This preliminary prospective study aimed to evaluate the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjunct treatment for angular cheilitis (AC) in critically ill patients and to investigate its feasibility in a high-complexity hospital setting. The study included 13 patients admitted to the intensive care unit (ICU) of a referral infectious disease hospital in Northeastern Brazil. The aPDT protocol consisted of 0.1% methylene blue (10-minute pre-irradiation) followed by low-level laser therapy (660 nm, 4 J/point, 40 s) applied to three points per affected commissure. Clinical evolution was monitored at T1 (72 h), T2 (7 days), and T3 (follow-up), with lesions classified according to severity. Most patients presented severe systemic compromise, predominantly related to HIV infection and diabetes mellitus. In addition, 76.9% of patients exhibited concomitant oral candidiasis, and 92.3% were receiving systemic antifungal therapy. Complete lesion regression was observed in 40% of patients within 72 h (T1). By the final follow-up (T3), the overall clinical cure rate reached 61.5% (8/13), including cases of delayed resolution confirmed up to day 15. Although a 30.8% loss to follow-up occurred due to the inherent challenges of the intensive care setting, no adverse effects or complications were reported. Within the limitations of this preliminary study, aPDT demonstrated promising clinical applicability as an adjunctive approach for managing angular cheilitis in critically ill patients.

Primary Sjögren disease (pSjD) is associated with a wide range of oral manifestations, including mucosal alterations such as oral ulcers, stomatitis, angular cheilitis, papillary atrophy, and tongue fissuration, as well as oral sequelae of sicca symptoms, including dysphagia, dysgeusia, and chewing difficulties. In addition to these oral findings, pSjD also presents with systemic manifestations such as arthritis, cutaneous vasculitis, and involvement of internal organs. This systematic review and meta-analysis aimed to assess the risk of oral disorders and differences in cariological and periodontal indices in pSjD patients compared with controls. The systematic search was conducted in PubMed, EMBASE, and CENTRAL on November 8, 2024 (PROSPERO: CRD42024608240). Studies meeting the eligibility criteria included adult patients with pSjD. Primary outcomes included the odds ratio (OR) and prevalence of oral disorders as well as the mean difference (MD) and single mean values of dental indices. Meta-analyses were performed using random-effects models to calculate pooled outcome measures and corresponding 95% confidence intervals (CIs). Seventy-five studies were included in the systematic review, with 49 eligible for meta-analysis. The following oral disorders showed increased risk: candidiasis (OR: 10.5; CI: 6.99 to 15.79), dysphagia (OR: 26.78; CI: 20.94 to 34.25), dysgeusia (OR: 17; CI: 4.52 to 63.96), stomatitis (OR: 2.65; CI: 2.17 to 3.23), angular cheilitis (OR: 6.31; CI: 1.94 to 20.53), papillary atrophy (OR: 6.68; CI: 1.12 to 42.16), and fissured tongue (OR: 11.72; CI: 3.42 to 40.18). Patients with pSjD were found to have fewer teeth (MD: -2.16; CI: -4.27 to -0.05) and a higher decayed, missing, filled teeth (MD: 4.72; CI: 3.01 to 6.43) and decayed, missing, filled surfaces (MD: 20.45; CI: 10.16 to 30.74) scores. Furthermore, periodontal parameters showed no significant differences. Patients with pSjD have up to a 30-fold higher risk of developing various oral disorders, emphasizing the need for preventive dental care and early recognition.

BACKGROUND: To compare the prevalence of oral mucosal lesions and oral health-related quality of life between nursing home residents (NHR) and community-dwelling older adults (CDA) in Türkiye. METHODS: This observational cross-sectional study included 639 individuals aged ≥ 65 years: 329 NHR from seven state-authorized nursing homes and 310 CDA attending a university dental clinic between July 2024 and January 2025. Demographics, systemic conditions, denture use, and dental visit history were recorded. Oral mucosal lesions were identified through standardized examinations by a blinded oral medicine specialist. Oral health-related quality of life was assessed using the validated Turkish version of the Geriatric Oral Health Assessment Index (GOHAI-TR). Group comparisons employed Chi-squared, Fisher’s exact, and Mann–Whitney U tests (p < 0.05). RESULTS: NHR had higher denture use (p = 0.001) and more Alzheimer’s and cerebrovascular disease, whereas CDA had more ischemic heart disease, smoking, and xerostomia (p < 0.05). Candidiasis and angular cheilitis were more common in NHR, while oral lichen planus, ulcerative lesions, and fissured tongue predominated in CDA. Red–blue lesions, particularly sublingual varicosities, were more frequent in CDA (41.6% vs. 31.6%, p = 0.009). CDA had higher GOHAI functional limitation scores (p = 0.001), indicating better self-perceived oral function, while NHR scored higher in pain/discomfort (p = 0.006). No significant differences were observed in psychological impact or total GOHAI scores. CONCLUSION: NHR exhibited greater functional limitations and higher rates of infectious oral diseases. Personalized oral care strategies, including specialist-led assessments, targeted infection prevention, and structured caregiver training, are needed in long-term care to preserve oral function and quality of life in older adults.

