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Differential diagnosis of systemic disease
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This article aims to review the etiology, clinical features and diagnosis of desquamative gingivitis in order to outline all the aspects necessary to increase the efficiency of patient management. Because of the polymorphic etiology, dental practitioners may elude the correct diagnose. Consequently, we find it important to underline all the clinica...
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... Generally, when the first clinical signs of DG appear, erythema and minimal desquamation of the mucosa initially predominate; only later does the appearance of vesiculobullous lesions occur. There have been several observed cases of extensive areas of ulceration [28]. Less severe cases, characterized by limited symptoms, can result in heightened sensitivity to spicy and/or acidic foods and discomfort when using specific toothpaste. ...
Desquamative gingivitis is a clinical condition with a chronic course, not specific to a particular disease, characterized by intense erythema, scaling, vesicles, and/or blisters that may involve both the marginal free gingiva (MG) and the neighboring adherent gingiva (AG). This scoping review aimed to investigate whether there is a correlation between oral hygiene and gingival lesions induced by autoimmune diseases of the oral cavity and whether periodontal disease can negatively influence a clinical picture of desquamative gingivitis due to an immune disorder of the oral cavity. Case series studies and randomized controlled trials were considered for this scoping review; studies that did not comply with the inclusion criteria were excluded. A total of seven studies were selected for this review. The PRISMA-ScR (preferred reporting items for scoping reviews) consensus has been followed. Based on the included studies, it is possible to state that improvement in disease and patient-reported outcomes may be the result of appropriate oral hygiene education when patients are found to have autoimmune diseases with gingival manifestations.
... Shifts in the oral microbiome may play a significant part in the evolution of autoimmune diseases. The oral cavity is often the site of the onset of autoimmune diseases like pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) [45,46]. PV and MMP are chronic autoimmune mucocutaneous diseases affecting the mucous membranes and the skin [47]. ...
... MMP predominately affects the mucous membranes, frequently involving the oral mucosae, especially the gingiva. MMP gingival manifestation is known as desquamative gingivitis [46] and can culminate in scarring and considerable morbidity. The MMP is not marked by a specific serologic marker alone. ...
The human oral cavity comprises an extensive range of microorganisms, viruses, bacteria, fungi, archaea, and protozoa, each having a particular role and interacting with each other and with the host in sickness or health. Changes in the microbiome composition can be crucial in balancing health and disease, locally and systemically. Various microbial species in commensal relationships form the oral microbiota, and when this commensalism undergoes variations the immune system can be pushed towards the activation of inflammatory and autoimmune processes. Through a systematic review of the literature, we set out to investigate the role that the oral microbiota can play in the development and evolution of pemphigus vulgaris and mucous membrane pemphigoid. We performed our systematic review by searching “microbiome OR microbiota” AND “pemphigus OR pemphigoid” on Medline, ISI Web of science and Embase, and we included randomized controlled trials (RCTs), prospective comparison studies, retrospective cohort studies, case–control studies, and case series. These autoimmune diseases need a genetic basis to develop, but as multifactorial pathologies they are influenced by environmental factors and the dysbiosis of the oral microbiota can be a trigger. If the human microbiome plays a critical role in the pathogenesis and manifestation of oral autoimmune diseases, the next step could be new and promising therapeutic approaches such as probiotics or prebiotics.
... 1 Desquamative gingivitis (DG) is also defind as presence of desquamation, ulcers, erosion and vesicle formation that involve both free and attached gingival margins. 2 Desquamative gingivitis commonly occurs in free and keratinized gingiva involving the buccal and labial gingival margins. 3 Literature shows that the evidence of DG was more depicted in women than men. ...
Desquamative gingivitis (DG) is a descriptive term used for inflamed and peeling off gingival epithelium. The aim of this study was to determine the frequency of desquamative gingivitis (DG) with respect to gender, age and clinical findings among dental patients. Study Design: cross-sectional study Place and Duration of Study: This study was conducted at the Dental Out-Patients Department (OPD) of Bahria University Health Sciences (BUHSC), Gateway Health Services (GHS, private dental practice), Karachi and Lahore Medical & Dental College, Lahore from January, 2021 to June, 2022. Materials and Methods: The present study included 68 clinically diagnosed patients of desquamative gingivitis age ranged between 10 to 90 years. The subjects were diagnosed on the basis of history, examination and clinical findings of DG. The data analysis was performed by using SPSS version 23. Results: Among 68 subjects of desquamative gingivitis, 40(58.8%) were males and 28(41.2%) female patients. The higher predilection of desquamative gingivitis was seen in males than in females. The poor oral hygiene was the most common causative factor noticed in both males 37(92.5%) and females 15(53.5%) patients. Conclusion: In present study, the p-value was found to be highly significant .000 when DG was cross tabulated with etiological factors and gender. No vesiculo-bullous diseases were observed in current study. Elimination of local gingival irritants, for instance dental plaque and calculus can improve the outcomes of DG treatment. Key Words: Mouth wash, mucocutaneous disease, Desquamative Gingivitis, Gingivitis
... The presence of erythematous areas showing red blood cells (RBCs), edema fluid, and histiocytes can also be noted. 17 Our case showed a similar histopathological picture where the surface epithelium was detached from the underlying connective tissue at the point of the BMZ. The lamina propria was infiltrated by lymphocytes and plasma cells with scattered neutrophils and erythrocytes seen in the subepithelial space. ...
