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Angular Chelitis - is inflammation of one, or more commonly both, of the corners of the mouth. The inflammation is caused by yeast development in the area. The condition may show itself as deep cracks or splits in the lips, and the inflamed area may extend onto the skin of the face. In severe cases, the splits can bleed when the mouth is opened and shallow ulcers or a crust may form. It is a fungal disease, which is difficult to treat long term, and commonly recurs.

Angular chelitis has long been a curious disorder to treat. It is difficult to know the cause of the angular chelitis from individual to individual. The usual culprits include poor diet and nutrition (specifically Zinc or Vitamin B2 deficiencies) and certain medications. Angular chelitis can also be caused by the loss of vertical dimension of the teeth. Vertical dimension refers to the height of our teeth, which over time becomes less and less as our teeth wear or our dentures break down. This in combination with the aging process can lead to loose flabby skin at the corners of the mouth. These folds cause a warm, moist, dark environment in which, yeast flourishes.

Solutions For Angular Chelitis

There have been many home remedies tried in treating angular chelitis. These include vitamin regimens, tea tree oils, fish oil, and even a combination of grapefruit and vodka. None of these angular chelitis treatments work. The best approach is to eliminate the source of the issue. Dentists have long known that the loss in vertical dimension coupled with the flabby skin at the sides of the mouth are the triggers in most cases of angular chelitis. Angular Chelitis treatments include:

-Topical Antibiotic/Antifungal Treatment – monostat topical cream is a very effective solution. It needs to be applied externally only, and throughout the day for 2-3 weeks. In many cases this is a temporary solution at best as the root cause of the problem, the mouth folds in the corners, has not been solved. As the patient loses more tooth height, the folds of skin will increase in depth causing the angular chelitis to become harder and harder to treat.

-Increase Vertical Dimension – Once the yeast has been treated and eliminated, the only way to keep it from returning is to address the corner folds. This can be done in a variety of ways but the goal is to open the bite, or increase tooth height, to remove or lessen the presence of the folds around  the mouth. This can be achieved through the fabrication of a new denture (for denture wearers) or through the use of crowns to modify the bite.

-Use of Dermal Fillers – Luckily, we have a third option which many prefer. It includes the use of dermal fillers (such as Restylane and Juvederm) to replace lost volume in the tissues of the lower face. These dermal fillers are generally used in combination with Botox to relax the muscles and subsequently smooth out the wrinkles surrounding the mouth.

Angular Chelitis Conclusion

Angular chelitis can be a long term problem if not treated correctly. It can become quite uncomfortable and unsightly. Some may only be able to utilize the topical antifungal treatment, while others may be able to remove the problem permanently by increasing dental height with the aforementioned dental treatments. Fortunately, we have options at our disposal to treat this condition. You no longer need to be frustrated or embarrassed by this infection. See your dentist to see which treatment is best for you!

Many believe that periodontal disease is a disease that is solely based on genetics. My grandparents had dentures, my parents had dentures, so will I. The truth is, that genetics plays a role, but is not a sentence for dentures. There are risks and limitations in the progression of periodontal disease… Can each patient limit the risks of developing full blown progressive periodontal disease?….The answer is a resounding…YES! It takes a good oral hygiene regimen, knowledge of the current state of your condition, and frequent professional cleaning to keep our mouths in a healthy, disease-free state.

Risk Factors Of Periodontal Disease

Patient Caused Risk Factors

-Poor Oral Hygiene – This is an obvious one that each individual can control. Brushing, flossing, rinsing, and seeking regular dental care are essential steps to remain periodontal disease free and avoid progression beyond gingivitis.

-Age - Research has shown that older people have the highest rates of periodontal disease. The research shows that over 70% of Americans 65 and older have periodontitis.

-Smoking Or Tobacco UseTobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Tobacco users also are at increased risk for periodontal disease. Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

-Poor nutrition- Eating an unhealthy diet will not supply you with the essential vitamins and minerals necessary for tissue healing and repair.

-Anatomy - The local anatomic risk factors for periodontal disease include:,

1. Furcation anatomy. These are the spaces between roots of molars.  In many instances, the entrance of  such furcations are restricted enough to limit access for proper hygiene maintenance. Risk factors for periodontal disease are classified according to their involvement in tooth furcations. A Grade I CEP presents with minimal projection of enamel toward the entrance of the furaction. A Grade II CEP approximates the entrance of the furcation, and the tip of a Grade Ill CEP is well within the furcation.

