Desquamative Gingivitis
Question 1. Describe the etiology, clinical features and management of chronic desquamative gingivitis.
Answer. Desquamative gingivitis was not a specific disease entity, but a gingival response associated with variety of conditions.
Desquamative Gingivitis Etiology
- Dermatological diseases such as lichen planus, mucus membrane pemphigoid or pemphigus.
- Infections, i.e. tuberculosis, chronic candidiasis and histoplasmosis.
- Endocrine imbalance, chronic imbalance and drug reaction.
- Abnormal response to irritation and idiopathic causes.
- Desquamative Gingivitis can be caused by chemical burns.
Chronic Desquamative Gingivitis Clinical Features
- Desquamative Gingivitis is more prevalent in women and occurs after age of 40 years.
- Gingiva becomes bright red, edematous and desquamation of surface epithelium of attached gingiva is also seen.
- It occurs in three form:
- Mild form: There is diffuse erythema of marginal, interdental and attached gingiva. It is painless and occurs most frequently in females between 17 to 23 years of age.
- Moderate form: There is patchy distribution of bright red and gray areas involving marginal and attached gingiva.
- Surface is smooth and shiny, normal resilient gingiva become soft edematous and massaging of gingiva results in peeling of epithelium.
- Patient complains of burning sensation and labial surface is involved.
- Severe form: It is characterized by scattered irregularly shaped areas in which gingiva is denuded and strikingly red in appearance.
- Gingiva seems to be speckled and surface epithelium seems shredded friable and can be peeled of in small patches this is known as Nikolsky’s sign
- The mucous membrane other than gingiva is shiny and smooth and may present fisuring in cheek, ill line of occlusion.
- The condition is painful
- There is constant dry, burning, sensation throughout oral cavity.
Read And Learn More: Periodontics Question And Answers
Chronic Desquamative Gingivitis Management
- Management consists of complete history of uncover possible coexistent extraoral cause
- It is divided into two parts:
Chronic Desquamative Gingivitis Local Treatment
- Oral hygiene instruction (toothbrush).
- Oxidizing mouthwashes, i.e. 3% diluted hydrogen peroxide.
- Topical corticosteroid ointments or cream like triamcinolone 0.1%, flurocinonide 0.05%.
Chronic Desquamative Gingivitis Systemic Treatment
- Systemic corticosteroids in moderate doses.
- Prednisolone can be used daily or at alternate days at dose of 30 to 40 mg and reduced to daily maintenance dosage of 5 or 10 mg.
Desquamative Gingivitis Treatment
Question 2. 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.
Question 3. Give differences between clinical appearances of lichen planus and leukoplakia.
Answer.
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