Angular Cheilosis/Cheilitis

Angular Cheilosis Cheilitis

Angular Cheilosis (also termed Cheilitis) is a condition that causes cracking and inflammation at the corners of the mouth. It can be very painful and occur on one or both sides when saliva gathers in the folds of the skin. This pooling of saliva provides an ideal environment for yeast (Candida) or bacterial infections.

Cheilitis is prevalent in patients presenting with:

  1. Orthodontics- braces contribute to Cheilitis because the brackets displace the lips making the closure of the lips difficult.
  2. Dentures which don’t fit well- Ill-fitting dentures can also cause gaps where the lips would normally close contributing to saliva collecting in the corners of the mouth.
  3. Continuous lip licking- this habit causes the lips and corner of the mouth to stay wet causing pooling of saliva.
  4. Malocclusion- When the teeth don’t properly occlude, a gap may be present forcing saliva out of the mouth.
  5. Thumb sucking- Sucking on the thumb causes saliva to keep the outside of the mouth moistened.

 Medical conditions which contribute to Cheilitis include:

  1. Iron or Vitamin B deficiencies
  2. Blood Cancers
  3. Diabetes
  4. Immune Disorders
  5. Down Syndrome
  6. Kidney, Liver, Lung, or Pancreatic Cancer

Symptoms of Cheilosis include swelling, pain, bleeding, blisters, itching, scaling, and cracking at the corners of the mouth. The lips can feel dry and uncomfortable, and there may be a burning sensation. There also may be a bad taste in the mouth.

Diagnosis includes evaluation of the fit and condition of dentures, oral habits, blood tests to evaluate for anemia or vitamin deficiency, and a culture of the area to determine the presence of yeast or bacteria.

Treatment involves adjusting ill-fitting dentures, steroids, antifungals, and antibiotics. Antifungal and antibiotics may be topical or systemic depending on the severity of the case. Although predominately a problem for the elderly, Angular Cheilitis can occur at any age and is easily managed when identified and treated promptly.

Fighting Plaque Biofilm


Plaque Biofilm has a very complex design with characteristics such as:   it’s a cooperative community arranged in microcolonies with channels in between, it’s encased in a protective matrix which manages the community and its needs, and it hosts a primitive communication system which sends out signals.

Surprisingly, it’s easy to remove this Biofilm, but it reforms very quickly making it difficult to maintain its absence. Brushing and flossing will remove the biofilm above the gumline, and some studies suggest that using a water jet device can remove or upset the Biofilm up to 6mm below the gumline.

Antibacterial agents in toothpaste are also helpful such as ones containing Triclosan. Mouthrinses containing Chlorhexidine (Prescription) and essential oils with alcohol are also effective.

It’s imperative that patients are seen at least every six months for dental prophylaxis to have the Biofilm removed in areas which can’t be reached underneath the gumline. Patients who are really susceptible to the bacteria in the Biofilm may need to be seen more frequently.

For those patients whose immune systems are suppressed, and are more reactive to the Biofilm, further intervention may be necessary. Antibiotics can be prescribed. However, antibiotics have a difficult time penetrating biofilms because their enzymes can break down the antibiotic before it can become effective. Site-specific antibiotics which are delivered directly into the periodontal pocket have been shown to be effective and less invasive than systemic antibiotics.

Researchers have been performing clinical trials on the amino acid L-arginine. While they’re not exactly sure how this amino acid disintegrates plaque biofilm, it appears to impede the cells from sticking together.

Although there doesn’t seem to be a lot of weapons in the war on plaque, scientists are working on more sophisticated ammunition. Until then, plaque must be fought daily to ensure proper oral and general health.

A Paradigm Shift in the Definition of Plaque

plaque stock photo

The definition of plaque and its impact on oral and overall health has developed over time into a complex interpretation. Furthermore, the evolution of an understanding of plaque has transitioned from a single bacteria to a complex community of a pretty sophisticated matrix. Today, we’ll take a look at the progression in the definition of plaque.

In the 1830’s during the Golden Age of Microbiology, it was thought that a single specific bacteria present in plaque was responsible for oral diseases. In the 1930’s, opinions held that decay, gingivitis, and periodontal disease was linked to a cause present in the host’s body such as calculus or a poor restoration. At this time it was thought that the entire bacterial flora of plaque was a factor in these diseases. In the 1960’s, thoughts returned to a specific bacteria in plaque being responsible for oral diseases.

In 1996, plaque was introduced as a “Biofilm.”  A Biofilm is defined as “any group of microorganisms in which cells stick to each other and often also to a surface.” The National Institute for Dental and Craniofacial Research hosted an international conference on microbial ecology that changed the dental professions thinking regarding plaque. What are some characteristics of a Biofilm?

