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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!

A dental abscess is an infection of the mouth, face, throat, or jaw that begins as a tooth infection or cavity. Generally these infections are caused by poor dental health and can be the result of lack of proper and timely dental care. A Dental abscess may also occur in people with medical conditions such as autoimmune disorders (Sjögren’s syndrome and similar conditions)  or conditions that weaken the immune system (diabetes, following radiation or chemo from cancer). A dental abscess can also be triggered by minor trauma in the oral cavity…such as a fractured tooth. Openings in the tooth enamel allow bacteria to infect the nerve tissue (the pulp) in the center of the tooth. Infection may spread out from the root of the tooth and out to the surrounding bones supporting the tooth.

A dental abscess occurs when there is an infection to a small area of tissue and the body is able to seal off the infection and keep it from spreading further. White blood cells (the body’s defense mechanism against certain infections) travel through the walls of the blood vessels in the area of the infection and collect within the damaged tissue. When this happens pus forms (A generally viscous, yellowish-white fluid  formed in infected tissue, consisting of white blood cells, cellular debris, and necrotic tissue). This pus pocket is the dental abscess, which is represented by inflammation, redness, and pain.

Dental Abscess

X-ray showing Dental Abscess

The inflamed area can burst, allowing the pus to drain out, but it will come back if the cause of infection is not removed. The bacteria and host cells cause quick destruction of connective tissues around the tooth and into the jawbones as the dental abscess develops. The pain is constant and may be described as gnawing, sharp, shooting, or throbbing. Putting pressure or something warm on the tooth may induce extreme pain. There may be a swelling present at either the base of the tooth, the gum, and/or the cheek, which can be alleviated by applying an ice pack. A Dental abscess can be acute or chronic. Acute abscess are the most painful. A chronic dental abscess may produce a dull pain with intermittent swelling, but can develop into an acute abscess at any point. Sometimes the infection can progress to the point where swelling threatens to block the airway, causing difficulty breathing. A dental abscess can also make you feel ill, with nausea, vomiting, fevers, chills, and sweats.

In some patients, a dental abscess may penetrate the bone and start draining into the surrounding tissues creating a localized facial swelling. it is also possible for the lymph glands in the neck will become swollen and tender in response to the infection. It may even feel like a headache as the pain can shift from the infected location. Generally, the pain does not travel across the face, only up or down as the nerves that serve each side of the face are separate.

A dentist can determine by a thorough examination, if you have a drainable dental abscess. X-rays of the teeth are usually necessary to show smaller abscesses that may be at the deepest part of the tooth. The objective of any treatment is to remove the infection, save the tooth (if possible), and prevent further complications.

The most frequently seen types of a dental abscess are:

1) Periapical abscess. These are located at the apex of an infected tooth surrounding the roots. This type of dental abscess can occur on any tooth that has severe decay or is broken or chipped.

Dental Abscess

Dental Abscess

2) Periodontal abscess. These are located in the periodontal ligament (PDL) surrounding the tooth. This type of dentalabscess will commonly involve the mandibular and maxillary first molars, maxillary incisors, and cuspids, followed by maxillary second molars.

Treatment of a dental abscess can include:

-A Regimen of antibiotics may be given to fight the infection. Along with drainage of the infected area (if it has not already begun to drain).

-Endodontic or Root Canal Therapy (RCT) can be performed if the dentist feels the tooth can be saved. Even after the root canal therapy is completed, the dentist may want to see the patient periodically to ensure the area is healing properly.

-Teeth that cannot be restored must be extracted, followed by curettage of all apical soft tissue to remove necrotic infected tissue..

An untreated dental abscess can be life threatening and should not be taken lightly. Timely treatment usually allows the dentist to be able to cure the infection. The tooth can usually be saved in many cases but not all. Prompt treatment of dental cavities reduces the risk of a dental abscess. Teeth that have been subject to trauma should be examined immediately by the dentist.