... The treatment modality for MMP changes based on the disease severity, site involved, and the patient's age, as there is no standard protocol for treatment. 17 In mild cases, topical corticosteroids, tacrolimus, and intralesional corticosteroids can be given. In moderate-to-severe disease immunosuppressive drugs come in four different categories, namely, antimetabolites (methotrexate and mycophenolate), T-cell inhibitors (cyclosporine and daclizumab), B-cell inhibitors, and cytotoxic agents (cyclophosphamide and chlorambucil) can be prescribed. ...
Aim:
To describe the diagnosis and management of mucous membrane pemphigoid (MMP) with oral and ocular presentation.
Background:
Mucous membrane pemphigoid constitutes a heterogeneous group of chronic, autoimmune vesiculobullous diseases characterized by blister formation that has a propensity to affect different mucous membranes of the body. The most commonly affected areas include the oral cavity, mucous membranes of the eyes, throat, genitalia, and nose. This disease usually affects elderly women with a peak incidence at around 50-70 years of age; however, rare cases have been diagnosed in children. The symptoms of MMP include recurrent blistering lesions which eventually rupture and occasionally heal with scarring that may lead to certain complications involving the eyes and throat regions.
Case description:
In this report, we describe a 66-year-old female patient who complained of oral and ocular lesions for a period of 2 years. Pain, burning mouth, and gingival inflammation were present. Ocular examination showed mild conjunctivitis with scar formation at the lateral canthus of the left eye. The patient also noticed periods of water-filled balloon-like formation in the gingiva that rupture spontaneously leaving sore spots. A biopsy was obtained from perilesional tissue and sent for histopathological examination, correlation of clinical and histological features directed us toward the diagnosis of MMP. The patient was treated for both oral and ocular lesions using topical corticosteroid therapy in conjunction with antifungal and antibacterial drugs. The response to local treatment was augmented via effective periodontal therapy to control the concurrent plaque-induced gingival inflammation and via using a customized application tray to sustain the drug efficacy.
Conclusion:
A multidisciplinary approach is often necessary in order to treat MMP lesions efficaciously.
Clinical significance:
Early diagnosis and effective treatment protocol using systemic or topical corticosteroid therapy along with other therapeutic means including periodontal therapy, good oral hygiene practice, and timely follow-up are very useful in preventing long-term complications due to this disease.
... The word "desquamative" originates from the latin "desquamare", which means to scrape fish scales. Ad literam, desquamation involves the loss of epithelium, exfoliation of the skin or mucous membranes [1]. ...
... Helicobacter pylori also induces the formation of proinflammatory interleukins and cytokines, involved in the pathogenesis of oral lesions. Tuberculosis, histoplasmosis and chronic candidiasis are also cited as a potential cause for DG [1][2][3]8]. ...
... A correct diagnosis is difficult to make in the absence of complementary examinations. In most cases, a biopsy of the affected tissue is performed, the pathological examination and direct immunofluorescence being required for a definite diagnosis [1]. In case of suspected autoimmune bullous disorders the protocol for paraclinical examinations includes Tzanck smear, pathological examination, electron microscopy, direct and indirect immunofluorescence [7,12,26,32,33]. ...
Desquamative gingivitis (DG) is a clinical term that describes erythema, desquamation and erosions of the gingiva, of various etiologies. Although the clinical aspect is not specific for a certain disease, an accurate diagnosis of the underlying disorder is necessary because the disease course, prognosis and treatment vary according to the cause. DG may inflict significant oral discomfort, which is why patients typically present to the dentist for a first consultation, rendering it important for these specialists to be informed about this condition. Our paper aims to review the ethiopatogenesis and diagnostic approach of DG, focusing on the most common underlying disorders (autoimmune bullous dermatoses and lichen planus) and on the management of these patients. Potential etiological agents leading to an inflammatory immune response in the oral mucosa and DG appearance include genetic predisposition, metabolic, neuropsychiatric, infectious factors, medication, dental materials, graft-versus-host reaction and autoimmunity. A thorough anamnesis, a careful clinical examination, paraclinical explorations including histopathological exam and direct immunofluorescence are necessary to formulate an appropriate diagnosis. Proper and prompt management of these patients lead to a better prognosis and improved quality of life, and must include management in the dental office with sanitizing the oral cavity, instructing the patient for rigorous oral hygiene, periodic follow-up for bacterial plaque detection and removal, as well as topical and systemic therapy depending on the underlying disorder, based on treatment algorithms. A multidisciplinary approach for the diagnosis and follow-up of DG in the context of pemphigus vulgaris, bullous pemphigoid, cicatricial pemhigoid or lichen planus is necessary, including consultations with dermatologists, oral medicine specialists and dentists.
