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Comment (Lester R. Cahn)
comment
(Lester
B. Cab)
The three commonest mnses cd those intertriginous erosions at the angles of t,he moutltr called “‘angular eheilosis” are: a vitamin d&ciency, particularly riboflavin; a decrease in vertical dimension, due to a. loss of all the teeth, or at lea,st the posterior ones; and the habit of licking the sides of the mouth. Since the early work of Sebrell and Butler,” it has been assumed that a deficiency in vitamin 33, (riboflavin) results in superficial erosions at the angles of the mouth. However, this is not the only sign of ariboflavinosis, for it has hem shown that, besides the angular cheilosis, there arc other indicai;ions of this deficiency, such as a seborrheic or “greasy” dermatitis a.bout the na.sotongue with swelling and labial fold a.nd alae of the nose, a magenta-colored mushroomlike appearance of the fungiform papillae a,nd, in some ca,ses, vasculsrization of the cornea. and other eye lesions. Without the other signs of ariboflavinosis, we cannot assume that angular sores are due to lack of vitamin B,. Also we now understand that no one specific deficiency of a comof just riboponent of the B complex exists by itself and the administration Alvin will be ineffectual, as the authors noted in their case report. It is also interesting to note in the case under discussion that there were no other signs of riboflavin or other vitamin deficiencies, which should have made one suspicious of the fact that t‘he angular lesions were not caused by an avitaminosis. Sores at the angles of the mouth due to the so-called “closing of the bite” were observed for many years, long before anything was known about vitamins. With the decrease in the vertical dimension, creases or folds occurred at the sides of the mouth which deepened and became macerated through the dribbling of saliva. In time, the eroded areas became infected, not infrequently by Monilia albicans, particularly if the patient wore poorly fitting dentures and was careless in keeping them clean. Yeast forms are of common occurrence under dirty dentures.2 It is quite possible that an avitaminosis contributed to t,he mischief, since many of these patients were unable to eat properly due either to lack of dentition or to poorly fitting prostheses. Nonetheless, the main cause of the trouble was the loss of the vertiea,l dimension between the jaws. Ellenberg and Pollock3 revived the theory of faulty dental restorations as t,he primary cause of angular cheilosis, rather than an avitaminosis. Last, we have the habit of moistening the angles of the mouth with ,the tongue as a cause of intertriginous sores. This is not an uncommon habit. The condition was first noted many years ago in children, and this habit of licking the lips gave rise to the term ‘ ‘perl&he, ” which is a French patois for “pour I believe that angular sores brought about lecher,” literally to “lick about.” through the habit of licking the tissues are the only ones that should be called “per&he.” !Phe other lesions, due either to an avitarninosis or closure of the bite, should be termed “angular cheilosis.” If we closely study the authors’ case, we note that neither adequate vitamin therapy nor correct prosthetic replacement resulted in a cure. Thus, we
ANGULAR
CEIEILOSIS
AND
MACROGLOSSIA
105
are left with the conclusion that the lesions at the angles of t,he mouth must have been factitious, possibly induced by the enlargement of the tongue. !t!his, then, would be a case of true per&he. References 1. Sebrell, W. H., and Butler, R. E.: Pub. Health Xep. 53: 83, 1938. 2. Cw,hn, L,. R.: The Denture Sore Mouth, Ann. Dent. 3 (old series) : 33, 1936. 3. LINenberg, M., and Polloek, 21.; Psouc?oarihoflavinosis, J. A. M. A. 119: 790, 1942.
(Lester
B. Cab)
The three commonest mnses cd those intertriginous erosions at the angles of t,he moutltr called “‘angular eheilosis” are: a vitamin d&ciency, particularly riboflavin; a decrease in vertical dimension, due to a. loss of all the teeth, or at lea,st the posterior ones; and the habit of licking the sides of the mouth. Since the early work of Sebrell and Butler,” it has been assumed that a deficiency in vitamin 33, (riboflavin) results in superficial erosions at the angles of the mouth. However, this is not the only sign of ariboflavinosis, for it has hem shown that, besides the angular cheilosis, there arc other indicai;ions of this deficiency, such as a seborrheic or “greasy” dermatitis a.bout the na.sotongue with swelling and labial fold a.nd alae of the nose, a magenta-colored mushroomlike appearance of the fungiform papillae a,nd, in some ca,ses, vasculsrization of the cornea. and other eye lesions. Without the other signs of ariboflavinosis, we cannot assume that angular sores are due to lack of vitamin B,. Also we now understand that no one specific deficiency of a comof just riboponent of the B complex exists by itself and the administration Alvin will be ineffectual, as the authors noted in their case report. It is also interesting to note in the case under discussion that there were no other signs of riboflavin or other vitamin deficiencies, which should have made one suspicious of the fact that t‘he angular lesions were not caused by an avitaminosis. Sores at the angles of the mouth due to the so-called “closing of the bite” were observed for many years, long before anything was known about vitamins. With the decrease in the vertical dimension, creases or folds occurred at the sides of the mouth which deepened and became macerated through the dribbling of saliva. In time, the eroded areas became infected, not infrequently by Monilia albicans, particularly if the patient wore poorly fitting dentures and was careless in keeping them clean. Yeast forms are of common occurrence under dirty dentures.2 It is quite possible that an avitaminosis contributed to t,he mischief, since many of these patients were unable to eat properly due either to lack of dentition or to poorly fitting prostheses. Nonetheless, the main cause of the trouble was the loss of the vertiea,l dimension between the jaws. Ellenberg and Pollock3 revived the theory of faulty dental restorations as t,he primary cause of angular cheilosis, rather than an avitaminosis. Last, we have the habit of moistening the angles of the mouth with ,the tongue as a cause of intertriginous sores. This is not an uncommon habit. The condition was first noted many years ago in children, and this habit of licking the lips gave rise to the term ‘ ‘perl&he, ” which is a French patois for “pour I believe that angular sores brought about lecher,” literally to “lick about.” through the habit of licking the tissues are the only ones that should be called “per&he.” !Phe other lesions, due either to an avitarninosis or closure of the bite, should be termed “angular cheilosis.” If we closely study the authors’ case, we note that neither adequate vitamin therapy nor correct prosthetic replacement resulted in a cure. Thus, we
ANGULAR
CEIEILOSIS
AND
MACROGLOSSIA
105
are left with the conclusion that the lesions at the angles of t,he mouth must have been factitious, possibly induced by the enlargement of the tongue. !t!his, then, would be a case of true per&he. References 1. Sebrell, W. H., and Butler, R. E.: Pub. Health Xep. 53: 83, 1938. 2. Cw,hn, L,. R.: The Denture Sore Mouth, Ann. Dent. 3 (old series) : 33, 1936. 3. LINenberg, M., and Polloek, 21.; Psouc?oarihoflavinosis, J. A. M. A. 119: 790, 1942.