  1. A biofilm is a complex “cooperating community of various types of organisms.”
  2. A biofilm is arranged in microcolonies with channels in between.
  3. These microcolonies are encased in a protective matrix which manages the flow of oxygen, nutrients, enzymes, waste products, and metabolites.
  4. The environments are different within the microcolonies.
  5. The microorganisms have a primitive system of communication which sends out chemical signals. These signals stimulate the bacteria to produce potentially harmful enzymes and proteins.
  6. Although the Biofilm is easily removed by mechanical methods (Brushing and Flossing), they reform immediately and easily.
  7. The microorganisms are resistant to antimicrobials and antibiotics.
  8. Biofilms are very common, and in nature, they can be very helpful. An example of a Biofilm in nature is slime on a rock in a pond or stream. In humans, Biofilms can be very detrimental.

Regarding this information, it’s easy to ascertain that plaque is pretty sophisticated and has complicated characteristics making it difficult to fight on a long-term basis. In our next blog post, we’ll examine ways to fight this incredible Biofilm.

What is a DSO and How Does it Affect your Practice?

Efficiency of Practice

Once upon a time, graduates of dental schools either obtained a loan and opened a practice or joined an established private practice. Economic conditions were certainly different, and getting a loan to open a new practice was easier to secure. Today, there is another option for new grads, and it’s becoming more and more prevalent.

The new option is DSO- Dental Service Organizations. A DSO is an “independent business support center that contracts with dental practices” and “provides business management and support to dental practices, including non-clinical operations.” In other words, the DSO purchases an existing practice or opens a new practice and implements their standards and procedures based on the laws of the State.  

Part of this change has evolved because of the new generation of dentists. At this point, 42% of Dentists are baby boomers over the age of fifty-five. Millennials are at the forefront of the transition to DSO’s because of economic conditions and the impossibility of starting a new practice. Most millennials graduate with an overwhelming amount of debt making opening a new practice impossible. Millennials also expect to practice with the latest and greatest technology which many private practices don’t possess.

With a DSO, you are an employee and the rules and regulations set by the DSO must be followed. Many practitioners see this as a positive because management is controlled by a third party.  A DSO also differs from a private practice in that they provide services seen in most professional businesses such as billing, IT, human resources, marketing, accounting, and payroll.

This business model is very controversial among dental professionals. While there are pros and cons, recent grads are drawn to this type of practice because it allows them to simply be an employee and focus on the practice of dentistry and paying off enormous student loans.

Knocked Out A Tooth- Now What?

b2ap3 thumbnail man covering mouth stockimages fdp

It’s Saturday morning, and you’re enjoying your child’s soccer game. Kids are running around everywhere when suddenly, a tooth gets knocked out. What now? When a tooth is knocked out is called “avulsed.” It usually happens in children’s sports, and it doesn’t have to be the end of the world. Prevention such as helmets and mouth guards help tremendously, but it still happens, and it’s quite scary.

Normally, teeth are connected to the socket by the Periodontal Ligament. When a forceful blow to the face is experienced, this ligament can stretch and split in half.  At this point, the tooth is displaced from its socket in the bone and comes out.

So, what do you do when you have a screaming bloody child with a tooth out? First of all, don’t panic and access the situation. If it’s a baby tooth, nothing needs to be done. Baby teeth don’t need to be reimplanted. A visit to the dentist will be necessary, but losing a baby tooth isn’t necessarily an emergency unless other factors are present such as lacerations or bone breakage.

If it’s an adult or permanent tooth, find the tooth. It may be dirty, but never touch the root surface because it’s covered with cells and fibers that need to stay intact for successful reinsertion. The best outcome is getting the tooth back into the socket by a dental professional. However, this isn’t always the only option.

Getting to the Dentist within an hour is ideal. Place the tooth in “Save a Tooth” kit and get to the dentist asap. “Save a Tooth” is a kit that’s available over the counter and has everything necessary to prepare a tooth for reinsertion by you or a dental/medical professional. If you can’t get to the dentist, use the save a tooth kit and follow the directions by rinsing the tooth very gently and then reimplant the tooth in the socket taking care to place it correctly. All sports complexes should have save a tooth kits, and it’s a good idea always to keep one on hand.

If you don’t have a save a tooth kit, you can use whole milk to gently rinse the tooth (only if it’s dirty) and reimplant it into the mouth. If the child has other injuries, it will be necessary to transport the tooth with the child to the ER or urgent care. Milk or Saliva are the best transporters if you don’t have a Save a Tooth Kit. Try to avoid ice water, salt water, and sports drinks. Also, keep the tooth submerged in the suggested liquid. Do not wrap the tooth in a napkin or handkerchief.

Reimplantation within an hour provides the best outcome for the tooth to reattach successfully. Don’t be afraid of handle the tooth by the crown and place it back into the socket. It’s much easier than you think, but if it’s not going in easily, turn it around to see if you’re putting it in backward. If it still doesn't go in easily, transport the child and tooth to the dentist, ER, or urgent care with the tooth in the suggested fluid.

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