2. Common anatomic deformities. These interfere with a patient’s ability to effectively remove plaque biofilm which are one of the risk factors for periodontal disease. An example are Cervical enamel projections (CEP). CEPs are tooth developmental deformities of the CEJ found on molars.

4. Palato-gingival grooves (PGG). POGs are tooth developmental deformities of maxillary central and lateral incisors. They begin in lingual pits and extend vertically onto root surfaces. PGGs could, on rare occasions, extend to the root apex. PGGs are commonly associated risk factors for periodontal disease with increased gingival inflammation, plaque accumulation, and probing depth.

5. Open contacts, loss of interdental papilla, and food impaction. Open contacts between teeth may allow for easy food impaction. Food impaction is defined as the forceful wedging of food between teeth. Loss of the pointed papilla between teeth leaves another area for food impaction.

-Medications - Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can have an affect on your oral health, causing dry mouth, inflammation and gum tissue overgrowth. It is important to tell your dentist the medications you might be on so they can tailor a treatment schedule for your needs.

-Other Disease - These include cardiovascular disease, diabetes, and rheumatoid arthritis.  These diseases can interfere with the inflammatory process, causing healing problems, and may worsen the condition of the gums.

-Poor Nutrition – A diet without all the essential nutrients for our bodies to function can compromise our immune systems, decrease healing ability, and make tissue weaker and easier to breakdown. This will make it harder to fight off infection. Since, periodontal disease essentially begins as an infection, this lack of nutrition can make the periodontal disease develop and progress faster than it normally would. Studies have also linked obesity with an increased risk of periodontal disease.

Dentist Caused Risk Factors

-Overhanging dental restorations – A poorly completed dental restoration typically has dental material overhanging the tooth. This creates an issue keeping the area clean and also creates an area for food and bacteria to build up. These overhangs can be irritating to the tissues and retain plaque and food more easily.

-Violation of the “biologic width” –  is the height between the deepest point of the gum pocket and the bone. This distance is important to consider when fabricating any dental restorations, because they must respect the natural architecture of the gingival attachment if harmful consequences are to be avoided. These consequences include bone and tissue recession.

-Open contacts and food impaction - If a dentist places a new dental restoration and does not create the proper tight contact between adjacent teeth, that area becomes a food and plaque trap. It will necessitate improved dental hygiene in that area to keep it clean. More often than not, food and debris will accumulate creating a localized area of periodontal disease.

-Occlusal trauma – If a new restoration is not properly set in alignment with the other teeth, a patient can create damage to the tooth as well as the surrounding tissue just from the act of chewing. The bite should always be checked and adjusted after dental work to prevent trauma to an individual tooth.

Periodontal Disease Conclusion

Luckily, with the exception of the anatomy we are born with, all of these periodontal disease risk factors can be overcome. The first step is to practice good oral hygiene by brushing, flossing, and using an antibacterial mouthrinse. The second step is to choose a well qualified dentist and keep a regular schedule to help give you the best fighting chance at preventing,  treating and stabilizing periodontal disease.

Frenectomy -  is the removal of a frenulum (small fold of tissue that prevents an organ in the body from moving too far). It can refer to frenula in several places on theFrenectomy Marielaina Perrone DDS human body. In dentistry, this procedure is routinely done for orthodontic purposes but can also be done for other functional reasons.

Types Of Frenectomy As Used In Dentistry

-Lingual Frenectomy – This refers to the frenum attachment between the tongue and the floor of the mouth. When this tissue is too tight, restricting movement of the tongue, it is referred to as ankyloglossia, “tongue-tied”. It is easily identified by having the patient lift their tongue up and if it is too tight you will see a heart shape form from the pulling of the tongue. Ankyloglossia comes in varying degrees from mild to one where the tongue is completely attached to the floor of the mouth. As you can imagine this restricts movement of the tongue in all directions. Ankyloglossia can have far reaching effects to include speech, oral hygiene, swallowing, and even eating.

-Labial Frenectomy – This refers to the attachments on the inside of the upper and lower lips. Most commonly, the upper frenum attachment  causes a large gap (also called a diastema) to appear between the upper two central incisor teeth as well as gum recession by pulling the gum tissue away from the bone. The frenectomy procedure is generally done on two populations of patients:

Orthodontic Patients – This procedure assists in closing the front gap between the 2 front central incisor teeth. The frenum attachment will prevent the teeth from closing on their own through normal orthodontic procedures.

