Desquamative Gingivitis in the Context of Autoimmune Bullous Dermatoses and Lichen Planus—Challenges in the Diagnosis and Treatment

Abstract

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.

Desquamative gingivitis: Clinical and epidemiological findings in patients from Northern Greece

“…A possible explanation of the desquamation is that autoantibodies are directed against molecules such as desmoglein 3, integrin, desmoplakin II and others in the basement membrane of the epithelium causing the lysis of intercellular connections and thus a friable epithelial lining. Other etiologic factors of DG constitute genetic predisposition (DG lesions associated with HLA-B7, metabolic disorders such as diabetes, medication such as NSAIDS or even infections such as those caused by hepatitis C virus (HCV) or hepatitis B virus (HBV) 8 .…”

Quantitive Assessment of Gustatory Function and Its Association with Demographics, and Systemic Morbidity

“…For example, Solomon et al demonstrated that the values of salivary parameters (calcium, phosphates, and pH) were significantly higher in patients with a small number of dental lesions, compared with the patients who had multiple carious lesions [54]. Moreover, oral mucosal conditions such as desquamative gingivitis, autoimmune bullous dermatoses, lichen planus, and symptomatic migratory stomatitis patients may avoid spicy foods, sour drinks, and alcohol, which exacerbate the pain [55,56].…”

Comparing the effects of lycopene and corticosteroids on oral lichen planus: a systematic review and meta-analysis

“…The effectiveness of a new drug for a disease could be assessed only in comparison with the standard therapy under standard treatment status. Currently, the dominant and standard treatment of OLP is corticosteroids, and its effect on the relief of signs and symptoms of OLP has been proven in earlier studies (25)(26)(27)(28)(29)(30). However, due to their complications and adverse effects, the continuous use of corticosteroids is limited (31,32).…”