Oral Health Guidance for Angular Cheilitis in a 7-Year-Old Boy

Patients and their need:

A 7 years old boy with her mother has been referred to me by the dentist for providing them an effective as well as clear oral health advice on angular cheilitis. After assessing theoretical health of the body, it has been seen that the body needs an effective oral heath guidance for prompting the cure and prevention of the further inflammation of angular cheilitis in hush mouth (Oza and Doshi, 2017). The angular cheilitis is an oral health condition in which inflammation occurs at the corners of mouth therefore developing the swollen and red patches in the corners. This condition is known as perleche or angular stomatitis. The inflammation at the corner can ranges from the mild sore and redness to the open bleeding blister which is very painful (Cabras et al. 2020). Symptoms of angular cheilitis includes bleeding sore at the corner of mouth, red swollen patches, crusty, cluster, painful scaly. If left untreated the inflammation gets worse with developing large bleeding sores. Therefore, the boy needs a good oral health advise and an immediate treatment for curing angular cheilitis as well as preventing the further inflammation at the corner of his mouth.

By performing the oral health assessment and the screening of tissues collected from the inflammation site of angular cheilitis following information are gained:

The boy never visits dental clinic before which makes him unable to get the clear information regarding his oral health condition. In the last week he develops a small sore at the both corners of his mouth which becomes deteriorate day by day and from the last three days the corners are bleeding with development of bleeding blister.

The dental screening is also performed to check whether there are any issues in the teeth structure, gums and the root area (Pandarathodiyil et al. 2021). The periodontal screening shows that the boy also has signs of periodontal abscess in which there is accumulation of pus in supporting tissues called periodontium.

A soft tissue check is also performed to check whether there are any issues in the soft tissues of the teeth which provide the support to the teeth structure. The positives factors about the soft tissue screening in case of this patient is that there are no damages in the soft tissues.

The personal history analysis of the boy shows that he lives with his parents and a 3-month-old sister. His father is busy at his office work and mother has to invest most of her times to the homemaking task and taking care of her baby girl. Therefore, there is nobody at home who will guide the boy regarding his oral health and hygiene. As his mother is very busy in her everyday schedule, she most of times is unable to send homemade tiffin to her son (the patient). This is why the boy eats oily and unhealthy junk food at school canteen almost every day. Additionally, he hardy brush his teeth twice a day. Due to the lack of parental guidance in most of the times after taking meal he does not wash his mouth properly which leads to bacterial infection in her mouth.

Advise provided:

The first session of this oral health check-up is held at my cabin. At first I provide the boy and his mother with leaflets and posters which contain the discussion on the prevention and cure of angular cheilitis. Then I explain the leaflet and posters detail to provide the clear information to the child and his mother regarding the possible cause, associated risk factors, the signs, symptoms and prevention process of angular cheilitis (Apriasari and Carabelly, 2018). After then I open some videos on angular cheilitis on my laptop and present a clear idea in front of the mother and the patient (boy) regarding the adverse health implications of angular cheilitis on physical and mental wellbeing of patients. I also use the demonstration teeth and mouth structure to explain the entire structure of mouth and teeth. By using a pointer light, I point out to the different parts of mouth and teeth and the normal functions of each part.

From the assessment it is clear that in case of the boy angular cheilitis occurs dur to the bacterial infection at the corners of his mouth. Therefore, I recommend the mother to apply antibacterial cream Bactroban or Fucidin on the inflamed site at corners of her son’s mouth (Federico et al. 2019). Bactroban and Fucidin contain mupirocin and fusidic acid respectively which work against any bacterial infection thereby resist the further bacterial colonization at the site of inflammation.

I also advise the mother to apply the emollient ointment on her son’s lip covering the inflamed areas which will soften the lip thereby reducing the further inflammation. As mentioned by Freitas et al. (2019), children with dry chapped lips are more likely to develop angular cheilitis. Therefore, the use of lip balm and the emollient ointment is useful in case of children to cure and prevent further inflammation of angular cheilitis.

I also recommend the patient (the boy) to stop brushing his teeth till the inflammation at the both corners of his mouth get cured properly. This is because brushing teeth can cause further injuries to the inflammation site thereby causing bleeding from the site (Kwon et al. 2018). Here I advise the patient to use regular mouth wash after each meal which keeps teeth free from any bacterial infection.