Denture Patients – This attachment can and often will become uncomfortable as a patients lips move through eating and talking. This will become irritated as it rubs against the dentures and often will not allow the denture to be as stable as it should be. The frenectomy in this case will remove the discomfort and allow the dentures to fit better than before.

The labial frenectomy procedure should not be done until the permanent central incisors have erupted at least 3/4 of the way into the mouth. The timing can be delicate because scar tissue can develop in this area following the frenectomy making it much harder to close the gap between these teeth through orthodontics.

How Is A Frenectomy Performed?

A frenectomy is a fairly, simple straightforward procedure, usually taking less than fifteen minutes from start to finish. The surgeon can choose to use a scalpel or a laser to excise the frenum. The laser has distinct advantages over the scalpel. The use of the laser tends to cause minimal bleeding, does not require the use of sutures, and is usually noted with little to no post operative discomfort. A frenectomy is usually done using only local anesthesia. Very small children will probably have to use general anesthesia to tolerate the frenectomy surgery.

Conclusion

A frenectomy is only necessary when the frenum attachment is causing pain, discomfort, difficult speech, eating difficulty, or a cosmetic issue. Of course, in cases of speech and eating, it is definitely recommended as it will affect a child’s development over time. Without the procedure, they will have trouble saying certain words and many children also will have trouble breast/bottle feeding. This can be a very serious matter in children with a severe form of attachment. It is important to have your child seen regularly by a dentist so that they can monitor their development and ensure these issues can be taken care of at their proper stage.

A dental emergency can arise at any time and place. These emergencies can be a loose crown, fractured tooth, or even a toothache. Many homes and even cars have

Dental First Aid Marielaina Perrone DDS

Be Prepared For The Entire Family With A Dental First Aid Kit.

emergency first aid kits in case of a medical emergency. Most do not even think twice about dental emergencies until they happen. Are you prepared for a dental emergency?

Items To Include in a Dental First Aid Kit

-Pain Medication. This can include Motrin or Aleve. Just something to relieve the pain until you can see your dentist for better pain relief. Do not use aspirin as this will inhibit clotting.

-Cotton or Gauze pads. These come in handy if there is any bleeding from an injury or even to have the patient bite down on to relieve some of the pressure. It also comes in handy if you have irritation from your braces or a denture. You can place the cotton or gauze in between the appliance and the sore to relive some of the discomfort.

-Wax. Another handy item to cover up areas of irritation like orthodontic brackets or wires.

-Floss. This can come in handy to remove food debris that gets lodged between teeth and beneath the gums that cause pain and discomfort.

-“Save A Tooth” System. This is for transporting teeth that have fallen out so that you have a better chance for long term survival once re implanted.

-Teabags. These are great for stopping bleeding following oral surgery or even a trauma in the mouth. Research suggests that bags containing tea from the plant camellia sinensis is better than herbal tea for this purpose. Tea bags may also be soothing if you bite your lip, cheek, or tongue.

-Denture Adhesive Paste. This can be used even if you do not have dentures. In addition to using it to secure dentures, it can also be used to temporarily secure a crown or bridge that has fallen out. A good example of this is Fixodent.

Dental First Aid Kit Marielaina Perrone DDS-Temporary filling material. This material tends to work better than wax for temporary replacement of a missing filling.

-Dental Mirror and Spatula. The mirror can come in handy if the emergency is back in the mouth and the spatula is necessary for using any temporary filling material in the mouth.

-Instant Ice Packs. These packs can come in handy if there is any trauma to the mouth or face.

-Topical Anesthetic. This can give temporary relief for denture sores, gum irritation, cold sores, canker sores, or sores from simply biting your lip, tongue, or cheek.

-Packets of Salt. These can be helpful if rinsing is necessary, as salt water helps clean and irrigate out wounds.

-Package of Colgate Wisps. This handy dental hygiene tool acts as toothbrush as well as a toothpick. These can help remove foreign objects lodged between your teeth.

-Orabase. A paste used for healing canker sores or sore mouths.

-Dentist Contact Information. Most dentists can be reached after hours via an emergency telephone line.

Dental First Aid Conclusion

All of the items listed above are readily available in most homes as well as drug stores. You can make a kit for at home and in your car for on the road. You never know when a dental emergency might arise and this kit can be a life saver or should I say tooth saver! As always visit your dentist regularly for dental examinations and professional cleanings as well as for follow up to any at home dental emergency.