Angular Cheilitis (AC) is an inflammatory skin condition causing painful irritation and cracking at the corners of the mouth. Also known as angular stomatitis or perleche, AC presents as redness, scaling, and sometimes crusting or bleeding. AC is a localized, non-contagious infection that thrives in specific environmental conditions. People wearing oral appliances, such as orthodontic retainers, often wonder if the device contributes to this recurring problem. Dental appliances can introduce factors that make the mouth corners more susceptible to developing AC.
What Exactly Is Angular Cheilitis?
Angular Cheilitis is defined by visible symptoms of inflammation and fissuring at the angles of the mouth. The skin may appear red (erythematous), swollen, and develop deep, painful cracks. These fissures can ooze or crust over, making it difficult to talk or eat. AC is a description of an inflammatory process, not a diagnosis itself.
The underlying cause is usually an opportunistic infection, most often involving the yeast Candida albicans. Bacteria, such as Staphylococcus aureus, may also contribute, resulting in a mixed infection. These microbes multiply rapidly in warm, moist environments, meaning saliva management plays a significant role in AC development. Cracking provides an entry point for these microorganisms to invade the tissue.
How Retainers Create the Perfect Environment
Retainers and other oral appliances can indirectly create conditions favorable for AC development through three mechanisms.
Saliva Pooling
One factor is the alteration of the mouth’s natural resting position, which can lead to saliva pooling at the corners of the mouth. Constant moisture causes the skin to become macerated, or softened, compromising the skin barrier and making it vulnerable to cracking. This warm, damp environment is a breeding ground for the Candida fungus.
Appliance Hygiene
A second mechanism relates directly to appliance hygiene. Retainers accumulate plaque, biofilm, and colonies of bacteria and fungi if not cleaned daily. When a contaminated retainer is placed back into the mouth, these microorganisms are constantly reintroduced to the oral cavity and sensitive lip corners. This direct contact increases the risk of infection.
Mechanical Irritation
An ill-fitting or improperly seated retainer can cause mechanical irritation. If the appliance edge rubs against the delicate tissue, it creates friction or minor abrasions. These small tears in the skin act as entry points for the opportunistic yeast and bacteria that cause the inflammatory response. Addressing the fit of the retainer may be necessary to resolve recurring AC cases.
Non-Appliance Causes of Angular Cheilitis
While retainers can be a contributing factor, many AC cases result from systemic or behavioral issues unrelated to oral appliances.
Systemic Factors
Nutritional deficiencies are a non-appliance cause, particularly low levels of B vitamins, iron, and zinc. Since these micronutrients are necessary for healthy skin and immune function, a deficit leaves tissue susceptible to inflammation and infection. Chronic health conditions also increase susceptibility to AC. For example, individuals with diabetes have higher glucose levels that encourage Candida yeast growth. Conditions that compromise the immune system or require immunosuppressive medications make the body less effective at fighting fungal and bacterial invaders.
Behavioral and Age Factors
Simple behavioral habits, such as chronic lip licking, can trigger AC by repeatedly wetting the area, leading to the cycle of drying, cracking, and infection. Age-related changes, such as the deepening of skin folds around the mouth, also promote saliva collection. These deep furrows create a persistent pocket of moisture that fosters microbial growth independent of any orthodontic device.
Cleaning Routines and Treatment Options
Preventing appliance-related AC requires maintaining meticulous hygiene for the retainer itself. It is also helpful to keep the corners of the mouth protected with a petroleum-based ointment when not wearing the appliance to create a barrier against saliva.
Retainer Cleaning
The retainer should be cleaned daily using a dedicated, soft-bristled toothbrush and a non-abrasive cleanser, such as mild dish soap or a specialized cleaning solution. Toothpaste should be avoided because its abrasive particles can scratch the surface, creating microscopic pits where microorganisms can hide. For a deeper clean, soaking the retainer weekly in a solution of equal parts white vinegar and water or a specialized effervescent tablet helps eliminate built-up plaque and kill microbes. When the retainer is not being worn, it should be kept in a clean, ventilated case to prevent pathogen growth.
Treatment
If Angular Cheilitis develops, consulting a healthcare provider or dentist is necessary to determine the specific cause and infection type. Treatment typically involves topical creams, most commonly an antifungal medication like miconazole or clotrimazole, applied for two weeks to eliminate the fungal infection. If inflammation is severe, a cream combining an antifungal agent with a low-dose corticosteroid may be prescribed to reduce redness and swelling.