I also advise the mother to take care of the oral hygiene of her son to ensure that her son must follow all the guidelines that I have given to him to cure the inflammation at the corners of mouth (Casu et al. 2019). I also recommend the mother to provide homemade and healthy foods to her son as it important for preventing the further bacteria infection.

Reference list:

Oza, N. and Doshi, J.J., 2017. Angular cheilitis: A clinical and microbial study. Indian Journal of Dental Research, 28(6), p.661.

Cabras, M., Gambino, A., Broccoletti, R., Lodi, G. and Arduino, P.G., 2020. Treatment of angular cheilitis: A narrative review and authors’ clinical experience. Oral diseases, 26(6), pp.1107-1115.

Pandarathodiyil, A.K., Anil, S. and Vijayan, S.P., 2021. Angular Cheilitis-An Updated Overview of the Etiology, Diagnosis, and Management. Int J Dentistry Oral Sci, 8(2), pp.1433-1438.

Lorenzo‐Pouso, A.I., García‐García, A. and Pérez‐Sayáns, M., 2018. Hyaluronic acid dermal fillers in the management of recurrent angular cheilitis: A case report. Gerodontology, 35(2), pp.151-154.

Apriasari, M.L. and Carabelly, A.N., 2018. Angular cheilitis and oral pigmentation as early detection of Peutz-Jeghers syndrome. Dental Journal (Majalah Kedokteran Gigi), 51(1), pp.29-32.

Federico, J.R., Basehore, B.M. and Zito, P.M., 2019. Angular Chelitis. StatPearls [Internet].

Freitas, J., Bliven, P. and Case, R., 2019. Combined zinc and vitamin B6 deficiency in a patient with diffuse red rash and angular cheilitis 6 years after Roux-en-Y gastric bypass. BMJ Case Reports CP, 12(8), p.e230605.

Kwon, C.I., Shin, Y.B., Jo, J.W., Jeong, H.B., Moon, Y.S., Jung, E.C., Kim, C.Y. and Yoon, T.J., 2018. P272: A case of angular cheilitis treated with botulinum toxin. 프로그램북 (구 초록집), 70(1), pp.413-413.

Casu, C., Nosotti, M.G., Fanuli, M. and Viganò, L., 2019. Photodynamic Therapy in Non-Responsive Oral Angular Cheilitis: 4 Case Reports. Multidisciplinary Digital Publishing Institute Proceedings, 35(1), p.69.

Topic: Angular cheilitis Patient Group; parents of preschool children

Patient age: 4-11 years old Gender: male Visit: “second”

The second visit is about to follow up the usefulness of the oral health advise that I have given to the patient (the boy) at his first visit to me. In dental science the follow up visit is important for all the dental health professionals to analyse that whether the oral health advise that are given to patients or the treatment that are applied on patients are useful to improve patient’s oral health condition. In this second visit, I start with performing some oral health tests to check whether there is any improvement in the inflammation at both corner of patient’ mouth. I have performed the dental screening, the soft tissues check, screening test in the tissues collected from the inflammation site of mouth and periodontal screening test (Argadianti et al. 2019). I also make a clinical observation on the inflammation site at that both corner of patient’s mouth to check whether the sore and open blister have been improved or there is further infection. The analysis and assessment of the test report show that, there is sign of improvement at the inflammation site such as the sore becomes smaller in size than earlier, there is no bleeding after the first visit of the patient, three is visible dryness in the sore that proves that the inflammation is healing,

Although there is sign of improvement in the inflammation site, the improvement does not meet my expectation level. The assessment of periodontal and soft tissues screening show that there is still the redness and swollen patches in the inflammation site of angular cheilitis (Mandasari et al. 2018.). On the other hand, there is no improvement on the periodontal abbess in the supporting tissues of teeth which can increase the chances of further bacterial infection to the site of angular cheilitis. The mouth screening test clearly shows that there is still stiffness in either corners of child’s mouth. There is also the small blistering on the skin of the inflammation site which enhances the risk of further development of open bleeding sores at this site (de Souza et al. 2020). This oral health condition of the child shows that, he does not follow all the guidelines that I have given him and his mother at their first visit. I also understand that the child makes negligence in maintaining proper oral hygiene as there is very bad smell in his mouth. On the other hand, the swollen red patches at the inflammation site of both corners of patient’s mouth show that there may be negligence in applying the antibacterial ointment on regular wise that I recommended the patient.

