
6. Low strength corticosteroids can be used in combination with anti fungal agents to decrease the infection.

Until all the Etiological factors are treated and along with anti inflammatory agents and anti fungal agents if needed complete treatment of Angular Cheilitis can be completed.