At TRACEY BELL DENTAL and Aesthetic Medical, addressing angular cheilitis extends beyond mere symptom relief; it involves a holistic understanding and approach to patient care. This condition, characterised by inflammation at the corners of the mouth, can significantly impact patients’ daily lives. Drawing from our clinical experiences and the latest treatment guidelines, including those from SDCEP, this expanded guide delves into the nuanced management of angular cheilitis.
Understanding the Condition
Angular cheilitis predominantly affects two groups: denture wearers, usually linked to fungal/bacterial infections, and individuals without dentures, where a bacterial cause is more common. The appearance of angular cheilitis can vary from mild redness and discomfort to severe cracking and bleeding, significantly affecting quality of life.
For Denture Wearers
In denture wearers, angular cheilitis is often accompanied by denture stomatitis, necessitating concurrent treatment. The primary culprit, Candida spp., thrives in the moist environment under dentures, exacerbating symptoms.
For Those Without Dentures
In individuals without dentures, angular cheilitis is more likely attributed to bacterial infections, particularly Streptococcus spp. or Staphylococcus spp. These cases require a targeted approach to address the bacterial involvement directly.
Broadening the Perspective on Causes
The development of angular cheilitis can be influenced by a variety of local and systemic factors. Recognising these causes is crucial for devising effective treatment strategies and, when necessary, collaborating with other healthcare providers to address underlying systemic conditions.
Local Factors
Local contributing factors to angular cheilitis primarily involve conditions or habits that create a favourable environment for fungal or bacterial overgrowth at the mouth corners. These include:
- Excessive Moisture: Saliva pooling, often exacerbated by lip-licking habits or anatomical changes like deep mouth creases, creates a moist environment conducive to microbial growth.
- Denture Issues: Poorly fitting dentures can trap moisture and debris while also causing micro-trauma that further predisposes to infection.
- Oral Hygiene Practices: Inadequate oral hygiene can allow the proliferation of pathogenic organisms at the corners of the mouth.
Systemic Factors
Systemic causes of angular cheilitis point to broader health issues that can influence susceptibility to this condition:
- Nutritional Deficiencies: Deficiencies in iron, vitamin B (especially B2, B3, B6, and B12), and zinc can impair the immune response and skin health, making infections more likely.
- Diabetes Mellitus: This condition is particularly relevant, as elevated blood glucose levels can encourage fungal growth and alter the body’s immune response.
- Immunocompromised States: Patients with HIV/AIDS, undergoing chemotherapy, or on immunosuppressive medications have an increased risk due to diminished immune function.
- Hematologic Disorders: Conditions like anemia can affect overall health and immunity and contribute to the development of angular cheilitis.
Incorporating Systemic Considerations into Treatment
Understanding the interplay between local and systemic factors is pivotal in our approach to treating angular cheilitis at TRACEY BELL DENTAL and Aesthetic Medical. This comprehensive perspective informs us:
- Assessment Procedures: We thoroughly evaluate oral health and inquire about general health, diet, and lifestyle to identify possible systemic influences.
- Treatment Planning: For patients with underlying systemic conditions like diabetes or nutritional deficiencies, we coordinate care with their general practitioners or specialists to address these issues alongside local treatment measures.
- Effective Treatments and Medications
Our treatment philosophy at TRACEY BELL is grounded in evidence-based practices and patient-centered care. Understanding the cause of angular cheilitis is pivotal in selecting the appropriate treatment regimen.
Miconazole Cream
Miconazole cream, effective against both Candida and gram-positive cocci, is our go-to for initial treatment and is suitable for most patients except those on warfarin or statins. The recommended application is:
- For Adults and Children: Apply a 2% miconazole cream to the angles of the mouth twice daily.
Patients are advised to continue the application for 10 days post-lesion healing to ensure complete resolution.
Sodium Fusidate Ointment
For cases clearly identified as bacterial in nature, sodium fusidate (fusidic acid) ointment is an effective alternative:
- For Adults and Children: A 2% concentration is applied daily to the affected areas.
To mitigate the risk of resistance, treatment duration with sodium fusidate is carefully limited to no longer than 10 days.
Miconazole and Hydrocortisone Combination
Unresponsive cases may benefit from a combination treatment of miconazole and hydrocortisone, which addresses both the infection and inflammation:
- For Adults and Children: A cream or ointment containing 2% miconazole and 1% hydrocortisone applied twice daily.
This regimen is recommended for a maximum of 7 days, with a cautious approach for patients on specific medications like warfarin or statins.
The TRACEY BELL Patient Pathway
Our approach to treating angular cheilitis involves a comprehensive pathway that ensures personalised care:
- Diagnosis and Evaluation: Initial consultations involve thorough assessments to understand the condition’s cause and severity.
- Tailored Treatment Plans: Based on the diagnosis, we develop a personalised treatment plan, selecting medications and home care practices best suited to the individual’s needs.
- Education and Support: We believe in empowering our patients with knowledge about their condition and its management, ensuring they are active participants in their recovery.
- Ongoing Care and Follow-up: Regular follow-ups allow us to monitor the treatment’s effectiveness and make adjustments as necessary, ensuring a successful outcome.
Conclusion
Managing angular cheilitis effectively requires a deep understanding of its causes, a commitment to evidence-based treatment, and a focus on patient-centred care.
At TRACEY BELL DENTAL and Aesthetic Medical, we are dedicated to providing our patients with the highest standard of care, leveraging our expertise and the latest clinical guidelines to ensure optimal outcomes.
Our holistic approach addresses the symptoms of angular cheilitis and aims to improve our patients’ overall oral health and well-being.
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