Desquamative gingivitis: A review

Gingival Manifestations in Oral Chronic Autoimmune Bullous Diseases: A Retrospective Study

Background and Objectives: Desquamative gingivitis (DG) is a clinical term indicating "peeling gums" and is associated with different oral manifestations. In this study, we aimed to assess the association between DG and autoimmune blistering mucocutaneous diseases (ABMD) with oral manifestations. Materials and Methods: A retrospective study including 88 patients diagnosed between 1998 and 2019 with ABMD (intraepithelial and subepithelial autoimmune blistering diseases) was performed at the Oral Medicine Department, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy in Bucharest. For each patient, the sociodemographic and anamnestic data, as well as clinical features of oral lesions (location), histological evaluation, and direct immunofluorescence data were collected. Results: Most of the patients involved in the study were female (78.4%). In total, 34 patients (38.63%) were diagnosed with subepithelial autoimmune diseases (SAD) and 54 (61.36%) had intraepithelial autoimmune diseases (IAD). Differences in the anatomic distribution of oral involvement were found between SAD and IAD. The presence of DG was significantly more common in patients with SAD compared to those with a diagnosis of IAD. Conclusions: Specific anatomical locations of the oral lesions are significantly associated with different subtypes of ABMD, with gingiva and hard palate mucosa being more involved in SAD and the soft palate and buccal mucosa in IAD. Desquamative gingivitis is a clinical sign that raises diagnostic challenges for several conditions in oral medicine.

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

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.

Retrospective study of gingival involvement in pemphigus: a difficult to treat phenomenon

BACKGROUND

Pemphigus is a group of autoimmune diseases characterized by flaccid lesions on the skin and mucous membranes. In pemphigus vulgaris, the most common subtype of pemphigus, lesions might be appeared anywhere on the oral mucosa, mostly in the buccal mucosa. However, the gingiva is a less frequently affected site.

METHODS

Here, we performed a retrospective study at Tehran University of Medical Sciences, covering a two-year period to identify pemphigus patients with active lesions confined to the gingiva.

RESULTS

Considering 1787 initially evaluated pemphigus cases, 512 (28.6%) were found to have a history of gingival involvement. Among them, 31 patients had only gingival involvement during their last visit, including 29 (93.5%) women and only two (6.5%) men. The mean of disease duration in this group was 5.29±3.46 years, and they had gingival involvement for a mean of 23.9±19.3 months. Of 28 patients, nine were negative for anti-Dsg3 and 24 were negative for anti-Dsg1. In 24 patients, who received rituximab, the mean PDAI specifically for gingiva was 4.76±0.74 at baseline, which had changed to 4.13±0.75 and 3.26±0.63 three and six months after rituximab administration, respectively. After three months, gingival lesions were either entirely resolved (n=3), partially resolved (n=11), remained unchanged (n=2), or progressed (n=7).

CONCLUSIONS

Gingiva-confined presentation of lesions in pemphigus could be non-anti-Dsg1/3 dependent in some patients. Such patients do not respond well to conventional treatments and rituximab therapy. More studies on the pathogenesis of gingiva-confined presentation of pemphigus are required. This article is protected by copyright. All rights reserved.

Prevalence and Characteristic of Oral Mucosa Lesions

(1) Background: Oral mucosa lesions (OMLs) are diagnosed worldwide in any population, age or gender, but in varied prevalence. OMLs can be found in each site of the oral mucosa; for some of them, it is characteristic to have a bilateral/symmetrical or unilateral/nonsymmetrical mucosal manifestation. The knowledge about its prevalence in varied populations can be useful from a clinical point of view. The aim of this study is to assess the prevalence of OMLs in patients attending outpatient dental clinic; (2) Retrospective analysis of 2747 patients’ oral cavity medical charts, who referred to oral pathology outpatient clinic. The type of diagnosed oral lesion, sex and age were evaluated. p ≤ 0.05 was considered statistically significant; (3) Results: In this study, the overall prevalence of oral mucosal lesions was found to be higher in older than younger patients. In our study, the age median was the highest in patients with xerostomia, burning mouth syndrome, angular cheilitis and oral candidiasis. The youngest median age was observed in patients with aphthae, mucocele and gingival enlargement. The higher OMLs frequency was related with the female gender. (4) It is important for clinicians to be familiar not only with distinctive features, which sometimes may not be clear, but also with linking the occurrence of OMLs with the gender and age.

Photobiomodulation of gingival lesions resulting from autoimmune diseases: systematic review and meta-analysis

Objectives

To evaluate the effects of photobiomodulation (PBM) in gingival lesions resulting from autoimmune diseases; to compare PBM and topical corticosteroid (CS) treatment; and to assess PBM outcome over time of follow-up.