100 million adults and 15 million adolescents currently use e-cigarettes, a type of Electronic Nicotine Delivery System (ENDS) or Electronic Non-Nicotine Delivery System (ENNDS). While they were introduced as smoking cessation aids, they are currently marketed as consumer products rather than prescription-based cessation tools. According to the WHO, as of 2025, 88 countries do not have minimum age restrictions, and 74 countries have no regulations. The growing popularity of ENDS and ENNDS has introduced a new and complex set of behaviours and exposures that might impact oral and overall health. E-cigarette aerosols are reported to impact cardiovascular health, heighten airway inflammation and increase risk of upper respiratory infections. In the oral cavity, a high caries risk, greater staining of teeth and restorations, higher incidence of xerostomia, gingival inflammation and a greater prevalence periodontal and peri-implant diseases when compared to non-users. Oral mucosal lesions such are nicotine stomatitis, hairy tongue, and angular cheilitis are more prevalent when compared to former smokers. Thus, evidence is emerging to indicate that ENDS and ENNDS impact both oral and systemic health, albeit in ways different from conventional cigarettes. However, high-certainty evidence also supports e-cigarettes as effective smoking cessation tools, with four additional quitters per 100 individuals. Therefore, it behooves oral health professionals to play a crucial role in counselling and support patients with evidence-based data. More evidence is needed to understand the long-term health impacts of e-cigarettes.

Systemic diseases often have oral manifestations that can significantly impact oral health. These manifestations can stem from hematological, gastrointestinal, and viral infections, resulting in various alterations within the oral cavity. Recognizing the crucial link between general and oral health, this research aims to evaluate the awareness of dental students and interns regarding the oral manifestations of systemic diseases. A cross-sectional study involving 244 dental students, including clinical stage dental students from the Faculty of Dentistry at the University of Damascus and intern dentists, was conducted. Participants completed a survey assessing their knowledge and sources of information about oral manifestations of systemic diseases. Additionally, they answered questions pertaining to oral manifestations of gastrointestinal diseases, viral infections, and hematological disorders, alongside inquiries about investigations warranted when observing oral lesions. The participants' awareness levels were categorized as excellent, good, intermediate, or poor. Awareness levels were assessed based on the percentage of correct responses. The study demonstrated that awareness of the oral manifestations of gastrointestinal diseases ranged between intermediate and good, knowledge levels of 71.3% for inflammatory bowel diseases and 55.7% for Crohn's disease. Conversely, awareness regarding the oral manifestations of viral infections was notably lower, with poor knowledge observed for hepatitis viruses (11.5%) and COVID-19 (28.85%), while intermediate awareness was recorded for viruses associated with nasopharyngeal carcinoma (39.55%). Regarding hematological disorders, awareness was good for conditions associated with gingival bleeding (62.3%) and glossitis (70.5%). However, intermediate levels of knowledge were noted for disorders presented with aphthous ulcers (56.84%), submucosal bleeding and hemorrhagic ulcers (43.9%), and angular cheilitis (57.97%). Overall the knowledge of Syrian dental students regarding the oral manifestations of systemic diseases was classified as intermediate, with relatively strong awareness in areas such as inflammatory bowel diseases and glossitis but significant gaps in understanding viral infections and hepatitis-related symptoms. Additionally, only 11.1% of students reported having diagnosed a systemic disease based on oral manifestations, indicating a limited application of this knowledge in clinical practice. There is a need to enhance and elevate the knowledge of dental students and practitioners regarding oral lesions in general, and the oral lesions of systemic background in particular.

Vitamins are essential biocatalysts that have wide-ranging functions in supporting cellular metabolism. Vitamin deficiencies can significantly impact oral health, manifesting in oral mucosal and periodontal conditions. Deficiencies in the vitamin B complex are associated with glossitis, angular cheilitis, and recurrent aphthous stomatitis. Vitamin C deficiency leads to scurvy-related periodontal issues, whereas vitamin A insufficiency predisposes to oral epithelial keratinization abnormalities such as dry mouth and susceptibility to Candida. A reduction in vitamin D levels is linked to the risk of periodontal disease, reduced oral immunity, and oral neoplasia. Low vitamin E does not induce oral disease, but vitamin K deficiency causes gingival hemorrhage. Oral mucosal diseases have a huge impact on morbidity. We discuss the diagnostic challenges in identifying vitamin-related oral manifestations and the associated systemic features that may accompany the mucosal changes. This review provides clinicians with insight into the mechanisms that govern oral mucosal pathology and the risk factors related to specific vitamin deficiencies. The role of vitamin supplementation in treating and preventing oral conditions is also addressed.

