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Oral thrush

Fungal Throat Infection is also referred to as oral thrush. It is an infection caused by the yeast fungus Candida albicans. In most people, the presence of Candida in the oral cavity is not uncommon. It is only when there is a change that favors the growth of candida that a fungal throat infection develops. Conditions such as diabetes, AIDS and malnutrition can trigger this change.


Persons suffering from oral thrush will notice whitish spots in the mouth. There may be burning or bleeding. It can lead to fungal infection of the throat and consequently nausea and difficulty in swallowing. A throat culture helps in identifying the micro organisms that cause the infection in the throat. It could reveal epiglottis, strep throat, pharyngitis or diphtheria. Anti fungal drugs such as nystatin, amphotericin or miconazole are used to treat oral thrush.

Burning mouth syndrome

Burning mouth syndrome (BMS) occurs predominantly in middle aged men and women. It is also called glossodynia or stomatodynia. This syndrome occurs in the oral cavity affecting the gums, lips and the tongue. In severe cases, the tongue becomes scalded and has a bruised appearance. Burning mouth syndrome can occur because of preexisting medical and dental conditions such as menopause, oral thrush caused by yeast infection and also some forms of allergies. The exact cause of the burning mouth syndrome is not identified, however when it is diagnosed it becomes absolutely necessary to evaluate the underlying conditions associated with its cause.


Burning mouth syndrome is high among post-menopausal women. Patients often complain of metallic taste; followed by numbness in the oral cavity. The chronic pain caused due to burning mouth syndrome gradually increases and persists. Some patients complain of these symptoms after undergoing a dental procedure. In case of burning sensation, the tongue becomes scalded and patches on the tongue can be seen. The scalded patch is usually 6-9 cm.

Another important condition associated with burning mouth syndrome is xerostomia which is also called dry mouth. In this condition, the salivary flow to the mouth is reduced to a large extent and the person experiences taste aberrations such as metallic taste or bitter taste in the mouth. Studies indicate that this syndrome is caused because of changes associated with neurotransmitter molecules of the central nervous system. Some clinical findings reveal that the major factor associated with BMS is stress. Stressful conditions often release neurotransmitters as a hormonal response. Any changes or insufficiency in these neurotransmitters can lead to BMS.

Diagnosing Burning Mouth Syndrome

Burning mouth syndrome can be treated effectively by working up a diagnostic pattern. The diagnostic measures taken are associated with the patient's history of underlying medical conditions, stress and lifestyle patterns. Patients who undergo cancer treatment and antimicrobial therapies have greater chances of BMS. In addition these factors, BMS is also caused due to trauma to the nervous system in the oral region.

Patients who suffer BMS are treated with an anesthetic mouthwash to reduce the pain and burning sensation. If the pain persists then the salivary glands are carefully examined. This enables detection of a neurological condition called Sjogren syndrome which is associated with salivary gland flow functionality. Patients are tested for their taste patterns and salivary flow analysis is done to assess the type of treatment required. Other patients who have normal taste patterns and BMS are examined for history of reflux disease and previous dental procedures.

Treating Burning Mouth Syndrome

Many patients are counseled to avoid stress as it plays a major role in the onset of BMS. Antidepressant drugs such as clonazepam are recommended for some patients. In case of dry mouth, patients are advised to drink plenty of water or even use sugar free chewing gum to facilitate the salivary flow. Many dietary recommendations are also given to patients suffering with BMS. Patients are advised to avid spicy food, carbonated drinks, acidic juices and also chewing of tobacco. Adequate protein intake along with fiber is recommended to avoid gastrointestinal reflux related BMS and malnutrition associated BMS.


Angular Cheilitis

Angular Cheilitis is a condition in which one or both corners of the mouth develop cracks and sensitive sores and eventually get infected. The ends of the lips become dry, scaly and painful. The infection is caused by continuous exposure to the bacteria present in the saliva. The bacteria get accumulated in the cracks of the lips giving rise to infection. The infection may be caused by various microbes like bacteria, virus or fungi leading to Oral Thrush or candidiasis.


Causes


  • Vitamin deficiency, particularly of B12
  • Exposure to irritants
  • Drooling of saliva in children
  • Poorly fitted dentures
  • Weakened immune system
  • Systemic disorders
  • Dry weather
  • Continuous licking of lips
  • Loss of teeth in elders

Signs and Symptoms

Initially, angular cheilitis will show up with mild symptoms, and if left untreated, turns chronic and causes severe discomfort. At the initial stage, Angular Cheilitis presents itself with the following symptoms:


  • Tight feeling near the angles of the mouth
  • Dry and scaly lips
  • Mild discomfort in opening the mouth.

As the condition worsens one may suffer from the following symptoms:


  • Redness with pain
  • Sores and bleeding fissures
  • Pain and oozing
  • Difficulty while talking and eating.


Angular Cheilitis causes

A single definitive cause is yet to be ascertained. Contributory factors are identified. Poor nutrition and infection score high as compared to other factors. One or combination of these factors is enough for bacteria or fungus in the mouth region to suddenly multiply and cause localized soreness.


  • Nutritional deficiency of mineral and vitamin (folate, iron, B-vitamin deficiency)

  • Deficient immune system

  • Poor hygiene

  • Diabetes, cancer, anemia, Celiac disease, HIV/AIDS, infection

  • Ill fitting dentures , dry mouth, tobacco smoking, make-up, lip balm, high fever, cold weather, allergic reactions, overdose of vitamin A

  • Facial disorders where the lips are enlarged, Down syndrome, Crohn's disease

  • Medications to treat specific health issues such as lithium (for mania), ionized (TB), D-penicillamine (Wilson's disease), retinoids for acne, chemotherapy agents, phenothiazine (for headache, mental disorders).


Angular Cheilitis signs and symptoms


  • Slight tightness in one or both corners of the mouth causing discomfort in opening mouth.

  • Formation of small flaky skin in the corners of the mouth.

  • Redness and swelling that tempt frequent licking of the mouth which aggravate the condition.

  • Split corners at the edges of the mouth.

  • Difficulty in eating and talking.


Treatment

Treatment for angular cheilitis involves applying topical anti bacterial and anti fungi creams or ointments along with oral medication. Ointment with emollient properties is usually prescribed and depending upon the microbial infection antibiotics, antifungal, anti-viral and topical steroids are prescribed.

Angular cheilitis can also be treated at home with the help of easily available natural products. Aloe Vera, honey or fresh neem leaves have anti bacterial and anti fungi properties. They can be gently rubbed on the wounded area at frequent intervals. Applying salt water on affected region works well as the saline water inhibits the growth of bacteria and kills the existing microbes.


Appearance of Angular Cheilitis is often misconstrued to be an outcome of cold sore throat. It is actually a form of dermatitis, a type of skin infection. Typically, one or both the corners of the mouth have lesions making opening of the mouth highly painful. If left untreated, the lips can chap and the areas around the lips may start to peel off thereby worsening the condition.


A culture test to establish the bacteria, fungus or virus is required. A swab from the affected corner is taken and tested. Nutritional supplements containing Vitamin B12, folate and iron are suggested. Maintain good oral hygiene and avoid lip makeup till the condition improves.


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Bibliography / Reference

Collection of Pages - Last revised Date: November 15, 2019