VOL 54 NO 5 MAY 2005 THE JOURNAL OF FAMILY PRACTICE - PDF document

VOL 54, NO 5 / MAY 2005 THE JOURNAL OF FAMILY PRACTICE patients demonstrated complete healingwhereas only 1 patient had complete heal-ing after the placebo, giving a numbercontrolled trial from 1975 studied lozengeThere is some evidence demonstrating thatantifungals effectively treat angular cheili-tis. A prospective, double-blind, placebo-controlled study of 8 patients compared theThese patients were referred to aDepartment of Oral Diagnosis for sore lipsCandida albicanslocated bilaterally.side and the other on the left side.and how is it treated?Cheilitis is a broad term that describes inflamma-tion of the lip surface characterized by dry scalingand fissuring. Specific types are atopic, angular,granulomatous, and actinic. Angular cheilitis iscommonly seen in primary care settings, and itspecifically refers to cheilitis that radiates from thecommissures or corners of the mouth. Other termssynonymous with angular cheilitis are perlche,commissural cheilitis, and angular stomatitis.Evidence reveals that topical ointment prepara-tions of nystatin or amphotericin B treat angularcheilitis (strength of recommendation [SOR]: Improving oral health through regular use ofxylitol or xylitol/chlorhexidine acetate containingchewing gums decreases angular cheilitis in randomized, placebo-controlled trial). BASEDANSWER To prevent recurrence, use xylitol gum orlip balms/petroleum jelly in the skin foldsAngular cheilitis is often mistakenly thought to becaused by a vitamin deficiency. As noted in thisClinical Inquiry, infections in the moist skinfolds around the mouth are the cause in elderlypatients. The controlled trials show that antifungalpreparations clearly work. In my experience, mosttopical anti-candidal agents work. To prevent recurrence, xylitol gum or aggressive use of lipbalms or petroleum jelly in the skin folds is neededRichard Hoffman, MD, Chesterfield Family Practice, Chesterfield, Va CLINICALCOMMENTARY Nadine Skinner, MD; Jessie A. Junker, MD, MBANew Hanover Regional Medical Center Residency in Family Medicine, Wilmington, NC; Donna Flake, MSLS, MSASCoastal AHEC Library, Wilmington, NC CLINICAL INQUIRIES brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by University of Missouri: MOspace What is angular cheilitis and

how is it treated?VOL 54, NO 5 / MAY 2005www. Dry scaling and fissuring of FAST tatin, amphotericin B, or placebo andcures rates at 1 month compared withtinuing therapy were the same. The onlymethod proposed to treat angular cheilitis.mouthwashes, or medicated chewing gums. A randomized controlled, double-blindstudy, performed in 21 English nursingyears and older with some natural teethchewing gum on oral health.1 year, the 111 patients (67%) completedthe study. Fifty-seven percent of the partici-Several aspects were measured includ-ing the presence of angular cheilitis. Therewere 3 arms: no gum, xylitol gum, andgums were used after breakfast and theevening meal and consisted of 2 pellets tobe chewed for 15 minutes. Adherence wasdescribed as chewing gum at least 12 timesper week for 12 months. A blinded investi-gator examined patients at baseline, 3, 6, 9,angular cheilitis in both the xylitol andchlorhexidine acetate/xylitol group at 12months when compared to the no gum)of the xylitol group (compared with 27%at baseline), 7% of the chlorhexidineacetate/xylitol group (a reduction from28%), and 32% of the no gum group (nochange). The NNT was 7.7 for the xylitolbe exaggerated as the study randomized bynursing home not individual patients, andthere was no statistical adjustment for theChewing gum impregnated withchlorhexidine is not readily available in theUnited States, whereas xylitol-containinggums are available in many retail stores andRecommendations from othersWe found no clinical guidelines regardingthe treatment of angular cheilitis. Theoral health and diabetes.TaylorÕs 1.Ohman SC, Jontell M. Treatment of angular cheilitis:The significance of microbial analysis, antimicrobial1988; 46:267Ð272.2.Nairn RI. Nystatin and amphotericin B in the treatmentof denture-related candidiasis. Oral Surg Oral MedOral Pathol 1975; 40:68Ð75.3.Simons D, Brailsford SR, Kidd EA, Beighton D. Theeffects of medicated chewing gums on oral health infrail older people: a 1-year clinical trial. J Am Geriatr2002; 50:1348Ð1353.4.Vernillo AT. Dental considerations for the treatment ofpatients with diabetes mellitus. JADA5.Taylor RB, ed. Family Medicine: Principles and6th ed. New York: Springer; 2003.6.Cassel CK, ed. Geriatric Medicine: An Evidence-Based4th ed. New York: Springer; 2003