Desquamative Gingivitis: Causes, Classification, and Diagnosis

Desquamative Gingivitis

Write in brief on desquamative gingivitis.
Answer.

Classification of Desquamative Gingivitis

• Dermatological:
  • Lichen planus
  • Mucous membrane pemphigoid
  • Bullous pemphigoid
  • Pemphigus vulgaris
  • Chronic ulcerative stomatitis
  • Linear IgA disease
  • Lupus erythematosus
• Allergic reaction:
  • Dental restorative materials
  • Food (Reaction to oral hygiene products, chewing gum)
  • Drug induced mucocutaneous disorder
• Traumatic lesions:
  • Physical injury
  • Chemical injury
  • Thermal injury
• Miscellaneous conditions

Histopathological Features

• Lesions in desquamative gingivitis can be bullous or lichenoid.
• Bullous lesions show features of mucous membrane pemphigoid while lichenoid type lesions show features like lichen planus.
• Separation of epithelium is seen from underlying connective tissue which starts via the separation of collagen firils.
• Epithelium appears to be atrophic with decrease in the keratinization as well as infiltration of connective tissue with inflammatorycells.

Chronic Desquamative Gingivitis Diagnosis

Diagnosis is based on the following features, i.e.

• Clinical history: Thorough clinical history should be taken to begin assessment of desquamative gingivitis.
• Clinical examination: Pattern of distribution of lesions, i.e. focal or multifocal, with or without involvement of skin provide information to formulate differential diagnosis.
• Biopsy: Incisional biopsy should be taken and is sent for microscopic evaluation.
• Immunoflorescence: It is of two type, i.e. direct and indirect. Immunoflorescence test are positive if florescent signal are seen either in epithelium, basement membrane or in connective tissue.