Science Based Angular Cheilitis Treatment
The medical and dental literature abounds with articles describing extra-abdominal, oral signs of inflammatory bowel diseases (IBDs), which include aphthous-like ulceration, gingivitis, candidiasis, pyostomatitis vegetans, cobblestone appearance of the oral mucosa, oral epithelial tags and folds, persistent lip swelling, lichenoid mucosal reactions, granulomatous inflammation of minor salivary gland ducts, and angular cheilitis. Current dental literature focuses on the oral status of IBD patients with regard to the potential use of thalidomide against antitumor necrosis factor-a for the treatment of recalcitrant oral granulomatous lesions, caries rate, salivary antimicrobial proteins, and infections of bacterial and fungal origins. Interestingly, oral manifestations of IBD may precede the onset of intestinal radiographic lesions by as long as a year or more. IBD is of interest to both physicians and dentists because of their complicating oral sequelae and their diagnosis and...
Oral manifestations of malabsorption may be seen as mucosal and gingival pallor, angular cheilitis, and atrophic or a beefy-red glossitis. Additionally, as previously described, oral manifestations of anemia, may occur, particularly in undiagnosed or poorly controlled disease. Nutritional deficiencies are directly related to the section of the bowel affected by the GI disease. Persistent malnutrition is often a problem and the dentist can assist the physician in monitoring compliance with recommended dietary supplementation.
The Plummer-Vinson syndrome, originally described as hysterical dysphagia, is noted primarily in women in the fourth and fifth decades of life. Dysphagia is the hallmark of this disorder resulting from esophageal stricture causing many patients to have a fear of choking (Hoffman and Jaffe, 1995). Patients may present with xeroderma and a lemon-tinted cutaneous pallor, spoon-shaped fingernails (koilonychia), and splenomegaly. The oral manifestations are the direct result of an iron deficiency anemia. These include an atrophic glossitis with erythema or fissuring, angular cheilitis, thinning of the vermilion borders of the lips, and leukoplakia of the tongue. Inspection of the oral mucous membranes will disclose atrophy and hyperkera-tinization. These oral changes are similar to those encountered in the pharynx and esophagus. Carcinoma of the upper alimentary tract has been reported in 10 to 30 of patients (Chen and Chen, 1994). Thorough oral, pharyngeal, and esophageal examination are...
Oral findings are usually associated with vitamin deficiencies, bleeding, and anemia, including angular cheilitis, glossitis, and mucosal pallor. Yellow pigmentation may be observed on the oral mucosa and may be accompanied by scleral and cutaneous jaundice. Salivary gland dysfunction, secondary to Sjogren's syndrome, may be associated with primary biliary cirrhosis. Pigmentation of oral mucosa is only rarely observed in hemochromatosis.
IBD patients appear to be at an increased risk of dental caries as well as bacterial and fungal infections. These are multifactorial in etiology but appear to be related to either the patient's altered immune status or diet (Benvenius, 1988 Malins et al, 1991 Muerman et al, 1994 Rooney, 1984 Sundh and Emilson, 1989 Sundh et al, 1993). Oral manifestations of anemia such as pallor, angular cheilitis, and glossitis may occur, particularly in undi-agnosed or poorly controlled disease has been reported in patients with active ulcerative colitis (UC).
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