Bryan Trump, DDS recaps his lecture on Oral Pathology on Thursday, November 9, 2023, at the 4th Annual Elevate-Derm PA/NP Conference in Coachella Valley, CA

In this video

After a rapid-fire word-association game on oral pathology terms, Dr. Trump gets serious about angular cheilitis, which he describes as a combined fungal and bacterial infection at the corners of the mouth. He explains the patients most at risk: those with dry mouth, tooth loss that deepens the bite, and elderly patients with accentuated folds where saliva pools and creates "a perfect environment for the yeast infection" alongside staph organisms. He looks for redness, bleeding, or cracking in the corners, and counsels patients that it will recur unless the underlying problem changes.

Because dry mouth drives so much of the picture, Dr. Trump's main advice is to stimulate the patient's own saliva every waking hour "their own saliva is the best medicine" through candies, mints, and gum, favoring xylitol so bacteria can't ferment it into acid. He notes salivary medications like cevimeline and pilocarpine can help but should be eased in to avoid sweating and side effects. He also flags acidic and carbonated beverages, alcohol, and citric-acid sodas (average pH 3.5-4) as problems, since anything below 5.5 can dissolve enamel, while alkaline seltzer he considers safe.

  • Angular cheilitis is usually a combined fungal and bacterial infection at the corners of the mouth look for redness, bleeding, or cracking, especially in dry-mouth, tooth-loss, and older patients with deep folds.
  • Counsel patients it will keep coming back unless the underlying cause changes; treat as needed and be prepared to repeat rather than promising a cure.
  • Treat dry mouth first: stimulate the patient's own saliva every waking hour with candies, mints, or gum, favoring xylitol so oral bacteria can't ferment it into acid.
  • Cevimeline and pilocarpine are options for saliva, but ease patients in gradually to avoid diffuse sweating and other side effects.
  • Watch acidic and carbonated drinks alcohol, citric acid, and sodas (pH ~3.5-4) can dissolve enamel and worsen burning; alkaline seltzer is generally fine, but check flavored versions for added citric acid.