Materials and methods

A comprehensive electronic search was performed in four electronic databases. Treatment effects were measured through visual analog scale of pain (VAS) and clinical evolution of lesion (Thongprasom scale for oral lichen planus (OLP)). Meta-analysis was performed to compare PBM with topical corticosteroid treatment and to evaluate PBM effect over time of follow-up.

Results

Seventeen studies were included in this review, of which six were used for the meta-analysis. Meta-analysis results showed no significant differences between PBM and topical CS in pain reduction at baseline (MD = 0.20, 95% CI =  − 0.92, 1.32, p = 0.72) and 60-day follow-up (MD = 0.63, 95% CI =  − 3.93, 5.19, p = 0.79); however, VAS showed significant pain reduction when compared before and after PBM at 30-day (MD =  − 3.52, 95% CI =  − 5.40, − 1.64, p = 0.0002) and 60-day (MD =  − 5.04, 95% CI =  − 5.86, − 4.22, p < 0.00001) follow-up. Thongprasom clinical scale for OLP also showed significant improvement at 30-day follow-up (MD =  − 2.50, 95% CI =  − 2.92, − 2.08, p < 0.00001) after PBM.

Conclusion

PBM led to significant reduction of pain and clinical scores of the lesions, not having shown significant differences when compared to topical CS.

Clinical relevance

PBM has been used in the treatment of autoimmune gingival lesions, but so far there is little strong evidence to support its use.

Idiopathic Desquamative Gingivitis

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

Herbal Dentifrices: Emerging Trends and Patterns

Background:

Herbal extracts have been employed since ages in dentistry as tooth cleansing and antimicrobial agents. The use of herbal medicines continues to expand and trend rapidly across the world. Herbal extracts have been used in dentistry for multiple uses as reducing inflammation, as antimicrobial plaque agents, for preventing release of histamine and as antiseptics, antioxidants, antimicrobials and analgesics. They also aid in healing process and are very effective in controlling microbial plaque and other disorders related to gums.

Objective:

The present review aims towards the combined review as well as compilation of available herbs under the category of various dental associated problems.

Materials and Methods:

The herbs were studied by sectioning them as for looking after different works or findings done against dental caries, tooth ache, scouring teeth, gum troubles and herbs as mouth fresheners.

Results:

Herbal extracts have been used on a large scale in dentistry as tooth cleansing and antimicrobial plaque agents. Many people take herbal derived medicines or herbal based products for the purpose of reducing inflammation, as antimicrobial agents, for preventing release of histamine and as antiseptics, antioxidants, antifungals, antibacterials, antivirals and analgesics. Herbal extracts are used in dentistry for treatment of various dental disorders.

Conclusion:

The use of herbal medicines are blooming rapidly across the world. Herbal extracts and the various herbs on the whole or their specific parts have been used in dentistry. They relieve the problems of gums and act as excellent mouth fresheners. The natural herbal remedies act as an effective substitute to antibiotics and represent a promising approach for prevention and as therapeutic strategies for various oral infections as they are natural, eradicate the problem from its root and provide long lasting relief. The herbal remedies are advantageous over conventional treatment.

Oral hygiene instructions and professional control as part of the treatment of desquamative gingivitis. Systematic review

Background

The aim of this present article was to evaluate the scientific evidence on the efficacy of daily hygiene and professional prophylaxis for treatment of desquamative gingivitis.

Material and Methods

The present systematic review was conducted following the PRISMA protocol. Searches were carried out in Pubmed, Embase, Web of Science and Cochrane Library up to July 2018, randomized clinical trials and cohort studies on desquamative gingivitis (DG), and oral diseases joined to DG.

Results

After screening, we found that nine publications met the eligibility criteria eight cohort studies and one randomized control trial. The diagnosis of the diseases corresponded to oral lichen planus (n=185), mucous membrane pemphigoid (n=13); plasma cell gingivitits (n=15) and pemphigus vulgar (n=11). The follow-up was between a week and a year after instructing patients. Dental daily hygiene and professional prophylaxis, at least with supragingival scaling and polishing have significantly improved the extension of the lesion and reduced the activity of DG, and gingival bleeding in all patients. Furthermore, these techniques have also reduced pain and gingival plaque.

Conclusions

In conclusion the studies presented support the efficacy of maintaining personal and professional oral hygiene in patients with GD, reducing the clinical signs of the disease, regardless of its pathogenesis.

Key words:Desquamative gingivitis, oral hygiene, oral lichen planus, mucous membrane pemphigoid; pemphigus, plasma cell gingivitis.