Makindo Medical Notes

Stomatitis is inflammation of the mouth. Cheilitis is inflammation of the lip. Angular stomatitis refers to the painful 'split' or cracking at the corner of the mouth (labial commissure).

About

• Commonly seen in edentulous (toothless) elderly individuals.
• It can be secondary to candidal infection, especially in moist areas like the corners of the mouth.

Aetiology

• Malnutrition, particularly deficiencies in vitamins and minerals.
• Elderly patients with poorly fitting dentures, leading to irritation and moisture retention.
• Deficiency of Vitamin B12, Vitamin B6, Folate, or Iron can predispose to angular stomatitis.
• Associated with seborrhoeic dermatitis, which can contribute to lip irritation and inflammation.

Clinical Features

• Fissuring or cracking at the corners of the mouth, which may extend into ulceration.
• Redness and inflammation are commonly observed at the labial commissure.
• The condition is often painful, especially when opening the mouth or eating.

Differential Diagnosis

• Consider oral cancer if the lesion persists or presents with atypical features (e.g., non-healing ulcers, nodules, or induration).

Investigations

• Blood tests may be warranted to check for nutritional deficiencies or underlying systemic conditions:
  • Full Blood Count (FBC): To assess for anemia.
  • Erythrocyte Sedimentation Rate (ESR): To check for underlying inflammation.
  • B12, Folate, and Ferritin levels: To rule out megaloblastic anemia (caused by deficiencies in B12 or Folate).

Management

• Proper dental care: Assess the need for new or better-fitting dentures, as well-fitting dentures may help reduce irritation.
• Topical treatment: Vioform-Hydrocortisone cream (Hydrocortisone 1%, Clioquinol 3%) can reduce inflammation and treat secondary infection (whether staphylococcal or Candida).
• Improving nutritional status by addressing deficiencies in vitamins and minerals (e.g., iron, B12, and folate) may help resolve symptoms.
• Good oral hygiene: Encouraging patients to maintain proper oral care to prevent further infections.