... The diagnostic process of immune-mediated DG was conducted through a combination of clinical report (e.g., clinical onset, extra-oral involvement, anamnesis, Nikolsky's sign), laboratory data (i.e., immuno-fluorescence and immunoenzymatic tests) and histological examination [6,7,19,20]. ...
Desquamative gingivitis (DG) denotes a heterogeneous immune-mediated disease for which early diagnosis represents a great challenge. The main aim of this study is to validate diagnostic concordance between specific Optical Coherence Tomography (OTC) patterns for DG related to oral Lichen Planus (OLP), Pemphigus Vulgaris (PV), and Mucous Membrane Pemphigoid (MMP) and definitive histological diagnosis. Forty-three patients with suspected immune-mediated DGs, were progressively recruited. Before biopsy, an OCT preliminary evaluation was performed using specific pre-determined OCT diagnostic patterns (i.e., morphology and localization of blisters, status of the basal membrane, epithelial thickness, presence/absence of acantholytic cells into blister and/or inflammatory infiltrate) related to OLP, PV and MMP. After histological confirmation, OCT and histological diagnoses were compared. Using pre-determined patterns, OCT diagnoses of DGs were: 22 (51%) OLP, of which 11 (26%) were with the bullous variant, 4 (9%) PV and 6 (14%) MMP. The same diagnoses were found by histological investigations (with the main OCT discriminatory potential for the bullous variant of OLP). The concordance between the two diagnostic methods was confirmed by the Fisher exact test (p-value < 0.01). These specific OCT patterns show a diagnostic reliability in 100% of the cases investigated, suggesting their accuracy to support the complex diagnosis and management of immune-mediated DGs.
... In 1960, McCarthy suggested that desquamative gingivitis was a gingival response associated with vesiculobullous lesions and adverse reactions to chemicals or allergens. [3] According to Glickman, in 1953, chronic desquamative gingivitis may represent a manifestation of several disease processes. [4] This involves the erythema, desquamation, and ulceration of the free and attached gingivae. ...
Desquamative gingivitis is described as an erythematous, desquamated gingival lesion. There are many etiologic factors for the appearance of such lesions. The aim of this case report is to diagnose the cause of the lesion by analyzing the complete medical, dental, and personal histories. An elaborated differential diagnosis is done, and the lesion is successfully treated accordingly. The gold standard treatment is usually provided by systemic or topical corticosteroids. Another treatment option is antioxidant therapy which provides rapid healing of the tissue
... MMP frequently involve the oral cavity [2], especially the gingiva [1][2][3]. Gingival manifestation of MMP is called Desquamative Gingivitis (DG), that is characterized by desquamation, erythema, erosions of the gingival epithelial and vesiculo-bullous lesions [4,5]. The autoantigens of MMP that have been identified by circulating autoantibodies in the patients' sera include 180 kDa bullous pemphigoid antigen 2 (BP180) [1,[6][7][8][9] and bullous pemphigoid antigen 1 (BP230) [10][11][12], two hemidesmosome components. ...
Background/Aim: Desquamative gingivitis (DG) is a clinical feature-sign associated with other several mucocutaneous or systemic diseases and disorders. The aim of this research was to present the clinical and epidemiological characteristics (prevalence, age, sex, extend of lesions, coexistence with underlying pathologies) of a cohort of 200 patients from Northern Greece that exhibited clinical appearance of DG. Material and Methods: 200 patients with DG were referred to the Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki during the years 2004-2014. The patients were examined clinically, and a biopsy was performed to settle the diagnosis of any possible underlying disease. The epidemiologic parameters being studied were the gender and age, and the investigated clinical characteristics contained the localization of the lesions and the prevalence in relation to coexisting pathologies, habits etc. Statistics were performed by SPSS 22.00 by chi-square test (p= 0,05) and STATA14 program. Results: Clinically, most DGs cases (81%) were accompanied by erosions-vesicles mainly in buccal mucosa (68%), tongue (29, 5%) and lips (27%). The most common underlying disorders were immune-related mucocutaneous diseases including OLP (55,5%) and MMP (29,5%), followed by erythema multiforme (7%), and pemphigus vulgaris (6%). Overall, most patients (76%) had a localized form of DG at the gingiva of anterior teeth. This finding was more prominent in OLP. Interestingly, the diffuse DG form was mostly found in males. Conclusions: DG constitutes an early or the only clinical sign, mostly indicative for immune-related mucocutaneous disorder. Indeed, a properly taken biopsy can validate an earlier diagnosis and treatment. This would be crucial in order to avoid patient's discomfort and underlying diseases' complications.
