From the Guidelines
Angular stomatitis can be effectively treated with a sodium bicarbonate containing mouthwash, which should be used four to six times a day to prevent stomatitis and increased up to each hour if necessary to treat it, as suggested by expert opinion 1. The treatment approach for angular stomatitis involves a combination of preventive measures and therapeutic interventions.
Preventive Measures
Preventive measures are crucial in reducing the severity of stomatitis, including eliminating sources of trauma and avoiding painful stimuli such as hot foods and drinks, and hard, sharp, or spicy foods 1.
- Effective oral hygiene is essential, and patients should be educated about oral complications before treatment.
- Regular dental examinations are recommended to assess the oral cavity and identify any potential issues early on.
Therapeutic Interventions
For the treatment of angular stomatitis, the following approaches can be considered:
- Sodium bicarbonate containing mouthwash: Expert opinion suggests that patients should rinse their mouth with a bland non-alcoholic, sodium bicarbonate containing mouthwash four to six times a day to prevent stomatitis, and increase the frequency up to each hour if necessary to treat it 1.
- Chewing gum, candy, salivary substitutes or sialogogues: Sugarless chewing gum or candy, salivary substitutes or sialogogues can be considered to treat oral dryness, as suggested by expert opinion 1.
- Analgesics: Adequate pain management, such as anesthetic mouthwashes (viscous lidocaine 2%), coating agents, or systemic analgesics, may be provided to treat pain from stomatitis, following the WHO pain management ladder 1.
- Topical NSAID: A topical NSAID (e.g. amlexanox 5% oral paste) may be considered to treat moderate pain from stomatitis, as suggested by expert opinion 1.
- Steroids: Topical high potency corticosteroids, such as dexamethasone mouth rinse (0.1 mg/ml) or clobetasol gel or ointment (0.05%), can be considered to treat ulcers, as suggested by expert opinion 1.
From the Research
Treatment Options for Angular Stomatitis
- Topical antifungal agents, such as nystatin, have been found to be effective in treating angular stomatitis, particularly when caused by fungal infections like oral candidiasis 2, 3, 4.
- A combination of 1% isoconazole nitrate and 0.1% diflucortolone valerate ointment has also been found to be effective in treating angular cheilitis, a condition similar to angular stomatitis 5.
- B-vitamin supplementation, particularly riboflavin, may also be beneficial in treating angular stomatitis, as riboflavin deficiency has been associated with the condition 6.
- Other treatment options, such as photodynamic therapy and disinfectant agents, have also shown promise in treating angular stomatitis and related conditions 2, 3.
Efficacy of Treatment Options
- Nystatin has been found to be effective in reducing clinical signs of stomatitis and mycological assessment in several studies 2, 3, 4.
- The combination of 1% isoconazole nitrate and 0.1% diflucortolone valerate ointment has been found to be effective in treating angular cheilitis, with a broad spectrum of activity against dermatophytes and bacteria 5.
- Riboflavin supplementation has been found to be associated with a reduced risk of angular stomatitis, particularly in populations with riboflavin deficiency 6.