Periodontal Implications: Mucocutaneous Disorders

Abstract

Question SetWhat are the currently accepted treatment modalities for mucocutaneous disorders? a. Indications/contraindications for each b. Relative strengths and weaknesses for each c. Therapeutic endpoints of success for each d. Future directions.

A Comparison of the Periodontal Status in Patients With Mucous Membrane Pemphigoid: A 5‐Year Follow‐Up

“…Although there does not appear to be a universally successful treatment regimen for MMP, the management of oral MMP relies mostly on the use of topical corticosteroids of different concentrations. In more severe cases, systemic steroids may be used, but patients require intensive monitoring to avoid potential adverse side effects such as candidal infections, other oral infections, adrenal suppression, hypertension, diabetes mellitus, and gastric ulcers 9 . Other successful modalities presented in the literature for treatment of MMP include use of dapsone, 10,11 combinations of topical corticosteroids and dapsone, 12 intravenous immunoglobulin, 13,14 pulse intravenous cyclophosphamide, 15,16 and anti‐tumor necrosis factor‐alpha agents 17 .…”

Esthetic Management of Multiple Recession Defects in a Patient With Cicatricial Pemphigoid

“…Such histologic findings lead to a differential diagnosis of cicatricial or bullous pem-phigoid, linear IgA disease, bullous lichen planus, erythema multiforme, epidermolysis bullosa acquisita, dermatitis herpetiformis, or herpes gestationis. 6,11 As evidenced by this report, vesiculobullous conditions such as cicatricial pemphigoid do not always adhere to a typical histological presentation. Data from our Stomatology Center indicate that gingival cicatricial pemphigoid will sometimes present normal histologic features or a non-specific inflammatory response.…”

“…10,20 Review of the literature has revealed no consensus as to the proper treatment regimens for patients with oral cicatricial pemphigoid. 11 Large-scale clinical trials are lacking, with most of the published literature consisting of case reports or case series. Therefore, treatment is generally directed towards controlling the patient's symptoms, eliminating inflammation caused by plaque or prosthetic devices, and eradicating gingival and mucosal lesions.…”

“…[8][9][10] Once a definitive diagnosis is determined, treatment is focused upon the alleviation of clinical signs and symptoms, referral for consultation with other specialists to assess the extent of the disease process, and the prevention of recurrence. 11 Although there is no consensus in the literature as to the appropriate mode of therapy for intraoral cicatricial pemphigoid lesions, 11 initial treatment usually includes the use of topical corticosteroid agents. 12,13 Refractory cases may require systemic steroid administration, dapsone, or other immunosuppressant agents either alone or in combination with topical agents.…”

Diagnosis and Management of Desquamative Gingivitis

“…Several treatment methods have been reported (Carrozzo & Gandolfo, 1999;Chan et al, 2002;Endo et al, 2008b;Fatahzadeh et al, 2006;Kirtschig et al, 2003;Lamey et al, 1992;Motta et al, 2009;Nisengard, 1996;Nisengard & Levine, 1995). However, treatment may achieve only a temporary effect if idiopathic or autoimmune diseases are causing the DG.…”