Diabetic neuropathy may present with a wide spectrum of sensory manifestations in the oral cavity, ranging from increased sensitivity to pain to impaired nociception. Early detection is crucial, since the changes have significant effects on dental treatment, patient safety and quality of life. We describe two contrasting pictures of patients with diabetes mellitus with signs of oral sensory neuropathy. The first case was a 14-year-old female with poorly controlled type 1 diabetes mellitus (T1DM) presenting with chronic carious lesions, gingivitis, and angular cheilitis. She also had amplified pain reactions to dental procedures despite adequate local anaesthesia and quantitative sensory testing revealed hyperaesthesia related to early diabetic neuropathy. The second patient was a 55-year-old male with a long-term history of type 2 diabetes mellitus (T2DM) with chronic periodontitis and reduced oral sensitivity. He complained of hypoesthesia and reduced pain perception during dental procedures with evidence of established neuropathic involvement. These cases illustrate the broad spectrum of clinical manifestations of diabetic sensory neuropathy in stomatology from early hyperaesthesia in a child with T1DM to late hypoesthesia in an adult with T2DM and illustrate the importance of metabolic control, interdisciplinary collaboration and individualised diagnostic and therapeutic strategies in dentistry.

PURPOSE: To assess whether applying topical dexpanthenol to the oral commissures immediately before surgery reduces the incidence of postoperative angular cheilitis in children undergoing adenotonsillectomy. METHODS: A total of 101 pediatric patients who underwent adenotonsillectomy were included in this study. Patients were randomly divided into two groups based on whether or not dexpanthenol was applied to the lip corners immediately before surgery. Postoperative pain and presence of angular cheilitis were assessed and compared between the groups on the postoperative first day and first week. RESULTS: In the study group, only 9.8% (n = 5) of patients exhibited angular cheilitis on postoperative first day, whereas in the control group angular cheilitis incidence was 44% (n = 22) and the difference between two groups was statistically significant (p < 0.001). On postoperative first week examination, 3.9% (n = 2) of patients in the study group and 10% (n = 5) of patients in the control group exhibited angular cheilitis and the difference between the two groups was not significant (p > 0.05). Logistic regression analysis revealed that topical dexpanthenol application significantly reduced the odds of developing angular cheilitis on the first postoperative day (Odds Ratio: 0.14; 95% CI: 0.05–0.41; p < 0.001). Pain scores recorded on postoperative first day and first week did not show significant difference between the two groups (p > 0.05). CONCLUSIONS: A single application of topical dexpanthenol immediately before surgery is a simple intervention and significantly reduces the early incidence of postoperative angular cheilitis without affecting postoperative pain scores in pediatric adenotonsillectomy patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT07002632, registered on 25 May 2025 (retrospectively registered).

Angular cheilitis (AC) is a descriptive diagnosis for an inflammatory skin process of varied etiology occurring at the labial commissure – the angle of the mouth. "Angular," or commissural, refers to a localized lip inflammation (i.e., “cheilitis,” from the Greek chilos or “lips”) that is distinguishable from the more generalized cheilitides that have different causes. The angles of the mouth are points of interface for the squamous epithelium of the face and oral mucosa. They are also a mechanically dynamic hinge for the oral aperture that endures more motion and tensile forces than the rest of the lips. Thus, the commissures are especially susceptible to certain stresses. Diffuse cheilitides may be a function of environmental, chemical, or infectious exposures. They may also reflect an internal condition, deficiency, or derangement. They include eczematous cheilitis, contact cheilitis, drug-induced cheilitis, infective cheilitis, actinic cheilitis, glandular cheilitis, granulomatous cheilitis, exfoliative cheilitis, plasma cell cheilitis, and nutritional cheilitis. Diffuse cheilitides will not be discussed here. Angular cheilitis is also called angular cheilosis, angular stomatitis, commissural stomatitis, rhagades, or perleche (from the French for “through licking”). Rhagades is a general term for fissuring of the skin in areas of motion, especially the labial commissures and nose.

Candida spp. are common components of normal microbiota in the oral cavity. However, Candida albicans can be a primary cause of superficial infections in the oral cavity and esophagus, especially in immunocompromised individuals. While these infections are rarely life-threatening, they can significantly impair quality of life and, in severe cases, progress to hematogenous dissemination. Oral candidiasis often exhibits as pseudomembranous, erythematous (atrophic), chronic hyperplastic, denture stomatitis, or angular cheilitis. Esophageal candidiasis is typically diagnosed by upper endoscopy, which involves histological examination and brushing. Clinical guidelines recommend topical antifungal agents for mild oral candidiasis, and systemic agents for moderate-to-severe disease or when topical therapy fails. However, azole antifungals pose a substantial risk of drug-drug interactions, primarily due to the inhibition of cytochrome P450 enzymes and drug transporters, which dramatically alters the pharmacokinetics of co-administered drugs. Additionally, amphotericin B, a polyene macrolide antibiotic, may cause nephrotoxicity and electrolyte disturbances (e.g., hypokalemia and hypomagnesemia). Moreover, the co-administration of nephrotoxic drugs may augment the toxicity associated with amphotericin B. Therefore, this review aimed to provide a comprehensive overview of the management of oral and esophageal candidiasis from the viewpoint of clinical pharmacology, with a particular focus on drug-drug interactions and adverse effect profiles.