The tissue screening at the inflammation site shows that there is crumbling skin on the either corner of patient’s mouth which causes difficulties for him to open the mouth (Kirlioglu and Unaldi, 2021). From this tissue screening it is clear that, despite giving the clear advice to the mother to ensure that her child (the patient) must follow all the given instructions that I have provided them in their first visit to me, she fails to guide the child regarding maintaining the proper oral hygiene which leads to slow healing of angular cheilitis (Sriwahyuni et al. 2017). The puffiness and redness on the either side of mouth at the of angular cheilitis provide that despite recommending the patient to use tooth brush until the inflammation of angular cheilitis is cured properly, he has brushed his teeth which leads to further redness and swollen areas in the inflammation site at the both corners of patient’s mouth.

In this context I strictly advise the child to stop bruising his teeth from now onward till the inflammation is permanently cured otherwise the inflammation gets deteriorated that can cause chronic infection at the site of angular cheilitis (Adha, 2021). I also recommend the mother that she must invest her time and effort to guide her son to follow and implement oral health advise that I gave them in that first visit, such as using the mouth wash after each meal, avoid junk and hard foods and use the homemade and easily chewable foods (Chintagunta et al. 2017). I also advise the mother to ensure that her son does not hard foods as these foods need fast movement of mouth to crush the foods. Therefore, hard foods can cause severe injuries and sore in the inflammation site or angular cheilitis.

The oral health test also shows that, despite giving instruction to the child to avoid junk foods and hard foods, there is negligence by the child to follow this instruction which result into the slow healing of sore and puffiness at the both corner of mouth (Sitorus, S.M., 2017). In this context, I recommend the mother to be stricter to her son’s oral health routine that is important for preventing the risk of further bacterial colonization at the site of angular cheilitis.

Finally, I share some videos and online leaflets with the mother to guide her about what types of guidelines as well as instruction her son needs to follow to cure the angular cheilitis. I recommend the mother to take her son to dental clinic at every month which is important for them to get clear update on the teeth condition, dental health and oral health condition of her son.

Reference list

Adha, T.U.T., 2021. Pengaruh Faktor Ekonomi dan Status Gizi Buruk terhadap Terjadinya Angular Cheilitis pada Anak Usia 6-12 Tahun.

Apriasari, M.L., 2019. The management of herpes labialis, oral thrush and angular cheilitis in cases of oral diabetes. Dental Journal (Majalah Kedokteran Gigi), 52(2), pp.76-80.

Argadianti, A.F., Radithia, D. and Soebadi, B., 2019. Angular Cheilitis in Elderly Patient with Diabetes Mellitus and Decrease of Vertical Dimensions. Acta Medica Philippina, 53(5).

Barquero, E.J., Gutiérrez, S.P. and Marrero, M.C.S., 2019. Angular cheilitis as an initial clinical sign of tuberculosis. Medicina Cutánea Ibero-Latino-Americana, 46(3), pp.219-221.

Chintagunta, S.R., Sana, S.N., Bukka, K.S. and Padma, S., 2017. Cheilitis granulomatosa: Case series. Journal of Dr. NTR University of Health Sciences, 6(3), p.174.

de Souza, V.J.T., Ferreira, C.H. and Frigotto, T.A., 2020. Traumatic angular cheilitis in sheep with secondary development of a fungal infection: case repo. PUBVET, 14(9).

Fireccius, T.F., 2019. Efek Pemberian Salep Ekstrak Daun Sirih Merah 10% terhadap Penyembuhan Angular Cheilitis di RSGM USU.

Kirlioglu, S.S. and Unaldi, N., 2021. Atomoxetine-Associated Angular Cheilitis. American journal of therapeutics.

Mandasari, M., Astuti, A.K. and Rahmayanti, F., 2018. A Case of Inconspicuous Recurrent Herpes Labialis Mimicking Unilateral Angular Cheilitis. Journal of Dentistry Indonesia, 25(3), pp.171-174.

Sitorus, S.M., 2017. Profil Penderita Angular Cheilitis di Departemen Ilmu Penyakit Mulut FKG USU Tahun 2016.

Sriwahyuni, H., Hernawati, S. and Mashartini, A., 2017. Insidensi dan Distribusi Penderita Angular Cheilitis pada Bulan Oktober-Desember Tahun 2015 di RSGM Universitas Jember (Incidence and Distribution of Angular Cheilitison October-December 2015 at DentalHospital of Jember University). Pustaka Kesehatan, 5(1), pp.120-127.

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