The question of whether a simple dental retainer can lead to the painful mouth condition known as Angular Cheilitis (AC) is common for appliance users. The answer is yes, retainers can contribute to the development of this irritation, but they are not the direct source of the infection itself. Rather, retainers and other oral appliances create an environment within the mouth that is highly conducive to the proliferation of infectious organisms.
What Angular Cheilitis Is
Angular Cheilitis is an inflammatory disorder that affects the labial commissures, which are the corners where the upper and lower lips meet. The common symptoms include redness, inflammation, and painful cracking or fissuring at the corners of the mouth, which may also be crusty or scaly.
The inflammation begins when the delicate skin barrier is broken down, often by irritation or continuous moisture. This compromised skin then allows opportunistic microorganisms to establish an infection. The most frequent infectious agent is the fungus Candida albicans, which is implicated in up to 90% of cases. However, bacterial strains, such as Staphylococcus aureus or beta-hemolytic streptococci, can also be responsible, either alone or as a secondary infection.
How Retainers Create the Environment for AC
Dental appliances like clear aligners and traditional Hawley retainers facilitate AC development through three primary mechanisms: moisture trapping, mechanical irritation, and acting as a microbial reservoir. The presence of the appliance can cause an accumulation of saliva in the commissures. This continuous pooling of saliva keeps the corners of the mouth chronically damp and warm, which is the perfect environment for Candida albicans to switch from its harmless yeast form to its pathogenic hyphal form.
Saliva itself contributes to the problem, as digestive enzymes cause maceration—a softening and breakdown—of the outer layer of skin. This breakdown weakens the skin’s natural defenses, making it much easier for any present microbes to invade the susceptible tissue.
Poorly fitting, broken, or ill-maintained appliances can cause micro-trauma or friction against the delicate skin at the mouth corners. Furthermore, the retainer itself, if not cleaned rigorously, can become a biofilm reservoir, harboring large colonies of fungi and bacteria. When the contaminated appliance is placed back into the mouth, it constantly re-infects the vulnerable skin, preventing healing.
Preventing AC While Wearing Appliances
Preventing Angular Cheilitis requires a dual approach focused on appliance hygiene and diligent skin care around the mouth. The retainer must be cleaned daily using proper protocols, including brushing it with a non-abrasive cleanser and potentially soaking it in a specific cleaning solution. It is important to ensure the appliance is completely dry before storing it, as moisture promotes fungal growth.
A new toothbrush should be used when AC management begins because the old brush may be contaminated with the causative fungi or bacteria. Users should also avoid licking the corners of the mouth, which is a common habit that perpetuates the cycle of skin breakdown and infection. Applying a barrier cream, like petroleum jelly or a thick emollient, to the mouth corners before bedtime creates a protective shield against saliva pooling and moisture.
Treatment Options
Once symptoms of Angular Cheilitis appear, professional consultation is necessary to determine the specific infectious cause. A medical professional, such as a dentist or physician, may take a swab culture from the affected area to identify the pathogen.
Treatment is tailored to the identified cause. If the infection is fungal, the provider will likely prescribe a topical antifungal cream, such as clotrimazole or nystatin. For bacterial infections, a topical antibiotic ointment, such as mupirocin, would be prescribed. In cases where inflammation is severe, a combination cream containing an antifungal, an antibiotic, and a mild steroid may be used to address all aspects simultaneously.