Sjogren's Syndrome and Angular Cheilitis

Image found here. 

Did you ever have to deal with those painful cracks and sores that occur at the corners of your mouth?

Lately, ever since our trip to the hot and dry southwest, I've been dabbing various ointments and lip balms on my lips in an attempt to heal these annoying and sore areas. I knew the medical terminology for them - angular cheilitis - but always assumed that they were simply the result of dryness and lack of saliva.

I did a little more research on angular cheilitis and found that my assumption was only partly correct. Yes, AC is definitely impacted by dryness of the oral mucosa, but also can be caused by an infection of Candida albicans, or an oral yeast infection. Decreased amounts of saliva in the mouth can set up an ideal environment for a Candida infection by the Sjogren's related alteration of pH, and reduction of the antimicrobial and other buffering components found in normal saliva. You can read more about how Sjogren's alters normal saliva here. Here's an interesting paragraph from the Johns Hopkins Arthritis Center:

Individuals with Sjogren's syndrome often will complain of taste alterations which may in fact be related to decreased solubility of food within the oral cavity by virtue of less fluid available and the associated absence of a substance known as gustin, a normal constituent found in salivary fluid. The antimicrobial aspect of saliva is related to the presence of several key components, namely secretory IgA as well as alpha and beta defensins, lysozymes, lactoperoxidase, lactoferrin, and histidine-rich proteins or so-called histatins. In the absence of saliva, these important elements are missing, therefore, one may expect an increased incidence of intraoral and oropharyngeal yeast infections, gum disease and dental decay.

Hm. I wonder what other symptoms that accompany an oral yeast infection?

Commonly called thrush, MayoClinic.com has an excellent online article which defines the condition and offers some home remedies. The following information has been taken from their site:

Oral thrush is a condition in which the fungus Candida albicans accumulates on the lining of your mouth. Symptoms include:

• Creamy white lesions on your tongue, inner cheeks and sometimes on the roof of your mouth, gums, or tonsils. 
• Lesions with a cottage cheese type appearance.
• Pain
• Slight bleeding if lesions are rubbed or scraped
• Cracking at the corners of your mouth
• A cottony feeling in your mouth
• Loss of taste

Some remedies suggested by MayoClinic.com:

• Eating unsweetened yogurt
• Taking acidophilus capsules
• Practice good oral hygiene
• Replace toothbrush
• Try warm salt water rinses: 1/2 teaspoon salt dissolved in one cup warm water. Don't swallow the rinse. 
• Limit the amount of sugar and yeast containing foods in your diet

If the above suggestions don't reduce your symptoms, see your doctor. Patients with compromised immune systems may require additional prescription anti-fungal medications to completely eradicate the infection.

What?! Decrease sugar and yeast containing foods??

Yet another reminder to eat healthy foods. Drat.